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460 Recipient Committee Campaign Statement - Termination 10-23-16 - 12-31-16 Recipient Committee Campaign Statement Cover Page from Statement covers period I Date of election if applica 10/23/2016 (Month,Day,Year) (_ 1_� HW FE8 - 72017 COVER PAGE of Official Use Only SEE INSTRUCTIONS ON REVERSE through 12/31/2016 11/08/2016 (,pERTiNO CITY CL RK_J 1. Type of Recipient Committee: All committees-complete Parts 1,2,3,and 4. 2. Type of Statement: 91 Officeholder,Candidate Controlled Committee ❑ Primarily 0 State Candidate Election Committee Formed Ballot Measure ❑ Preelection Statement ❑ Quarterly Statement Committee 0 Recall 0 Controlled El Semi-annual Statement ❑ Special Odd-Year Report (Also Complete Part 5) 0 Sponsored Termination Statement (Also Complete Part 6) ❑ General Also file a Form 410 Termination) Purpose Committee ❑ Amendment(Explain below) 0 Sponsored ❑ Primarily Formed Candidate/ 0 Small Contributor Committee Officeholder Committee 0 Political Party/Central Committee (Alsc Complete Part l) 3. Committee Information I.D.NUMBER Treasurer(s) 1390787 COMMITTEE NAME(OR CANDIDATE'S NAME IF NO COMMITTEE) Kris Wang for City Council 2016 NAME OF TREASURER Angela Tsai MAILING ADDRESS 7645 Dumas Dr. STREET ADDRESS(NO P.O.BOX) 7645 Dumas Dr. CITY STATE ZIP CODE AREACODE/PHONE Cupertino CA CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER,IF ANY CA 95014 408-931-8168 MAILING ADDRESS(IF DIFFERENT)NO.AND STREET OR P.O.BOX MAILING ADDRESS CITY STATE ZIP CODE AREACODE/PHONE CITY STATE ZIP CODE AREACODE/PHONE OPTIONAL: FAX/E-MAIL ADDRESS OPTIONAL: FAX/E-MAIL ADDRESS I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein and in the attached schedules is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoinq is true and correct. Executed on 1/31/2016 Date By Executed on B Date y Executed on By Date Executed on Date By Signature of Controlling Officeholder,Candidate,State Measure Proponent FPPC Form 460(Jan/2016) FPPC Advice:advice @fppc.ca.gov(866/275-3772) www.fppc.ca.gov Campaign Disclosure Statement Summary Page SEE INSTRUCTIONS ON REVERSE NAME OF FILER Contributions Received 1. Monetary Contributions................................................... Schedule A,Line 3 $ 2. Loans Received................................................................ Schedule B,Line 3 3. SUBTOTAL CASH CONTRIBUTIONS.............................. Add Lines 1+2 $ 4. Nonmonetary Contributions............................................ Schedule C,Line 3 5. TOTAL CONTRIBUTIONS RECEIVED....................................Add Lines 3+4 $ Amounts may be rounded to whole dollars. SUMMARY PAGE Statement covers period from 10/23/2016 through 12/31/2016 page of Column A Column B TOTAL THIS PERIOD CALENDAR YEAR (FROM ATTACHED SCHEDULES) TOTAL TO DATE 2550 $ 7226 0 0 2550 $ 7226 0 0 2550 $ 7226 Expenditures Made To calculate Column B, 6. Payments Made................................................................ Schedule E,Line 4 $ 1378.08 $ 7. Loans Made....................................................................... Schedule H,Line 3 0 8. SUBTOTAL CASH PAYMENTS.......................................... Add Lines 6+7 $ 1378.08 $ 9. Accrued Expenses(Unpaid Bills).......................................... Schedule F Line 3 1300 10. Nonmonetary Adjustment......................................................... Schedule C,Line 3 filed for this calendar year, only carry over the amounts from Lines 2,7,and 9(if 11. TOTAL EXPENDITURES MADE........................................Add Lines 8+9+10 $ 2678.08 $ W"111Ui11L Va.711 JL0LW111W1JL 12. Beginning Cash Balance............................ Previous Summary Page,Line 16 $ 13. Cash Receipts........................................................... Column A,Line 3 above 14. Miscellaneous Increases to Cash.................................. Schedule 1,Line 4 15. Cash Payments......................................................... Column A,Line 8 above 16. ENDING CASH BALANCE ..................Add Lines 12+13+14,then subtract Line 15 $ If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED................................ Schedule B,Part 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents................................................ See instructions on reverse $ 19. Outstanding Debts.............................. Add Line 2+Line 9 in Column B above $ 5926.08 0 5926.08 1300 7226.08 128 To calculate Column B, 2550 add amounts in Column A to the corresponding amounts from Column B 0.08 2678.08 of your last report. Some amounts in Column A may 0 be negative figures that should be subtracted from previous period amounts. If this is the first report being 0 filed for this calendar year, only carry over the amounts from Lines 2,7,and 9(if 0 any). I.D.NUMBER 1390787 Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 1/1 through 6/30 7/1 to Date 20. Contributions Received $ $ 21. Expenditures Made $ $ Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made' (If Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mm/dd/yy) _ JJ $ $ "Amounts in this section may be different from amounts reported in Column B. FPPC Form 460(Jan/2016) FPPC Advice:advice @fppc.ca.gov(866/275-3772) www.fppc.ca.gov Schedule A Amounts may be rounded Monetary Contributions Received to whole dollars. Statement covers period from 10/23/2016 SEE INSTRUCTIONS ON REVERSE I through ivnin�yr ri�am - Kris Wang for City Council 2016 DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL,ENTER RECEIVED (IF COMMITTEE,ALSO ENTER I.O.NUMBER) CODE * OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED,ENTER NAME OF BUSINESS) De Anza Maintenance ❑IND 10/26/16 960 N San Antonio Rd COM Los Altos, CA 94022 ❑OTH ❑PTY ❑SCC Veronica Lam ®IND 11/7/16 19665 Meritt Dr. ❑COM house wife Cupertino, CA 95014 ❑OTH ❑PTY ❑SCC Winnie Lee ®IND 12/2/2016 10386 Westacres Dr. ❑coM Dentist Cupertino, CA 95014 ❑OTH Lee's dental ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC 12/31/2016 Page I.D.NUMBER 1390787 AMOUNT RECEIVED THIS PERIOD SCHEDULE A of CUMULATIVE TO DATE PER ELECTION CALENDAR YEAR TO DATE (JAN.1-DEC.31) (IF REQUIRED) 2000 I 2000 150 1 150 400 1 400 SUBTOTAL$ 2550 Schedule A Summary 1. Amount received this period—itemized monetary contributions. (Include all Schedule A subtotals.).........................................................................................................$ 2. Amount received this period—unitemized monetary contributions of less than $100 ...........................$ 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.)......................TOTAL $ 2550 I 2550 "Contributor Codes IND—Individual COM—Recipient Committee (other than PTY or SCC) OTH—Other(e.g.,business entity) PTY—Political Party SCC—Small Contributor Committee FPPC Form 460(Jan/2016) FPPC Advice:advice @fppc.ca.gov(866/275-3772) www.fppc.ca.gov Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE Kris Wang for City Council 2016 Amounts may be rounded to whole dollars. Statement covers period from 10/23/2016 through 12/31/2016 SCHEDULE E Page of I.D.NUMBER 1390787 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP CNS campaign paraphernalia/misc. MBR member communications RAID radio airtime and production costs CTB campaign consultants contribution(explain nonmonetary)* MTG OFC meetings and appearances RFD returned contributions CVC civic donations PET office expenses petition circulating SAL TEL campaign workers'salaries FIL candidate filing/ballot fees PHO phone banks TRC t.v.or cable airtime and production costs candidate travel,lodging,and meals FND IND fundraising events independent expenditure supporting/opposing others(explain)* POL POS polling and survey research delivery TRS staff/spouse travel,lodging,and meals LEG legal defense postage, and messenger services TSF transfer between committees of the same candidate/sponsor LIT campaign literature and mailings PRO professional services(legal,accounting) VOT voter registration PRT print ads WEB information technology costs(internet,e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE,ALSO ENTER I.D.NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID SCC Voters Registrar Voter's list FIL 82 Quick Data LIT 1300 Kris Wang Candidate filing/ballot fee FIL 1296.08 Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 2678.08 Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.) 2678.08 2. Unitemized payments made this period of under$100.......................................................................................................................................... $ 0 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).)............................................................................. $ 0 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summa ry Page,e, Column A, Line 6. 2678.08 )...........................TOTAL $ FPPC Form 460(Jan/2016) FPPC Advice:advice @fppc.ca.gov(866/275-3772) www.fppc.ca.gov