410 Statement of Organization Recipient Committee – Amendment Stamped by SOS Statement of Qrganization DateStamp . i _ , �
Recipient Committee ; : -
Statement Type � �F��' y��� ' � _
❑ Initial 0 Amendment ❑ Termination—See Part 5 �- � �•--�� °'�`' ��"' ` - `�orb�,��a�useo�i�� _. � �
Q Not yet qualified In �e oiticc oT Ine S�c(U � ;�¢��'� � ` �i �': ;
of the State of C����ornia ��;
or 07 17 2018 = `' �
� Date qualified as committee � � � � �1�!± (l� ��'�� ` ' � F�-�� � r ���� ;
Date qualified as committee Date of termination t)€7 �t
/ / : ���-_—��_,�_�_ _ �
1. Committee Information �•D. Number 1407834 2. Treasurer and Other Frinc�pa)Office�-�— � �`�' � ������� � �
(if aPplitable) _
NAME OF COMMITTEE NAME OF TREASURER
Mahoney for Council -2�18 Carolyn Krizek-Mahoney
STREET ADDRESS(NO P.O.BO%)
COUNTY OF DOMICILE JUftISDICTION WHEftE COMMITTEE IS ACTIVE NAME OF PftINCIPAI OFFICER(5)
Santa Clara anta Clara County Orrin Mahoney
STREETADDRESS(NO P.O.BOX) �
3. Veri 'cation
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
MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTftOLLING OFFICEHOLDER,CANDIDATE,Oft STATE MEASURE PROPONENT
FPPCForm 410(Februaryf2018j
FPPC Advice:advice@fppc.ca.gov(866J275-3772)
www.fppc.ca.gov
Statement of Organization � • - �
Recipient Committee • - �
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NpME I.D.NUMBEft
Mahoney for Council-2018 1407834
• All committees must list the financial institution where the campaign bank account is located.
NAME Of FINANCIAlINSTITUTION AREACODE/PHONE BANKACCOUNTNUMBER
Wells Fargo 3176863482
AODRE55
4.T�/pe of Committee Complete the applicable sections.
iiiiiii '
• 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:' Stating"No party preference"is acceptable.
• If this committee acts jointly with another controlled committee,list the name and identification number of the other controlled committee.
� ELECTIVE OFPICE SOUGHT OR HELD YEAR OF PARTY
NAME Of CANDIDATE/OPRCEHOLDER/STATE MEASURE PROPONENT fINCLUDE DISTRICT NUMBER�f APPLICABLE) ELECTION
CHECK�NE
Nonpartisan Partisan (list political party belowj
Orrin Mahoney Cupertino City Council 2018 � �
Nonpartisan Partisan (list political party belowj
� �
Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(S)NAME OR MEASURE(S)FULL TITLE(INCLU�E BALLOT NO.OR LETTER� CANDIDATE(S)OFFICE SOUGHT OR HELD OR MEASURE(Sj 1URISDICTION
IF A RECAI.L,STATE"RECALL"IN FRONT OF THE OFFICEHOIDER'S NAME. {INCLUDE DISTRICT NO.,CITY OR COUNTY,AS APPLICABLE) CHECK ONE
$UPPORT OPPOSE
❑ ❑
SUPPORT OPPOSE
❑ ❑
FPPC Form 410(February/2Q18)
FPPC Advice:advice@fppc.ca.gov(866(275-3772j
www.fppc.ca.gov
Stafement of Organization � • - �
Recipient Committee • - �
INSTRUCTIONS ON REVERSE
Page 3
COMMITTEE NAME I.D.NUMBER
Mahoney for Council-2018 1407834
4.Type af Committee {Continued)
Not formed to support or oppose specific candidates ar measures in a single election. Check only one box:
❑ CITY Committee ❑ COUNTY Committee❑ STATE Committee❑ Political Party/Central Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
�• • �R � � , List additianal spo�sors on an attachment,
NAME OF SPONSOft INDt15TRV GROUP OR AFFILIATION OF SPONSOR
STftEET ADDRE55 NO.AN�$TREET CITY STATE ZIP CODE AftEA CODEJPHONE
e ❑
��
Date qualified
5.Termination Requirements By signing the verification,the treasurer,assistant treasurer and/or candidate,officeholder,or proponent certify that all of the fallowing 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 may 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.
FPPCForm 410(February/2018j
Clear Page Prinf FPPC Advice:advice@fppc.ca.gov{866/275-3772j
www.fppc.ca.gov .