410 Statement of Organization Recipient Committee - Initial Statemer�#of�rgan6zation � ��� � � � • � �
Rec�pient Co�nmitte�
Statement Type }nitiaf 0 Amendment 0 Terminatiora—See Part 5 � �or o���ai u�oniy
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O Date quaiifiirztiofl threshotd met �ate q�a6fication threshotd met Date or terriination
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NAMEOPCQMNH7TEE NAME OF TRE/15URER
Cupertino PQ�iticat Re#orms PAC ������e���
STRfEi A�LTRE55{NO P.O.30X) �
65053{37160
FUtL MAIf.ING ADDRESS(ff DIFFEREM"� STREET ADQRE55 jN0 P.d.BQXJ
E-MAtLAQDRE55(REQUIREDj/FAX(OPSfONAt) C�TY STATE ZtPCODE kREAC6DE/PH0f3E
COUNTY 6F DOMiCILE JURISDICFtOiV WHERE fAMMI'fTfE t5 ACTiVE NkME OF PR(NCIFAE OFFiCER(5J
SFREE3'ADDRE55{R}O P.6.30YJ
C!'fY STATE ZSF CODE AREA CODE(?H4N£
Qitach addit�onal�nformafion on appropreatefy tabeled continuation sheets.
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#have used afi!reasonable diligence ir�preparir�g this statement and ta the�est of my knowfedge the information contained herein is true and complete. t certif�r uncler
penalty of perjury under the taws of the 5#ate of Cafiforn'sa t9�at tt�se foregoing is true and correct.
Executed on '�����J��(J By �—�! �"
� DAIE 51@RRTttRf QF iRfAStIRER OR ASSISTANTTftEASURER
EX2CUt2C�OCI �v
DAFE SIGNATURE Of CQNTROit[NG OFFiC£HOLDER,CANDiDATE,OR STAFE MEASURf?ROPONENT
f�cecuted ors By
�A�� - Si6NA7URE Q�COM'fR4LCiN�OFFfCEHOLflER,CAWDIDATE,OR STATE MEASURE PROPQNfNT
fxQcuted nn By
� pATE SIGNATURE4FCONTROLLiNGOFEiLEHOiDER,CANDIDATE,ORSTATEMEASUREPRQPQNENT
FPPC�orm 410(AugustJ2018)
FPPC Advice:arlvece@fPpc.ca.gov(866/275-3772}
www.€ppc.ca.gov
Sfa�emer�t of Organizatioa� , � _ ,
Recipient C��mitEee � � ' �
4Id5TRUCFiQlVS E7N itEVERSE
Page 2
LOAAMf4'FEE NAMf I.D.NUMSfR
Cupertina Potiticai Re#orms PAC
• Aii commi�tees ra�ast 6is�the finaa�ciai ireststu#�on where the campaign bafak accotsn#9s 4ocatecl.
NANlE OF FtNANClAL INS7ITUTION AREk CADE/PHONE BANR RtCOt}NT NUMBER
A6DRE55 CITX STA'fE ZIPCQIIE
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• List the name of each controi#ing o�fice#�otder,candidate,ar state meas�are proponent. !f can�iidate or o#ficehaider ccsntrolieci,alsa#ist the elective oi�'ice sought or held,and
district number,if any,and the year of the elsctiort.
• List the p��'st�cal�arty with which each officeholder or candir�ate is affiliated oi cE��ck"raQnpartisan:' Stating"Na party preferen�e"6s acceptable.
• If this committee acts jointiy vuith anQther control{ed cotnmit#ee,iist the narrae ar�d€dent.ififica�ion rtumber af the other contrott2d committee.
ECECTIVf OEFlCE SOUGHT OR HftD Y€AR(}F ppgfy
NAME QE CAiVfllDATE[OFFILEHDLDER/STATE MEASURE P}?OFONENT (lNCtUDE DiSTRICT NUMBER IF APPLtCAB�E} EiECl"10N c+tfcKo[�
IVonpartisan Pa;lisan {list politica#party betow}
� �
�fonpartisan ParUsan tEist potiiicat pariy below}
� �
� • -• • Primarify#ormed to support or oppose specific cand�aates or rraeasa�res in a sangle etectior�. List beiowr:
CAPiDiDATE(S)WAME OR tvFEA513RP!53�ULL TiFLE(tNLtUOE 3RLLOF MO.OR EETTERj CkpSDiDATE(S}QFFiCE SOU6FtTOR HELD QR NiEASURE(SjlUR#SDiC770N
7F A RfCAtt,STATE"RECAtI"t1U Fi2QNT OF Ft'.E OEF3CEktOtDER'S i�IAME. (I{VLiIlQE Di5TR1CT NO.,CITY OR LOUMTI;AS APPilCABLEj CtkECK ONE
S{{1�PPOfiT 6PPOSE
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S!lPP�RT ORPOSE
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�C Farm 41fl(AugustJ203.�
�€�c Adv;ce:adv;ee@���c.ca.gav j866j2753772j
www fppc.q.gov
Sta#erv�erat of�rganizafion . � s ,
liecipie�t Corr�rnit�e s . � 1
lNSTRUCTIQNS OP!REVERS£
Page 3
tOMMflTEf NAME � �
� l.D.NIIMBER
Guper�ino Political Reforms PAC
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•° ' • -� Atot formed tD su#�{�ort or o#3pase specific canclida#es or rr�eas�sres crr a single eleetion. Check anly one box:
Q CIiY�orr►rnittee ❑ COftlIVTd Cocr�rrsittee [� STATE�oenevei�#ee
PROVtDE BRkEf DESCR{PT10N OF RC'f(V tTY
•�.� - -- List addi�iona!sponsors an an attachrraent.
NAM£OF SFONSOR 4MIIU57RY GRQItP OR AFFILiAT10N OF SPONS9R
STREETADDRES$ NO.ANDSTREET LF(Y STATE ZIPLOflE AREACADE/PHONE
s a e -
a��
Date quaEfied
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, �u S , .„ , ., / . , y P� e tce �aralt;:of,thefollo+nnn cond�uns.have6een;meY '>
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e This eommittee has ceased to receive ean�ributions and make expenditures;
• This cammittee does rrot anticipate recei�r[ng contributions or makirg�xpenditures iro�he future;
+ This committ�e has et9minated oc�aas no intention or abifity to discharge aBi debts,ioans received,and t�ther obligations;
s This comrraittee has no surp�us funds;and
• This committee has fiied af!campaign statements required by the Pola�hical Reform Act disdosing afl reportab�e transactians.
— There are res�r'actions on the d'sspasi�ion of s�rplus carnpaign€unds held by eiec#ed officers wh4 are l�aving oifce and by defeated candidates. #tefer to Govemment
Code Seciion 89519.
— Leftover funds of batiot measure eommi�tees rrsay be usec!for poiiticai,9egislative ae goerernme�ata!purpases ur�der�overnment Code Sections 89513-89518,and are
subject to Elections Code Section 18580 and FPPC Regulation 18521.5.
FPPC form 410{Auga�st/2018)
EPPC Aalv9ce:advice@fppc.p.goa(866/27537?2)
www#pgc.ta.gov