410 Amendment (state stamped)
STATEMENT OF ORGANIZATION
4'~
Statement of Organization
9.ecipient Committee
EIVEÓa7;"!im FILE
office of the Secretary of Sta'
of the State of Callfomi,
RE
¡nth
o Termination - See Part S
List 1.0. number:
Type or print In Ink
00 Amendment
List I.D. number:
o
Not yet qualified
Initial
Statement Type
2005
o
JUL 1 8 2005
sltUCE McPHER
I Secretary of St:
#
.--I I
Date of Termination
1237120
08 I 15 I 2001
Date qualified as committee
(If applicable)
#
or
.--I /
Date qualified as committee
o
AREA CODElPHONE
ZIP CODE
95014
Principal Offi
STATE
Ca
STREET ADDRESS
10222 Camnen Road
CITY
Cupertino
NAME OF ASSISTANT TREASURER, IF ANY
2. Treasurer and Other
NAME OF TREASURER
Claudia Chang
AREA CODE/PHONE
408 257-4934
ZIP CODe
95014
STATE
Ca
Committee Information
NAME OF COMMITTEE
Re-Elect Mayor Patrick Kwok
10222 Carmen Road
CITY
Cupertino
MAILING ADDRESS (IF DIFFERENT)
STREET ADDRESS (NO P.O. BOX)
1
STREET ADDRESS
AREA CODE/PHONE
ZIP CODE
STATE
CITY
E-MAIL ADDRESS
FAX
OPTIONAL,
NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE
PatrickSKwok@aol.com
COUNTY OF DOMICILE
COUNTY V'vHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
MAILING ADDRESS
AREA CODElPHONE
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
OATE
07-07-2005
5'ÄTE
sheets.
Attach additional infonnation on appropriately labeled continuation
3
penalty of
certify under
herein is true and complete.
OR ASSISTANT TREASURER
the information contained
By
Executed on
OR STATE MEASURE PROPONENT
SIG,
By
Executed on
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
By
OATE
Executed on
CONTROLLING ÖFFICEHOLDER, CANDIDATE, ORSTÃTE MEASURE PRopoNENT
FPPC Form 410 (January/OS)
FPPC TolI·Free Helplina: 866/ASK·FPPC (866/275-3772)
SIGNATURE OF
By
OATE
Executed on
.D. NUMBER
1237120
If candidate or officeholder controlled, also list the elective office sought or hel~, and
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
Re-Elect Mayor Patrick Kwok
4. Type of Committee Complete the applicable sections.
Controlled CommIttee
· List the name of each controlling officeholder, candidate, or state measure proponent.
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 controlled committee,
·
·
list the name and identification number of the other controlled committee.
jointly with another
ELECTIVE OFFICE
00 Non-Partisan
Patrick Kwok Cupertino City Council 2005
o Non-Partisan
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PRO¡
located (controlled "candidate election" committees only)
BANK ACCOUNT NUMBER
01852194364
-
STATE ZIP CODE
Ca 95014
AREA CODE/PHONE
408 255-6330
CITY
Cupertino
n where the campaign bank account is
NAME OF FINANCIAL INSTITUTION
Washington Mutual
ADDRESS
20573 Stevens Creek Blvd
below:
measures in a single election. List
Primarily formed to support or oppose specific candidates or
CA
....n~....'" vn~
I ¡-¡-
SUPPORT OPPOSE
CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDe BALLO·
FPPC Fonn 410 (January/aS)
FPPC TolI-Frae Helpline: 8661ASK-FPPC (866/275-3772)