460 Recipient Committee Campaign Statement 10-19-14 to 12-24-14 - AmendmentRecipient Committee
Campaign Statement
Cover Page
(Government Code Sections 84200- 84216.5)
fro
m
Type or print in ink.
Statement covers period I Date of election if applicable:
10119/2014 (Month, Day, Year)
SEE INSTRUCTIONS ON REVERSE
through 12/24/2014
1. Type of Recipient Committee: All Committees — Complete Parts t, 2, 3, and 4.
® Officeholder, Candidate Controlled Committee
❑ Primarily Formed Ballot Measure
Q State Candidate Election Committee
Committee
Q Recall
O Controlled
(Also Complete Part 5)
O Sponsored
❑ General Purpose Committee
(Also Complete Part 6)
O Sponsored
❑ Primarily Formed Candidate/
Q Small Contributor Committee
Officeholder Committee
Q Political Party /Central Committee
(AawCompietePaV)
3. Committee information I I.D. NUMBER
1365260
COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTE
Don Stan for Cupertino City Council 2014
STREET ADDRESS (NO P.O. BOX)
4. Verification
COVER PAGE
D� iteeived
JAN 7 - 1 rage 1 of
_j For Official Use Only
11/04/2014 I Processed b
Type of Statement:
❑ Preelection Statement ❑
❑ Semi - annual Statement ❑
❑ Termination Statement ❑
(Also file a Form 410 Termination)
Quarterly Statement
Special Odd -Year Report
Supplemental Preelection
Statement - Attach Form 495
Z Amendment (Explain below)
To amend the "statement period" for the Termination Statement filed
on 12/24/2014
Treasurer(s)
NAME OF TREASURER
Helen Fu
MAILING ADDRESS
NAME OF ASSISTANT TREASURER, IF ANY
MAILING ADDRESS
GITY STATE ZIP CODE AREA CODEIPHONE
OPTIONAL: FAX / E -MAIL ADDRESS
I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein and in the attached schedules is true and complete. I certify
under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Executed on 01/04/2015
Date
Executed on 01/04/2015
Date
Executed on
By
By
By
Signatureof Controlling Officeholder, Candidate, State Measure Proponent
Executed on By Date Signature of ControTng Officeholder, Candidate, State Measure Proponent
fPPC Form 460 (January105)
FPPC Toll -Free Helpline: 8661ASK -FPPC (8661275 -3772)
State of California