410 Statement of Organization Recipient Committee – TerminationStatement of Organization Recipient Committee Date Stamp StatementType ~l□-,n-it-ia-,-------1~--------~1~-""''"------------11 D Amendment I' ~If,; 0 Not yet qualified ~-or 0 Date qualification threshold met I Date qualification threshold met CUPERTINO CITY Date of termination --1--1----1--1--I.D. Number ~~ (if applicable) NAME OF COMMITTEE NAME OF TREASURER ::fc '1 lJ l l\ e ~ -for Cu~rn·n,o CoCAM.ct\ Q.otg --:f"oa.V\ leu.JVu" CWV"\ STREET ADDRESS (NO P.O. BOX) \0\~2..., ~, \lOI\. t">L o STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE I ~g 7 0 --rl \Son Av Cu.. +t·,t0 CA-qt,01<1 <./o8. H87. 745~ CITY (\.t-~C+'\~ STATE CA ZIP CODE C\-50\4 AREA CODE/PHONE '--10& .<l83,~to5 NAME OF ASSISTANT TREASURER, IF ANY FULL MAILING ADDRESS (IF DIFFERENT) STREET ADDRESS (NO P.O. BOX) E·MAIL ADDRESS (REQUIRED)/ FAX (OPTIONAL) ~w:\\E.""\@ ui. (,n\-Q),Of CITY STATE ZIP CODE AREA CODE/PHONE COUNTY OF DOMICILE .SU/\1. fCL, C (Cl.Ka.., $DICTION WHERE COMMITTEl?-rS ACTIVE C(~ o~ Cu <-n'~ NAME OF PRINCIPAL OFFICER(S) STREET ADDRESS (NO P.O. BOX) Attach additional information on appropriately labeled continuation sheets. CITY STATE ZIP CODE AREA CODE/PHONE 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 foregoin is true and correct. ~ Executedon ,-~L{-2.oz..3 By ·. ~~ c~ Executed on Executed on Executed on 1 ___ l r: T",... 2.. 0 ~ 5 By IG . .RE OF v£R OR ASSISTANT TREASURER DATE SIGNATURE OF CONTROLLING ',f°FICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT DATE DATE By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT By -------------------------------,,-----,,,,,,.-,,,.,,.-,-,,,,,.--:-..,,,-=-=-=-=-:cc-:-,:--,-,:--c:----------s1GNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (August/2018) FPPC Advice: adv[~ppc.ca.gov {866/275-3772) www.J~Q\/