410 Statement of Organization Recipient Committee - Amendment Statement of Organization
Recipient Committee
Statement Type ❑Initial
Not yet qualified ❑ or
Date qualified
® Amendment ❑ Termination—See Part 5
List I.D.number: List I.D.number:
#1376003 #
01 109 /2017
Date qualified as committee
(If app I Ica ble)
1. Committee Information
NAME OF COMMITTEE
Cupertino Residents for Sensible Zoning Action Committee
STREET ADDRESS(NO P.O.BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
MAILING ADDRESS(IF DIFFERENT)
FAX/E-MAIL ADDRESS
wulvIY Ur UUMIOLE JURISDICTION WHERE COMMITTEE IS ACTIVE
Santa Clara Cupertino, CA
Date of Termination
2. Treasurer and
NAME OF TREASURER
For Official Use Only
JAN - ) 2017
C JPERTINO CITY CLEIIK
Xiaowen Wan
STREET ADDRESS(NO P.O.BOX)
CITY
Principal Officers
STATE ZIP CODE AREA CODE/PHONE
NAME OF ASSISTANT TREASURER,IF ANY
STREET ADDRESS(NO P.O.BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
NAME OF PRINCIPAL OFFICER(S)
Xiangchen Xu
STREET ADDRESS(NO P.O,BOX)
Attach additional information on appropriately labeled continuation sheets. CIIY
STATE ZIP CODE AREA CODE/PHONE
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 California that the fo egoing is true and correct.
Executed on f / ! 1L �'? —
DATE 7
PROPONENT
Executed on By
DATE
Executed on
DATE
SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
By
SIGNATURE OF CONTROLLING OFFICEHOLDER,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 CALIFORNIA
Recipient Committee
FORM 4100
INSTRUCTIONS ON REVERSE
Page 2
MITTEE ME
upe `6 Residents for Sensible Zoning Action Committee I.D.NUMBER
1376003
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION I AREA CODE/PHONE BANK ACCOUNT NUMBER
ADDRESS
4.Type of Committee Complete the applicable sections.
Controlled Committee
CITY
STATE ZIP CODE
• 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 committee, list the name and identification number of the other controlled committee.
NAME OF CAN MEASURE PROPONENT
ELECTIVE OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
Primarily Formed Committee Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATES)NAME OR MEASURE(S)FULL TITLE(INCLUDE BALLOT NO.OR LETTER)
CANDIDATE(S)OFFICE SOUGHT OR HELD OR MEASURE(S)JURISDICTION
(INCLUDE DISTRICT NO..CITY OR cniINTV Ac Appl IrnRl Gl
FPPC Form 410(Jan/2016)
FPPC Advice:advice @fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
' -- -----"---'
LHECK
ONE
SUPPORT
OPPOSE
SUPPORT
OPPOSE
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 3
` U'lJMMO Residents for Sensible Zoning Action Committee I.D.NUMBER
1376003
4.Type of Committee (Continued)
General Purpose Committee 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
Sponsored Committee List additional sponsors on an attachment.
NAME OF SPONSOR
STREET ADDRESS NO.AND STREET
Small Contributor Committee
Date qualified
CITY
RY GROUP OR AFFILIATION OF SPONSOR
STATE ZIP CODE
5.Termination Requirements By signing the verification,the treasurer,assistant treasurer and/or candidate,officeholder,or proponent certify 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 or ability to discharge all debts, loans received,and other obligations;
• This committee has no surplus funds;and
• This committee has filed 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 maybe 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