410 Termination tatement of Organization
Recipient Committee
Statement Type [] Initial
Notyetclualilted I-1 or
'l~pe or print In Ink
[] Amendment
List I.D. numbec
I I I I
Date quatBed as commtttee Date qualified as committee
,Of~~.,)
1. Committee Information
G~OFF PATNOE FOR CITY OOUNCIL ''
STREET ADDRESS (NO RO. BOX)
10384 ALPINE DRIVE #2
CITY STATE ZIPCODE AREA CODF-JPHONE
CUPERTINO CA 95014 (408) 773-1400
MAJUNG ADDRESS (IF DIFFERENT)
OPTIONAL= FAXI E-MAILADDRESS
COUNTY OF DOMICILE I COUNTY WHERE COMM; I I EE IS ACTIVE IF Dm~=~[l'
I THA~. COUNT~ OF DOMICILE .
Attach ad~l~onal lnforma~ton on approprlafely la~eled con#nuatlon shee~.
8TATEM ENT OF ORGANIZATION
[] Termination - See Part 5
Ust I.D. numbec.
#123~¢7R
DEC 1 3~2001
C.F CUPER
Date of Termination
2. Treasurer and Other Principal Officers
NAME OF TREASURER
~(~ HALT,
STREET ADDRESS
21040 ~OMESTF_AD ROAD
CITY STATE ZIP CO~E AREACuu. E~PHONE
f/3PERTINO CA 95014 (408) 773-1400
NA~E OF ASSlSTAN~ TREASURE~ IF AN~
STREET ADDRESS
Cr~' =1^1E ~P CODE AREA CODr-,"~..ONE
NAMEAND PosmoN OF OTHER P~4NCIPAL OFFICER(S), IFAPPUCAB~E
MNUNG ADDRESS
cFrY ST~E 2~PCODE AREA CODF.~HONE
3. Verification-
I have used all reasonable diligence In prepaflng this statement and to the best of my knowledge the Information contained herein is true and complete. I ca,fY under penalty of
perjury under the laws of the State of Califomla that the foregoing is true and correct.
Executed on
Executedon
Executed on
SIGNATURE OF CONTROLUNG OFFICEHOLOER, C,~HDIDATE.
SIGNATURE OF CONTROLUNG OFfiCEHOLDER, C,N~IDATE. OR STALE MEASURE:
SIGNATURE OF CONTROLUNG OFFICEHOLO ER, CANOIDATE, OR STATE MEASU~
FPPC Form 410 (Jan/O1)
FPPC Toll*Free Halpllne: 866/ASK-FPPO
Statement of Organization
Recipient Committee,
INSTRUCTIONS ON REVERSE
STATEMENT OF ORGANIZATION
COMIVal lEE NAME
G~0FF PATNOE FOR Ci~f ODUN~-TT.
1233678
4. Type of Committee COmpleteth~ eppllcablesecflon$.
· List the name of each controlling officeholder, candidate, or state measure proponenL If candidate or officeholder controlled, also list the elective office Bought 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 controlled committee.
· ' ELECTIVE OFFICE BOUGHT OR HELD P~ R'TY
RICT NUMBER IF APPUCABLE) YEAR OF ELECTION
· Mst the'financial Institution where the campaign bank account is located (controlled "candidate election" committees only)
NAME OF RNANC4AL INS1TTUllON I AREA CODF./PHONE I BANK ACCOUNT
ADDRE~ CITY STATE ZIP CODE
~:V.i~.l~.,--~;,],.m,E'~,--,mK'-[~-- P~marlly formed to suppod or oppose specific candidates or measUres In a single election. Ust below:.
CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
*4J,.OT NO. OR tm:, ~ ER) CITY OR COUNTY, AS APPMCABLE) CHECK ONE
FPPC Form 410 (Jan/01)
FPPC Toll-Free Helpline: 866/ASK-FPPC