410 Initial
Statemen f Organization
Recipient Committee )-L ~
. 0~
Type or print in Ink 1;2 ~ 1'-1 7 I
STATEMENT OF ORG'
Il,TION
Statement Type
~Initial
Not yet qualified 0 or
o Amendment
List 1.0. number;
RE
in th
o Termination - See Part 5
List 1.0. number:
Dale Stamp
EIVED AND FILE
office of the Secretary of Sta
of the State of California
CALIFORNIA 41 0
FORM
For Official Use Only
/ I
Date qualified as committee
I I
Date qualified as committee
(~ applicable)
J I
Date of Termination
JUN 2 0 2006
CE McPHERSO
ecretary of State
2. Treasurer and Other Principal Officers
B
#
#
1. Committee Information
NAME OF COMMITTEE
CONCERNED CITIZENS OF CUPERTINO
20850 Pepper Tree Lane
CITY
STATE
ZIP CODE
AREA CODE/PHONE
NAME OF TREASURER
Marolyn O. Chow
STREET ADDRESS
21941 Columbus Avenue
CITY
Cupertino
NAME OF ASSISTANT TREASURER, IF ANY
STATE
CA
ZIP CODE
95014
AREA CODE/PHONE
408.257.7883
STREET ADDRESS (NO P.O. BOX)
Cupertino
MAILING ADDRESS (IF DIFFERENT)
PO Box 1466, Cupertino, CA 95015.1466
CA
95014
408.255.5175
STREET ADDRESS
CITY
STATE
ZIP CODE
AREA CODE/PHONE
OPTIONAL: FAX I E-MAIL ADDRESS
COUNTY OF DOMICILE
COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
NAME AND POSITION OF OTHER PRINCIPAL OFf1CER(S), IF APPLICABLE
;C:dtutLfd J. 641/7
MAILING ADDRESS
tRCJR'S-O ,t?~f'r." 7tZt€ ~i
CITY STATE ZIP CODE AREA CODE/PHONE
vI- 5715
Santa Clara County
Attach additional information on appropriately labeled continuation sheets.
3. Verification
I have used all reasonable diligence in preparing this statement and to the best of my knowl,
perjury under the laws of the State of California that the foregoing is true and correct.
Executed on June 17, 2006 By
DATE
Executed on June 17, 2006 By
DATE
Executed on By
DATE
Executed on By
DATE
. is true and complete. I certify under penalty of
LING FFICEHOLDER, CANDIDATE. OR STATE MEASURE PROPONENT
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE. OR STATE MEASURE PROPONENT
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANOIOATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (January/OS)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)