410 Termination tatement of Organization STATEMENT OF ORGANIZATION
Recipient Committee Ty., o~ print in Ink - Date Se~mo
Statement Type E] Initial [] Amendment g'l Termination - See Part 5 For o~d u~e o~y
Notyetqualified [] o~ UMI.D. numbec L;a-tI.D, number. /
! .I i i 121 3~ I 2001
Datequaliliedascammittee Datequalifiedascommittee Datec~Terminatian CUP£RTINO GII~ GL -5~K
(i/NMMoM)
1. Committee Information 2. Treasurer :~nd Other Principal Officers
$~EET ~X;RE~S
1083 SHADY D~r.~.
10720 ATDEI~H~OOK LANE CAMPBR~.T? CA 95008 (408) 377-3570
CUPErtinO CA 95014 (408) 725-8939 ED I~)FFMAN
, $1RE~ ADD~
MNUNG AOOR~S~ (IF OIFFERENT)
10720 ALDERBROOK LANE
125 SOUI~ MARKET ST., STE. 1160, SAN JOSE, CA 95113 oM sxa~ ZIPOOOE AREArX)Dr~ON£
O~nO~U FaXlE-~L~SS (~JPERTINO CA 95014 (408)725-8939
NAMI= AND POSmON OF OTHER ~Rll~Dl~ OPFICER($~ IF A/~UCABLE
COUNTY OF DOMICILE COUNTY WHERE COMMI I I I=E IS AC~VE IF DIFFERENT
SANTA CLARA C0UNTY
CITY STARE ZIP CODE AREA CODE/PHONE
3. Verification
! have used ali reasmmble diligence in preparing this statement and to the best of my knowledge the infonnatk~ contained herein is true and comp]ete, i cer'dfy under pena~ of
Executed anPerjury under the //laws .of~o/,~t~O/'the S)ate of California that the foregoing is tmeByand correct. ~ ,~.~
FPPC Form 410 (Jard01)
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