410 Amendment ~en>~Alnt of Organization
1lcipient Committee
Ittement Typs ^ Initial
Not yet qualified ^ or
/ /
Date quaNied as oarwnigee
Type or print M Ink
Q Amendment
Llet I.D. number:
fj 1299673
10/Z /2007
DEIts quaWied es cornntillee
p ~pple~bN)
^ Termination -See Part 5 '~ ~~.
LIst1.D. number: ' ~~ r~
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5"1~17BtlENT DF OROANQATtON
UNOnIr
Committee Information 2. Treasurer and Other Principal Officers
NAME OF COMMITTEE NAME OF TREASURER
Cupertino Chamber PAC (Sponsored by Cupertino Chamber of Commerce)
STREET ADDRESS (NO PO. SOX)
20455 Silverado Avenue
CITY STATE ZIP CODE AREA CODE/PHONE
Cupertino, CA 95014
408-Z5Z-7054
MAIUNO ADDRESS (IF DIFFERENT)
OrT10NAL: FAX / E-MAIL ADDRE93
408-Z5Z-0638
COUNTY OF DOMICILE ~ COUNTY WHERE COMMITTEE tS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE
Santa Clara Count
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Bob Adams
STREET ADDRESS
20455 Silverdo Avenue
CITY STATE ZIP CODE AREA CODElf+HONE
Cupertino, CA 95014 408-252-7054
NAME OF ASSISTANTTREASURER, IF ANY
STREET ADDRESS
CITY SA4TE 21P000E AREACODEfPHONE
NAMEAND POSITION OF OTHER PRINCIFAL OFFICER(S), IFAPPUCABLE
Bob Adams -President
MAIUNCi ADDRESS
11669 Olive Spring Court
CITY BTATE ZIP CODE AREACODE/PHONE
Cupertino, CA 95014 408-257-4137
Verification
I have used aU reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is true and complete.
perjury under the laws of the State of Cali~mia that the foregoing is true and correct.
F~re~uledon ~-~~~x~~ ~r ~ Cf,
''~ ~~~~j n 8K4NRURE OF TREASURER OR TREASURER
Exepr6ed On ~ ~ /2 ! ~ 1 ~ ~ ~~ l/L i _ s' ° '_.~_....._ _'°°. •° --- ---•--- -- ---- ----• •--
~~ ~ DATE
8KiNA1XtE Of CONTROLLMI(3 OFFICEHOLDER, CANDIDRE, OR 8714E PROPONENT
Exeglted Ofi By
DATE
1 certify under penalty of
FPPC Form 410 ~JunNOe)
www.rret!lfe.can
FPPC Toitlfr+e~ fNlplh»: tNQiAaKfPPC
tatement of Organization STATEMENT OF ORGANIZATION
Zecipient Committee ~ • - ~ , ~
•-
~STRUCTIONS ON REVERSE
2 of 4
:OMMITTEE NAME
I.D. NUMBER
Cupertino Chamber PAC (Sponsored by Cupertino Chamber of Commerce)
1299673
'a. Additional Officers
NAMEAND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE NAMEAND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE
Nick Amman - VP
MAILING ADDRESS MAILING ADDRESS
1 Infinite Loop
CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE
Cupertino, CA 95014
NAMEAND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE NAMEAND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE
Lynn Ching - VP
MAILING ADDRESS MAILING ADDRESS
10025 Tantau Avenue
CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE
Cupertino, CA 95014 408-205-5868
NAMEAND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE NAMEAND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE
MAILING ADDRESS MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE
NAMEAND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE NAMEAND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE
MAILING ADDRESS MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE
FPPC Form 410 (June/09)
FPPC Toll-Free Helpline: 866/ASK-FPPC
www.neKile.com
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
OMMITTEE NAME
Cupertino Chamber PAC (Sponsored by Cupertino Chamber of Commerce)
I.D. NUMBER
1299673
4. Type of COnlmlttee Complete the applicable sections.
• List the name of each controlling officeholder, candidate, or state measure proponent. If candidate or officeholder controlled, also list the elective office sought 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.
• List the financial institution where the campaign bank account is located (controlled "candidate election" committees only)
AREA CODE/PHONE
NU
NAME OF FINANCIAL INSTITUTION
ADDRESS
CITY
STATE ZIP CODE
• , Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHTOR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE
OPPOSE
FPPC Form 410 (June109)
FPPC Toll-Free Helpline: 8681ASK-FPPC
www.netfile.com
ELECTIVE OFFICE SOUGHT OR HELD
NAME OF CANDIDPIEIOFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
tatement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME I.D. NUMBER
Cupertino Chamber PAC (Sponsored by Cupertino Chamber of Commerce)
1299673
4. Type of Committee (Continued)
• • Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
^x CITYCommittee ^ COUNTYCommittee ^ STATECommittee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
To support city of Cupertino candidates
• • - • • List additional sponsors on an attachment.
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR
Cupertino Chamber of Commerce Chamber of Commerce
STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE
20455 Silverado Avenue
Cupertino, CA 95014
• • • •
^ ~_J Check box and provide the date this committee qualified as a small contributor committee. If the committee qualified as a small
Datequalified contributorcommittee onJanuary 1, 2001, enter 1/1/01.
rJ.Termlrlatlorl ReC~UlrementS By signing the verification, the treasurer, assistanttreasurerand/orcandidate,officeholder, orproponentcertifythatallofthefollowingconditionshavebeenmet:
• This committee has ceased to receive contributions and make expenditures;
• This committee does not anticipate receiving contributions or making expenditures in the future;
• This committee has eliminated or has no intention or ability to discharge all debts, loans received, and other obligations;
• This committee has no surplus funds; and
• This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions.
-- There are restrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. Refer to
Government Code Section 89519.
-- Additional filing obligations will be incurred if, after terminating, the committee receives or spends any funds, or receives the forgiveness of a loan,
repayments of loans made to others, or any other receipts.
FPPC Form 410 (Junel09)
www.netfile.com FPPC Toll-Free Helpline: 886/ASK-FPPC