410 Termination tatement of Organization
Recipient Committee
Type or print in ink
vlENT OF ORGAN IZATI ON
Statement Type [] Initial
Not yet qualified [] or
I I --J.~J.~
Date qualified as committee Date qualified as committee
(if applicable)
1. Committee Information
NAME OF COMMIlq'EE
[] Amendment ~'Termination - See Part 5 JAN 2 42002 , official Use Only
List I.D. number: List I.D. number:
IT / _~1 / 0{ CUPERTINO CITY Ci
Date of Termination
STREET ADDRESS (NO P.O. BOX)
10940 i i mo c?d
2. Treasurer and Other Principal Officers
NAME OF TREASURER
STATE
NAME OF ASSISTANT TREASURER, IF ~Y
ABEAOOD~PHONE
STREET
CITY STATE ZIP CODE
ZIP CODE
AREA CODE/PHONE
OPTIONAL: FAX / E-MAIL ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE
COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
Clam co
Attach additional information on appropriately labeled continuation sheets.
NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE
MAILING ADDRESS
CITY STATE ZIPCODE AREA CODE/PHONE
3. Verification
I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained heron is true and complete. I certify under penalty of
perjury under the laws of the State of California that the foregoing is true andExecuted on I/t~[~ATE?~ By correc~) ~'T)~' -/~ ~'~"~.~
~/~ URE OF TREASURER OR ASSISTA,~TXTREASURER
Executed on By v ~ SIGNATURE OFONTR~L~NG~ FFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF ~3NTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (Jan/D1)
FPPC Toll-Free Helpline: 866/ASK-FPPC
tatement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
4. Type of Committee Complete the applicable sections.
STATEMENT OF ORGANIZATION
Page2
I.D. NUMBER
· 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 "non-partisan."
· If this committee acts jointly with another controlled committee, list the name and identification number of the other controlbd committee.
ELECTIVE OFFICE SOUGHT OR HELD
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEar OF ELECTION PARTY
~,Non-Partisan
[] Non-Partisan
· List the financial institution where the campaign bank account is located (controlled "candidate election" committees only)
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER
ADDRESS I ~ CITY STATE ZiP CODE
S reven (reek 151vd, CUl rqino, g 4
Primarily formed to suppo~lor oppose specific candidates or measures in a single election. List below:
CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE
SUPPORT OPPOSE
SUPPORT OPPOSE
FPPC Form 410 (Jan/01)
FPPC Toll-Free Helpline: 866/ASK-FPPC
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
STATEMENT OF ORGANIZATION
Page 3
I.D. NUMBER
4. Type of Committee (Continued)
~'~Jx=~'li~*l'~"~=~"x'~m~'Jtl~"-= Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
N ~ [] CITYCommitte. ["'~ COUNTYCommitte. [] STATECommitte.
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
NAME OF SPONSOR
STREET ADDRESS NO. AND STREET
INDUSTRY GROUP OR AFFILIATION OF SPONSOR
CITY
STAE ZIP CODE
1. J
Date qualified
Check box and provide the date this committee qualified as a small contributor committee. If the committee qualified as a sma!
contributor committee on January 1,2001, enter 1/1/01.
· 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 tD
Government Code Section 89519.
-- Additional filing obligations will be incurred if, after terminating, the committee receives or spends any funds, or receivesthe forgiveness of a loan,
repayments of loans made to others, or any other receipts.
FPPC Form 410 (Jan/01)
FPPC Toll-Free Helpline: 8661ASK-FPPC