410 Statement of Organization Recipient Committee – Initial Stamped by SOS � �� � ��� QateStamp a � • �
I�
�ta�emet�t of(��ganizati�n ,� ��� ����� ���� ����,�� �' � . �� ����'��I�' ' �
�G'Ci�l�ll��t)�'i'�[t'9��� �— ��� in t�r at�ce 6i t�e�ee�e�ary of�t���� - ' _
Statement T � d r� ' r�� �u��o�iy
Yp �]tnitial } . [� Amendment ❑ 1'erminat�on—�ee Part 5 ��e Sta�a of G�li�omia _ ��;�� � ,4 ,
(} lVot yet qualified '�� �
Ji�� 2a ��i� -<
ar y { :
� Qate qualifled as committee --�-----j ----�----"-� � �=�� � �;; �
bate qualifed as committee Date of t�rmin�tion � • '� � �� � `
3
� � 12 � 2Q1$ = ' ,�.--- ' ;
LD. Nu�b�r ��� ' e
�. ����������fc�rr��ti�� `, ��`�'����r�r�������r���������#���� � �� � .�.�� �_��: ���� _
� � ' f+#�aut�eab�ej � , E �� : � �
NAME OF COMMITiEE � � NAME Of TRE�SUqER � � �
Mahoney for Council-2Q18 Carolyn Krizek-i4lahoney
5'fREEj AbpRE55{NO P.O.BOX�
MAILING ADDRESS(IP DIFFERENT) � � � � � � StREEj ADORE551N0 P.O.80X)
COUNTY OF DOMICI�E lURISDIC714N WMERE COMMiTiEE IS AC71VE � � � � NAME Of PRINCIPAL OFF�CER(5)� � � � � �
Santa Ciara Santa Glara County
57REE7 ADORE$S�NO P.O.BtlA}
CiTY STATE 2�PCQPE AREAGt7�DEIPH9NE
Attach additiona/lnformation on approprlotely labeled cantinua�iotr sheets.
3. ;11�r� ���cat� : _ ; . �
� � , „�,_. � .��,-,��_,:.: _- �:,.., : . � _. .,:, � �, . � ��:� �.. � �
� �.�,��
I have used all reasonable dil�gence in pCeparit�g thls stat�ment and tp the�iest of my I�nowrl�dge the infc�rma�ion c�ntain�d herein is true�nd complete. I c�rtify under
penalty of perjuey under the laws of the
MEASURE PRqPQNENT
Executed on @y
DATE � SIGNATURE QF CONTROILING OFF�CEHOLOER,CRNQIDA7E,OR STATE MEASURE PRQPONENT
Executed on By
DATE � SIGNATURE OF CQNTROLLING OFFICENOIDER,CANDIDATE,QR STATE MEASURE PROPONENT
�PP�Farm 410{FebruatyjZ0i8j
FRPC Advice:adv�ce@fpp�.ca.g�v{856J275-377a)
www.fppt,ca.gov
+ � � � �
Statement ��Urganizati�r�
�
Recip6ent Ca�mr�itt�e • `
INSTRUCTIONS ON REVERSE
Pag�2
COMMI7"fEE NAME I.b.NUMBER �
Orrin Mahoney far Council-2018
+ AN committees rrfust list the financial institufion where the campaign ba�k account is lacated.
�NAME OF FINANCIALINSTITUTION AREACODEJPHONE BANK�+CCOUNTNUM6ER -
Viteils Fargo 3176863482
�.�'�p����� ���t�� ���������t���ppli�a�������i�n�. � � �
� #�� _ �� � , � ,
�� �
e List the name of each controlling officeholder,candidate,or state measure proponent. If candidate or officehalder controlied,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 afFiceholder or candidate is affiliated or check"nonpartisan:' Stating"t�o party preference"is acceptable,
a If this committee acts jointly with another controlled cammittee,list the name and identification number of the other contralled committee.
ELECTIVE OFFICE SOUGHT OR NELD YEAR OF PARTY
NAME OF CANDIDATEIOFFICEHOLDERISTATE MEASURE PRQPQNENT (WC�UDE DISTRICT NUMBER IF APPLICABLE) ELECTION CHECKONE
Nonpartisan Partisen (list po�ltical party elaw)
Orrin Mahoney Cupertino City Council 201� � �
Nonpartisan Partisan (list po 1tica1 party be qw
� �
. Primarily formed to support or oppase specific candidates or measures in a single election. List t�elow:
CANDIQATE(S)NAME OR MEASURE�S)fULL TITLE(INCLUDE BALLOT NO.OR IETTER) CANDIDATE{S}OFFICE SOUGHT OR HELD OR MEASURE(S)JURISD4CTION
IF A RECAIL,STATE"RECALI."IN FRONT OF THE�OFFICEH�LDER'S NAME. {INCLUQE DISTRICT NQ.,CITY OR COUNTY,AS APPLICABLE) CHECK 4NE
� St1PPOFT� RRPO§@ �
� �
3U�T PPC25E _..
FPPCFarm 410{Febru�ry/201$)
FPPC Advice:advice@fppc.ca.gav(866/275-�1772)
www.fppc.ca.gov
� �IN, I P
Statement of Orga�izatio� _ ' � a j �
Reclpiet�t Coms�it�ee
� • J
INSTRUCTIONS ON REVERSE Page 3
. I.b.NUMBER
COMMITTEE NAME �
Orrin Mahoney for Council-2Q18
�.'�'�'�3�������1'�� ��; {����s�d� ,
Not farmed to support or�ppo�e specific candidates ar measures in a single election. Check anly one bax:
[] CI't'Y Cammiite� [] CC}UNtY CQmmit�ee(� 57ATE Commitkee[] Pulitical PartylCentral Cammittee
FROVIDE 9RIEF DESCRIFTION OF ACtIVITY
�� _-;�' List addi�ianal sponsors art an a�tachment.
.# � � . �
NAME Of SPQNSOR INDUSTRY GROl1P OR AFFILIA?ION OF SRONSOR
STREETADQRE55 NO.ANDSTREE7 CITY � STATE ZIPCODE AREACODEJPHONE
�/r� - .�r s e.' �� �',�.�lill �--�—,t�l
Date qualified'
�.���`1'�1��€��{?�����IC��1���� . . _�����!?�n����v�ri���!'�t���asurer,as�ls�nt tre�sur�r ar�d�tzr e��did�f��fPic�P�older,car�capt��er�t,c��ify.thai alI��e.f�allciw�n�candi�c�r��#���k��n m�t:,,::...,..
* This committee has ceased to r�celve cc�ntribufions and make exp�nditures;
e This committee does not anticipate receivir�g contributions or making expenditures in the future;
• This committee has eliminated or has no intention or ability to discharge all debts,loans received,and ather obligations;
• This cammittee has na surpius funds;and
• This cammittee has filed all campaign statements required'by the Political �eform Act disclosing all reportable transactions.
-- There are restrictior�s 4n the dispasition of suCplus c�mp�ign fund5 held by el�cted�ffiiCers who are leaUjng office and by defeated candidates. Refer tc�Government
Code Section 89519.
— �eftover funds of ballot measure committees may b�used for political, legislativ�or govemmental purposes under Gover�nment Code Sections 89511-8951�,and are
subject ta Elections Code Sectian 186�Q and FPPC Regula�ion 1�521.5.
FPPG Form 410(February/2018)
��@��' �'�£��� ��0�� � FPPC Advice:advice@fppc.ca.gov(866J275-3772)
� ,� g
wvuw.fppc.ca.gov