410 Amendment (reassign)
STATEMENT OF ORGANIZATION
Type or print in ink
Statement of Organization
Recipient Committee
2005
II
8
~LE
1
JUL
I
o Termination - See Pa
List I.D. number:
00 Amendment
List 1.0. number:
o
o
Not yet qualified
Initial
Statement Type
or
CuþERTINO CITY CLER'
#
--1 I
Date of Termination
1237120
~ 15 ,2001
Date qualified as committee
(If applicable)
#
--1 ,
Date qualified as committee
2. Treasurer and Other Principal Officers
NAME OF TREASURER
Committee Information
NAME OF COMMITTEE
Patrick Kwok
1
-,
L-
Claudia Chang
STREET ADDRESS
10222 Carmen Road
CITY
Re-Elect Mayor
liP CODE
95014
STATE
Ca
Cupertino
NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS (NO P.O. BOX)
10222 Carmen Road
CITY
AREA CODElPHONE
408 257-4934
liP CODE
95014
STATE
Ca
Cupertino
MAILING ADDRESS (IF DIFFERENT)
STREET ADDRESS
AREA CODE/PHONE
ZIP CODE
STATE
CITY
E-MAIL ADDRESS
FAX
OPTIONAL:
NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE
COUNTY V\lHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
PatrickSKwok@aol.com
COUNTY OF DOMICilE
MAILING ADDRESS
AREA CODE/PHONE
ZIP CODE
STATE
CITY
Santa Clara
Verification
I have used all reasonable diligence in preparing this statement and to the best of my knowledge
pe~ury under the laws of the State of California that the foregoing is true and correct.
07-07-2005
DATE
07-07-2005
i5ÃTE
certify under penalty of
Attach additional infonnation on appropriately labeled continuation sheets.
3
contained herein is true and complete.
OR ASSISTANT TREASURER
the information
By
Executed on
OR STATE MEASURE PROPONENT
SIG
By
Executed on
SIGNATURE OF CONTROLLING OFFICEHOLDER CANDIDATE, OR STATE MEASURE PROPONENT
By
DATE
Executed on
SIGNATURE DF CONTROLLING OFFICEHOLDER. CANDIDATE, OR STATE MEASURE PRopoNENT
FPPC Form 410 (January/05)
FPPC Toll-Free Helpline: 866/ASK-FPPC (8661275-3772)
By
DATE
Executed on
D. NUMBER
1237120
list the elective office sought or held, and
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
Re-Elect Mayor Patrick Kwok
4. Type of Committee Complete the applicable sections.
candidate or officeholder controlled, also
If
state measure proponent.
List the name of each controlling officeholder, candidate, or
district number, if any, and the year of the election.
List the political
·
is affiliated or check "non-partisan.
candidate
controlled committee,
party with which each officeholder or
f this committee acts jointly with another
·
·
list the name and identification number of the other controiled committee.
I''U;; '' I \IN....LUUC Uli) I 1'\1....1 I",-,mc"'''''· nrr..''-''''..........J
iii Non·Partisan
Patrick Kwok Cupertino City Council 2005
o Non·Partisan
List the financial institution where the campaign bank account is located (controlled "candidate election" committees only)
. I
candidate election" committees only)
oiled
NAME OF CANDIDATE/OFFICEHOLDER/S
BANK ACCOUNT NUMBER
01852194364
-
STATE ZIP CODE
95014
Ca
AREA CODE/PHONE
408 255-6330
CITY
Cupertino
NAME OF FINANCIAL INSTITUTION
Washington Mutual
ADDRESS
20573 Stevens Creek Blvd
-
. Primarily formed
·
below:
I "_""",, "",--" ,,_._--~ I ~.;;-r;;.o.,
SUPPORT OppOSE
to support or oppose specific candidates or measures in a single election. Lis
CANDIDATE(S) NAME OR MEASURE(S) FULL TIT!
FPPC Form 410 (January/OS)
FPPC TolI-Fr.. Helpline: 866/ASK-FPPC (866/275-3772)