Semi-Annual Statement of No Activity 7-1-12 to 12-31-12 Semi-Annual Statement of No Activity Type or print in ink Date Stamp STATEMENT OF NO ACTIVITY
. . .
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For use b reci ient committees that have not received an contributions and have not made an ex enditures �� � `� `� `V/
Y P Y Y P D r fficial Use Only
during the six-month period covered by a semi-annual statement. Candidate controlled committees formed for
an elective office may not use this form.
JAN 3 ; 2���3
See the Information Manual on Campaign Disclosure Provisions of the Political Reform Act for additional information and
information required to be provided to you pursuant to the Information Practices Act of 1977.
CUPERTlNO CITY LERK
I.D.NUMBER
1. Committee Information 128747 Treasurer(s)
COMMITTEE NAME NAME OF TREASURER
CONCERNED CITIZENS OF CUPERTINO Marolyn O. Chow
MAILING ADDRESS
21941 Columbus Avenue
STREET ADDRESS(NO P.O.BOX) CITY STATE ZIP CODE AREA CODE/PHONE
20850 Pepper Tree Lane Cupertino CA 95014 408.257.7883
CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER,IF ANY
Cupertino CA 95014 408.255.5175
MAILING ADDRESS�IF DIFFERENT)NO.AND STREET MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE
OPTIONAL: FAX 1 E-MAIL ADDRESS OPTIONAI: FAX/E-MAIL ADDRESS
2. Period of No Activity
No contributions have been received and no expenditures have been made during the period covering the dates below:
Check one of the following boxes and complete the year. ❑January 1, through June 30, 20 0 July 1, through December 31, 20 12
3. Verification
I have used all reasonable diligence in preparing this statement. I have reviewed the statement and�o the best of my knowledge the information contained herein is
true and complete. I certify under penalty of perjury under the laws of the State of California that the'foregoing�ig''true�rr¢ �eet.
f �:� / /�/ ?�° )
January 30, 2013 / /��1�i'1 f �r' � . �`'�_/
Executed on By - ��
DATE SIGNATUR,�F TREASURER/ASSISTANT TREASURER
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FPPC Form 425(Jan/01)
FPPC Toll-Free Helpline: 866/ASK-FPPC
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