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460 Recipient Committee Campaign Statement 10-19-14 to 12-31-14Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200- 84216.5) SEE INSTRUCTIONS ON REVERSE Type or print in ink. Statement covers period from 10/19/2014 through 12/31/2014 1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4. ® Officeholder, Candidate Controlled Committee ❑ Ballot Measure Committee Q State Candidate Election Committee 0 Primarily Formed Q Recall Q Controlled (Also Complete Part 5) O S onsored ❑ General Purpose Committee Q Sponsored Q Small Contributor Committee Q Political PartylCentral Committee p (Also Complete Part 6) ❑ Primarily Formed Candidatel Officeholder Committee (Also Complete Part 7) 3. Committee Information I.D. NUMBER 1370390 COMMITTEE NAME (OR CANDIDATE'S NAME fF NO COMMITTEE) VAIDHYANATHAN FOR CUPERTINO CITY COUNCIL 2014 STREET ADDRESS (NO P.O. aOX) MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODEIPHONE COVER PAGE Date Stamp Date Received Date of election if applicable: II (Month, Day, Year) 7 1:'? 2 2015 Page I of For Official Use On,iy 11/04/2014 Processed by 2. Type of Statement: ❑ Preelection Statement ❑ Quarterly Statement ® Semi - annual Statement E] Special Odd -Year Report ❑ Termination Statement ❑ Supplemental Preelection ❑ Amendment (Explain below) Statement - Attach Form 495 Treasurer(s) NAME OF TREASURER RAMAMURTHY VAIDHYANATHAN MAILING ADDRESS NAME OF ASSISTANT TREASURER, IF ANY CAROLYN KRIZEK- MAHONEY MAILING ADDRESS OPTIONAL: FAX I E -MAIL ADDRESS OPTIONAL: FAX i E -MAIL ADDRESS Savita4CoundI§gmail.com 4. Verification 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. certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. 91, Executed an �-J 0 ! - �� By Date Signature ofTrnasurerorX4zs§ArTeasursr ! / Executed a L7_- - By Date Si o erttro ing Officeholder, Candidate, State Measure Proponent or Resoonsible OfflCgte Snnnsnr Executed on By Date Signature of Controlling Cffimholder, Candidate, State Measure Proponent Executed on Date By SignatureofConirollingOffimircider, Candidate,SlateMeasureProponent FPPC Form 460 (Juneltll} FPPC Toll -Free Helpline: 866/ASK-FPPC State of California Type or print in ink. COVER PAGE - PART 2 Recipient Committee Campaign Statement CALIFORNIA Cover Page — Part 2 FORM MT 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE SAVITA VAIDHYANATHAN OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO. (DR LETTER JURISDICTION ❑ SUPPORT CITY COUNCIL, CUPRRTINO, CA ❑ OPPOSE RESIDENTIALIBUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP Identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT Related Committees Not Included in this Statement: Listany committees not included in this statement that are controlled by you or are primarily formed to receive OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY contributions or make expenditures on behalf of your candidacy. COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? 7. Primarily Formed Committee List names of officeholder(s) or candidate(s) for [7 YES F7 NO which this committee is primarily formed. COMMITTEE ADDRESS STREETADDRESS (NO P.D. BOX) CITY STATE ZIP CODE AREA CODE /PHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) 6. Ballot Measure Committee NAME OF BALLOT MEASURE Page 7/ of NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets if necessary FPPC Form 460 (June/01) FPPC Toil -Free Helpline: 866/ASK-FPPC State of California Campaign Disclosure Statement Summary Page SEE INSTRUCTIONS ON REVERSE NAME OF FILER RAMAMURTHY VAIDHYANATHAN Type or print in ink. Amounts may be rounded to whole dollars. SUMMARY PAGE Statement covers period from 10/19/2014 through 12/31/2014 Page .5 of q Contributions Received $ Column A TOTALTHIS PERIOD (FROMATTACHEDSCHEDULES) Column B CALENDAR YEAR TOTALTODATE 1. Monetary Contributions ............ ............................... Schedule A, Line 3 $ 6,724 $ 23,675 2. Loans Received ....................... ............................... Schedule B Line 3 -3,000 551 3, SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1 + 2 $ 3,724 $ 23,726 4. Nonmonetary Contributions ..... ............................... Schedule C, Line 3 0 0 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3 +4 $ 3,724 $ 23,726 cxpenanures made 6. Payments Made ........................ ............................... Schedule E, Line 4 $ 8,348 $ 23,039 7. Loans Made .............................. ............................... Schedule H, Line 3 0 0 8. SUBTOTAL CASH PAYMENTS ..... ............................... Add Lines 6 + 7 $ 8,348 $ 23,039 9. Accrued Expenses (Unpaid Bills) ............................... schedule F Line 3 -75 0 10, Nonmonetary Adjustment ........... ............................... Schedule C, Line 3 0 0 11. TOTAL EXPENDITURES MADE ............... ..Add Lines e + 9 + 10 $ 8,273 $ 23,039 Current Cash Statement 12. Beginning Cash Balance ....................... Previous summary Page, Line 16 $ 5,310 To calculate Column fi, add 13. Cash Receipts ...................... .. Column A. Line 3 above 3,724 amounts in Column A to the 14. Miscellaneous Increases to Cash ........................... Schedule 1, Linea 0 corresponding amounts from Column B of your last 15. Cash Payments ................... ............................... Column n A, Line s above ,348 report. Some amounts in Column A may be negative 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ 686 figures that should be If this is a termination statement, Line 16 must be zero. subtracted from previous period amounts. If this is the first report being fled 17. LOAN GUARANTEES RECEIVED ........................... Schedule B, Part 2 $ 0 for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if Cash Equivalents and Outstanding Debts 18. Cash Equivalents ......... ............................... See instructions on reverse $ 0 any). 19. Outstanding Debts ......................... Add Line 2 +Line 9 in Column B above $ 51 I.D. NUMBER 1370390 Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 111 through 6130 711 to Date 20. Contributions Received $ $ 21. Expenditures Made $ $ Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made` of Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mmlddlyy) $ �1 I $ $ *Since January 1, 2001. Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (June101) FPPC Toll -Free Helpline: 866/ASK-FPPC Schedule A Type or print in ink. ..__. -_._ __.. � SCHEDULE A nrnuurrr5 may we ruunueu Statement covers Monetary Contributions Received to dollars. period whole 10/19/2014 CALIF ORNIA 460 from FORM 12/31 /2014 r1-If SEE INSTRUCTIONS ON REVERSE through Page r of NAME OF FILER I.D. NUMBER RAMAMURTHY VAIDHYANATHAN 1370390 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED (IFCCMMITTEE, ALSO ENTER I.D. NUMBER) CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE (IF SELF - EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) _ OF BUSINESS) 10/23/2014 Sridhar Prathivadi ®IND ❑COnn Sr. Director, Ops Eng 500 500 21491 Columbus Ave 71 OTH Apple Cupertino, CA 95014 ❑ PTY ❑SCC 10/23/2014 California Real Estate, PAC ❑IND ❑ coM 500 500 525 S. Virgil Ave., k] OTH Los Angeles, CA 90020 [] PTY FPPC ID 890106 ❑scc 11/03/2014 Carolyn Krizek- Mahoney �conn Real Estate Consultant 200 200 10870 Kester Dr. 710TH Cupertino, CA 95014 ❑ PTY ❑SCC 11/03/2014 Jayne Ham R IND Real Estate Investor 200 200 11713 Dorothy Anne Way 710TH Cupertino, CA 95014 ❑ PTY ❑ SCC 11/03/2014 Ken Tersini ®IND ❑COM President 2,500 2,500 11640 Regnart Canyon Dr. ❑ OTH KT Properties p Cupertino, CA 95014 ❑ PTY ❑ SCC SUBTOTAL $ 3,900 Schedule A Summary 1. Amount received this period — contributions of $100 or more. (Include all Schedule A subtotals.) ........ ............................... 2. Amount received this period — unitemized contributions of less than $100_ ........ 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) . ............... $ 91 TOTAL_ $ 6,600 124 6,724 'Contributor Codes IND— Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other PTY — Political Party SCC —Small Contributor Committee FPPC Form 460 (June/01) FPPC Toll -Free Helpline: 866/ASK-FPPC Schedule A (Continuation Sheet) Monetary Contributions Received Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 10/19/2014 SCHEDULE A (CONT.) SUBTOTAL $ 2,700 'Contributor Codes IND - Individual COM - Recipient Committee (other than PTY or SCC) OTH - Other PTY -Political Party SCC - Small Contributor Committee FPPC Form 460 (JunelOt) FPPC Toll -Free Helpline: 866/ASK -FPPC through 12/31/2014 � Page of NAME OF FILER I.D. NUMBER RAMAMURTHY VAIDHYANATHAN 1370390 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER AMOUNT CUMULATIVETO DATE PER ELECTION RECEIVED (IFCOMMITEF,ALSOENTERI.D.NUMGER) CODE* OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) DF IRUSINESS) 11/03/2014 Mark Tersini ®IND ❑coM SVP 2,500 2,500 111 Lasuen Ct. ❑OTH KT Properties Los Gatos, CA 95032 -3900 ❑ PTY ❑SCC 11/03/2014 Simitian for County Central ❑IND 200 200 Committee 2016 ®COM F-1 OTH 726 Greer Road ❑ PTY Palo Alto, CA 94303 ❑SCC ❑IND ❑ COM ❑ OTH ❑ PTY ❑SCC ®IND ❑ COM ❑ OTH ❑ PTY ❑SCC KIND ❑ CONI ❑ OTH ❑ PTY ❑ SCC SUBTOTAL $ 2,700 'Contributor Codes IND - Individual COM - Recipient Committee (other than PTY or SCC) OTH - Other PTY -Political Party SCC - Small Contributor Committee FPPC Form 460 (JunelOt) FPPC Toll -Free Helpline: 866/ASK -FPPC T— .. —i-4 .. :—L, SC:HFI7l N F R- PART 1 oluileuuie C5 — r''ari "l Amounts may be rounded Statement covers period Loans Received to whole dollars. 10/19/2014 _ o oil from SEE INSTRUCTIONS ON REVERSE through 12/31/2014 Page of NAME OF FILER I.D. NUMBER RAMAMURTHY VAIDHYANATHAN 1370390 FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER OUTSTANDING ib) AMOUNT ic) AMOUNTPAID (d) OUTSTANDING [ej INTEREST (f) ORIGINAL (g) CUMULATIVE OF LENDER ( IFCCMMITEE, ALSO ENTER I.D.NUMBER) (IF SELF - EMPLOYED, ENTER BALANCE BEGINNING THIS RECEIVED THIS OR FORGIVEN BALANCE AT CLOSE OF THIS PAID THIS AMOUNT OF CONTRIBUTIONS NAMEOFBUSINESS) PERIOD PERIOD THIS PERIOD' PERIOD PERIOD LOAN TO DATE SAVITA VAIDHYANATHAN COMMUNITY LEADER ❑ PAID CALENDARYEAR 7704 OROGRANDE PL "none" 5 8,000 $ 51 0 3,051 $ 51 CUPERTINO, CA 95014 RATE ❑ FORGIVEN PERELECTION— $ 3,051 $ 5,000 5 $ 0 8/4/2014 $ t® IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED ❑ PAID CALENDARYEAR $ $ % 5 $ ❑ FORGIVEN PER ELECTION ** RATE tEl IND ❑ COM ❑ OTH ❑ PTY ❑ SCC 5 $ $ $ $ DATE DUE DATE ❑ PAID CALENDARYEAR ❑ FORGIVEN PER ELECTION'"" RATE t❑ ❑ COM ❑ OTH ❑ PTY ❑ SCC IND $ $ 5 5 $ DATE DUE DATE INCURRED SUBTOTALS $ 5,000 $ 8,000 $ 51 $ Schedule B Summary 1. Loans received this period .......................................... .. " " ".......................... (Total Column (b) plus unitemized loans less than $100.) 2. Loans paid or forgiven this period ............................... ............................... (Total Column (c) plus loans under $100 paid or forgiven.) (include loans paid by a third party that are also itemized on Schedule A.) 3. Net change this period. (Subtract Line 2 from Line 1.) ............................. Enter the net here and on the Summary Page, Column A, Line 2. ..."" ................. $ ........ .................... " " "........ $ ........................ "" NET $ tcn:er )ej on Schedule E. Line 3) 5,000 8,000 -3,000 (May be a negative number) " Contributor Cosies ND— Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other PTY— Political Party SCC —Small Contributor Committe *Amounts forgiven or paid by another party also must be reported on Schedule A. "* If required. FPPC Form 460 (June /01) FPPC Toll -Free Helpline: 8661ASK -FPPC Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER RAMAMURTHY VAIDHYANATHAN Type or print in ink. Amounts may be rounded to whole dollars, Statement covers period from 10/19/2014 through 12/31/2014 Page ;f- of I.D. NUMBER 1370390 SCHEDULES CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CNP campaign paraphernalia /misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)' OFC office expenses SAL campaign workers' salaries CVC civic donations PET' petition circulating TEL t.v. or cable airtime and production costs FIL candidate €ilinglballot fees PHO phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS staff /spouse travel, lodging, and meals Ili independent expenditure supporting /opposing others (explain)* POS postage, delivery and messenger services TSF transfer between committees of the same candidatelsponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration Lri campaign literature and mailings PRT print ads WEB information technology costs (internet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTERLD NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNTPAID Allegra Printing Printing of mailers Cupertino LIT 4,023.75 Post Master, LISPS Postage of mailers Cupertino POS 3,730.48 Smart & Final, Mary & Homestead, Snacks for volunteers Sunnyvale, CA CNS 141.51 " Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 7,895.74 Schedule E Summary 1. Payments made this period of $100 or more. Include all Schedule E subtotals. $ $,145.74 2. Unitemized payments made this period of under $100 .................... $ 201.81 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).) ................................................ ............................... $ 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6. ........... TOTAL $ 8,347.55 FPPC Form 460 (June/01) FPPC Toll -Free Helpline: 866/ASK-FPPC Schedule E Type or print in ink. (Continuation Sheet) Amounts may be rounded Payments Made to whole dollars. SEE INSTRUCTIONS ON R NAME OF FILER RAMAMURTHY VAIDHYANATHAN Statement covers period from 10/19/2014 SCHEDULE E (CONT.) through 12/31/2014 Page 9 of I I.D. NUMBER 1370390 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CIVP campaign paraphernalia /misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)" OFC office expenses SAL campaign workers' salaries CVC FIL civic donations PET petition circulating TEL t.v. or cable airtime and production costs candidate filingiballot fees PHO phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS staff /spouse travel, lodging, and meals IND independent expenditure supportinglopposing others (explain)` POS postage, delivery and messenger services TSF transfer between committees of the same candidate /sponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration UT campaign literature and mailings PRT print ads WEB information technology costs (internet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER 1 _ NUMBER} Universal Media, San Jose CODE OR DESCRIPTION OF PAYMENT Radio Spots RAD AMOUNT PAID 250.00 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 250.00 FPPC Form 460 (June /01) FPPC Toll -Free Helpline: 8661ASK -FPPC Schedule F Type or print in ink. Amounts may be rounded Accrued Expenses (Unpaid Bills) to whole dollars. SEE INSTRUCTIONS ON REVERSE NAME OF FILER Statement covers period from 10/19/2014 through 12/31/2014 SCHEDULE F Page A— of i I.D. NUMBER RAMAMURTHY VAIDHYANATHAN 1370390 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CI MP campaign paraphernalialmisc. MBR member communications RAID radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTS contribution (explain nonmonetery)* OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL t.v. or cable airtime and production costs FIL candidate filing /ballot fees PHO phone banks TRC candidate travel, lodging, and meals FIND fundraising events POL polling and survey research TRS staff /spouse travel, lodging, and meals ND independent expenditure supportinglopposing others (explain;)' POS postage, delivery and messenger services TSF transfer between committees of the same candidate /sponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs (internet. e-mail) NAME AND ADDRESS OF CREDITOR (IE COMMITTEE, ALSO ENTER I.C. NUMBER) CODE OR DESCRIPTION OF PAYMENT (a) OUTSTANDING (b) AMOUNT INCURRED (c) AMOUNTPAID (d) OUTSTANDING BALANCE BLGINNING THIS PERIOD THIS PERIOD BALANCE AT CLOSE OF THIS PERIOD (ALSO REPORT ON E) OF THIS PERIOD Laurie Stapleton PO Box 700058 PRT San .lose, CA 95170 75.00 0 75.00 0.00 rayments that are contributions or independent expenditures must also be summarized on Schedule D. gDgTpAI -5 $ 75,00 $ 0 $ 75,00 $ 0.00 Schedule F Summary 1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for accrued expenses of $100 or more, plus total unitemized accrued expenses under $ 100 .) ........................... 2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on accrued expenses of $100 or more, plus total unitemized payments on accrued expenses under $100.) ........... 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and onthe Summary Page, Column A, Line 9.) ........................................................................... ............................... INCURRED TOTALS $ PAID TOTALS $ M 75.00 .......... NET $ -75.00 May be a negative number FPPC Form 460 {June /01) FPPC Toll -Free Helpline: 866/ASK-FPPC