410 Statement of Organization Recipient Committee - Initial Stamped by SOS �� �J
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Statement of Organization dr' � DateStamp � _
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Recipient Committee ��� • - �
$tatement Type �Initial ❑ Amendment ❑ Termination—See Part 5 p � � �.t � '� 5J ���cra�'us nl'� � ' �
List I.D.number. List I.D.number: 6t�v����� ��°� � � '� � � ��_��_��;����..�/ `-' � '
Not et qualified ❑ or Of$# � I
Y in{h j of the State of Cali orni� ��
# # OCT l 2 2016 �,
09 �15 �2016 � � �_� �E� �.� ZOIb
Date qualified as committee Date qualitied as committee Date of Termination
(Ifapplicable) f11 'nrinTini� n�T�� (��r�ll/
1. Cammittee Information �� � � � � �� 2. Treasurer and Other Principal Officers # ��'°�`�'���`"`�```*���`��`'`"����'"�`''� �''"� _�
� NAME OF COAAMITTEE NAME OF TREASURER
Kris wang for City Council 2016 Anqela Tsai
STREET AODRESS(NO P.O.BOX�
STREETADDRESSINOP.O.BOX) CITY STATE ZIPCODE AREACODE/PHONE
(
CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER,If ANY
Cpertino CA 95014 (
MAILING ADDRESS(IF DIFPERENT) STREET ADDRESS(NO P.O.BOX)
FA%/E-MAILA�DRESS CITY STATE ZIPCODE AREACODE/PHONE
COUNTYOF DOMICILE I lURISDICTION WHERECOMMITTEEISACTNE NAMEOF PRINCIPALOPFICER�S)
STREET ADDRESS(NO P.O.BOX)
CITY STATE ZIPCODE AREACODE/PHONE
Attach additional information on appropriately labeled continuation sheets.
3. Verification
I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is true and complete. I certify under
penalty of perjury under the laws of the State of ' er.pia that the foregoing is true and correct. _
Executed on —`— `�'�� gy
� DATE �
CANDIDATE,ORSTATE MEASUREPROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING O -EHOLDER,CANDI�ATE,OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFlCEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
FPPC Form 410(Jan/2016)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
Statement of Organization • - '
Recipient Committee • - �
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME I.D.NUMBER
Kris wang for City Council 2016
• All committees must list the financial institution where the campaign bank account is located.
NAKE OF FlNANCIALINSTITUTION AftEACODE/PHONE BANKACCOUNTNUMBER
Wells Fargo Bank (
ADDRESS ❑TY STATE ZIP CODE
4.Typ2 Of COrTtlttlttee Complete the applicable sections
��� _ _
�jii�,lla%it4.;ru�u�7�t�=t�d�3�
• List the name of each controlling officeholder,candidate,or state measure proponent. If candidate or officeholder controlled,also list the elective office sought or held,and
district number, if any,and the year of the election.
• List the political party with which each ofFiceholder or candidate is afFiliated or check"nonpartisan."
• If this committee acts jointly with another controlled cummittee,list the name and identification number of the other controlled committee.
ELECTIVE OFFICE SOUGHT OR HELD
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
� Nonpartisan
Kris Wang Cupertino City Council 2016
❑ Nonpartisan
■m.7���.u��.�•..���,•��•�,��,,,�t;�� Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(5)NAME OR MEASURE(S)FULL TITLE(WCLUDE BALLOT NO.OR LETTER) CANDIDATE(5)OFFICE SOUGHT OR HELD OR MEASURE(5)JURISDICTION
pNCLUDE DISTRICT NO.,CITY OR COUNTY,AS APPLICABLE) eHecK oNe
SUPPORT 07POSE
� �
SUPPORT OPPOSE
❑ ❑
FPPC Form 410(1an/2016�
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
Statement of Organization � • - �� �
Recipient Committee • - �
INSTRUCTIONS ON REVERSE Page 3 'l�f'�I
COMMITTEE NAME I.D-NUMBER
Kris wang for City Council 2016
4.Type of Committee tca��;�,uea)
Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
❑ CITY Committee �] COUNTY Committee❑ STATE Committee
PROVIDE BRIEf DESCRIPTION OF ACTIVITY
r��7,�•.�'�,.�;i1,�rs:�,;�,,,'�t�,�n List additional sponsors on an attachment.
NAME OF SPONSOR IINDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREETADDRE55 NO.ANDSTREET CITY STATE ZIPCODE
��L,} •ILIYS•��6����iil�in�ti=1�l�i! ❑
,,�•..�x�l:�•, / /_
Da[e quallfied
�S.T@C►'I71t38tlOtl ReC�U1C@t118i1'CS By signing the verification,the treasurer,assistant treasurer and/or car�didate,officehofder,or proponent certi',y that all of the following conditions have been met:
• This committee has ceased to receive contributions and make expenditures;
• This committee does not anticipate receiving contributions or making expenditures in the future;
• This committee has eliminated or has no intention c�r ability to discharge all debts,loans received,and other obligations;
• This committee has no surplus funds;and
• This committee has fi�ed all campaign statements required by the Political Reform Act disclosing all reportable transactions.
-- There are restrictions on the disposition of surplus campaign funds held by elected ofFicers who are leaving ofFice and by defeated candidates. Refer to Government
Code Section 89519.
-- Leftover funds of ballot measure committees m�y be used for political,legislative or governmental purposes under Government Code Sections 89511-89518,and are
subject to Elections Code Section 18680 and FPPC Regulation 18521.5.
FPPC Form 410(Jan/2016)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov