410 Statement of Organization Recipient Committee - Amendment � .
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07 17 2018 3 � °
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Date qualified as committee date of termination �� , � �� _� � �
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1. C�menittee 6�forma�iora �'�' �����T �407834 2. Treasurer aastD�ther Pr6nei{aal O�cers
(if applicoble)
NAMEOFCOMMITTEE NAME OF TREASURER
Mahoney for Counci!-20'i 8 Carolyn Krizek-Mahoney
CQUNTY OF OOMICtLE lURtSDICTION WHERE COMMITfEE IS ACTIVE NAME OF PRINCIAAI OfFICERiS)
Santa Clara anta Clara County Orrin �lahoney .
STREET AODRESS(NO P.O.80X�
3. V�a-� cafia�n
I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained nerein is true and complete. I certify under
penalty af perjUry under the laws of the State
Executed on gy
DATE 516NATURE FCONTROLUN6 OFFICEHOLDER,CANOlDATE,ORSTATE MEASUREPROPONENT
Executed on gy
DATE SIGNATUftE OF CONTROILING OPFlCEHOLDER,CANOIDATE,OR S7ATB MEASURE PROPONENT
FPPC Form 410(FetsruaryJ201��
�PPC Advice:aduite�fpgac.ca.gov(866J275-3772}
www.fppc.ca.gmv
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Sta�e�ent af��g�n��a�i�n
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INSTRUCTIONS ON REVERSE
Pa�e 2
COMM�'fTEE NAME I.D.NUMBER
Mai�oney for Got�nei!-2018 14Q7834
• A(g committees mus�Iss�the fiesancial i�ass4itut�on wrhere the campaign�Sank account is located.
NAME OP fINANCIALINSTITUTlQN AREACODEJPHONE BANKACCQUNTNUMBER
Weils Fargo 3176863482
�.1'yj���f�O�l�9'9t'tte� Complete the applicable sectaans.
•s d2�P e s e'slr�
• List the narne of each controlling offiteholder,candidate,ar state measure proponent. If candidate or officeholder controlled,also list the eiective offie�sought or held,and
district number,if any,and the year of the elec4ion.
• List�he politica!party vvith which each officeholder or candidate is afiiliated or check"nonpartisan:' Stating"f�a party preference"is acceptable.
o Ig this committee acts jointfy with anather controlled committe�,list the name and identification number of the other controlled committee.
ELECTIVE OFflCE SOUGHT OR HELD YEAR OF PARTY
NAME OF CANDIDATE/OFFICEHOlQER/STATE MERSURE PROPONENT {�NCLUOE DiSTRICT NUMBER IF APPLICABLE) EIECTiQN
CHECK ONE
Nonpa�tisa� Partisan (list politicaf party belowj
Qrrin Mahoney Cupertina Cify Council 2Q18 � ❑
Nonpartisan Partisan (�ist political party helowj
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. Prirnarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIOATE(S}NAME OR MEASURE(51 FULLTITLE(INCLUDE BRLLOT NO.OR IETTERj CANDIdATE(5)OPFICE SOUGHT dR HEID OR MEASURE(S}JURISDICTIflN
IF A RECALL,STATE"RECALI"IN FRONT QP THE QfFICEHOLDER'S NAME. (INCLUDE DISTRlCT NO.,C1TY OR GOUNTY,AS APRLICABI@} CHECK OwE
SUPFQRT OPPOSE
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SUPP4RT OPPDSE
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EPPC F�rr�a 414(Februaryj2018j
FPPC Adwice:adviee@rppc.ca.gov{866j�75-3772)
wwwr.��pc.sa.gov
St�t�rr��e�t �f�r�ani�ation , ' ��� . , i
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INSTRUCTIONS ON REVERSE Page 3
I.D.NUMBER
COMMITTEE PdAME
Mahoney for Gouncil-201$ 14Q7834
�,"�����pf����j'��� (Continued}
- Not formed to support or oppose speeific candidates or measures in a single election. Check on�y one bax:
❑ Cli'Y Carsarnittee [� COl1P�TY C�manittee(� 5'F�TE��ra�arvsitt�e� Po96�ca1 Rerty/Cen#ra1 Co�nmittee
PROVIDE BR�EF DESCRIPiION OF ACTIVITY
�' - List additional sponsors on an attacf�ment.
NRME OF SPOPlSOR INDUSTRY GROUP OR AFfiLiATION OF SPONSOR
STREET ADDRE55 �JO.AND STREET CITY STATE 21P CDOf AftEA COOE�PNO(VE
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Date qualificd
�3.1'errnie�a���Req��rerr�ents 8y signing the verificadon,the treasurer,assis[ant treasurer and/or candidate,officeholder,or proponent certify that aIi of the foilowing conditions have been met:
� This cammittee has ceased to receive contributions and make expenditures;
a This committee does not anticipate receiving contributions or making expenditures in the future;
• This committee has eliminated or has no intention t�r ability to discharge ai)debts,loans received,and other obiigations;
+ This committee has na surplus funds;ar�d
a This committee has fiied a31 campaign statements required by the Political Reform Act disclosing HII repor��ble tranSaCtionS.
-- Tner�a«�e�tr���;o�5 0�the d�s�o5�c;on of s�rplus campaign funds held by elected afficers wha are leaving of�ce and by defeate�candidafies. Refer ta Government
Code Seciion�9519.
-- leftover funds of bal{ot measure cammittees may be used for politica{,12gI51dtIV�01'gRV�t'Rf118t1td)�3Uf�t]Se5 Utlder Government Code Sections 89511-89518,and are
5ubject to Elections Code Section 18580 anc6 FPPC Regulation 18521.5.
FPPC Forrn 410(Eebrua�+j2Q18}
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