410 Termination 12-31-2009 tatement of Organization
Recipient Committee
Statement Type 0 Initial
Not yet qualified ~ or
Type or print in ink
Q Amendment
List LD. number:
a
_~_ J 1999
Date qualified as committee
1. Committee Information
-J-J
Date qualified as committee
(Nepplicable)
® Termination -See Palt 5
List I.D. number:
#sso787
12 1 31 12009
Date of Termination
NAME OF COMMITTEE
Dolly Sandoval for Supervisor-Debt Retirement Committee
STREETADDRESS (NO P.O. BOX)
10720 Alderbrook Lane
CITY STATE ZIPCODE AREACODEIPHONE
Cupertino
CA 95014 408-725.8939
MAIIINGADDRESS (IF DIFFERENT)
OPTIONAL: FAXIE•MAILADDRESS
2, Treasurer and
STATEMENT OF ORGANIZATION
Date Stamp
I
I~~~'I_~II~~ ~~
For
FEB -1 2010
UPERTINO CITY CLE K
Principal Officers
NAME OF TREASURER
Ms. Dolly Sandoval
STREETADDRESS (NOP.O.BOX)
10720 Alderbrook Lane
CITY STATE ZIP CODE AREACODEIPHONE
Cupertino CA 95014 408.725.8939
NAME OF ASSISTANT TREASURER, IFANY
STREETADDRESS(NO PO.BOX)
CITY STATE ZIP CODE AREACODEIPHONE
NAME OF PRINCIPAL OFFICER(S)
COUNTY
COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT
THAN COUNTY OF DOMICILE STREETADDRESS (NO P.O. BOX)
Attach additional information on appropriately labeled continuation sheets.
CITY STATE ZIP CODE AREACODEIPHONE
3. Verification
I have used all reasonable diligence in preparing this statement and to the best of my knowledge the inforrtt~on contained herein is true and complete.
perjury under the laws of the State of California that the foregoing is true and correct. 1 ~ ,(~
'~1 L ~ ,Jk--K
Executed on gy
Executed on ~ ~ 2 ~ l ~~ ~ ~
Executed on
DATE
Executed on
DATE
By
I certify under penalty of
By
IGN TU N R LLIN F I H LDER, AN IDAT , R TA E M U RO NE
FPPC Forth 410 (June109)
FPPC Toll•Free Helpline: B661ASK•FPPC (8661275.3772)
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT