410 Statement of Organization Recipient Committee – Termination a
Statement of Organization Date Stamp
CALIFORNIA �"-
Recipient Committee — u U FORM 47r0A NI
Statement Type ❑ Initial 0 Amendment p Termination—See Part 5 Q For officialUse Only
Not yet qualified ❑ or
List l.D.number: List l.D.number:
# # /3.2 /S oS" FEB 1 6 2016
o .,- l?- .2-016
Date qualified as committee Date qualified as committee Date of Termination CUPERTINO CITY C LE•K
(Il applicable)
IACommittee lnformatton ;EZ ,;.S•Rt 5a ;,„,Z ti ',,.,. ;';';; ,:, ,,,, 2 I Treasureiloici tWSPrineipalaOfficers ',. :;;,
NAME OF COMMITTEE R...........v • .x~��" NAME OF TREASURER ^M d5,77: ,
Skil/2- crr4i54 -PPR z CotcCi �
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STREET ADDRESS(NO P.O.BOX) STREETADDRESS(NO P.O.BOX)
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/`��CIITYY'//"�
FAX/E-MAIL ADDRESS STREET ADDRESS(NO P.O.BOX)
barn, 4 c..R-(s=R7z4o @ ;y lNu.✓.e ,.
COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE CITY STATE ZIP CODE AREA CODE/PHONE
5A-iJ rA c I AR €f Ci-r/ Dr cup6-R r2- x1 o
NAME OF PRINCIPAL OFFICER(5)
84,a.ay ‘44,4-A[62STREET ADORE 5(NO P.O.BOX)
Attach additional information on appropriately labeled continuation sheets.
/
CITY STATE ZIP CODE AREA CODE/PHONE ,
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3 Venficatlon r r ..,J t � 1 >. I' t �fi � 5� C�t'C hr -+:r' s Ja '# 't1 y� � .. x:<ar' t✓�' ^i' is : �.`1e ,,�
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I have used all reasonable diligence in preparing this statement and to 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
-
DATE 51G. 7. OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
Executed on By VVV v
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CAN DIDATE,ORSTATEMEASURE PROPONENT •
Executed on - By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
FPPC Form 410(Dec/2012)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
Statement of Organization CALIFORNIATP,
A
Recipient Committee FORM ' 4.'I;.'
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME 1.0.NUMBER
. 1 ,A z RY cw,A,i% Fop, ctc c1eff-c 13 y Lear
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER
/3AAI K o P ifi (&grafi .
ADDRESS CITY STATE ZIP CODE
- cu-p6-2Tzi10 CA 9.-1)/41
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lab elfiC m ttee .-Ri teathe1appllcablesections ' I�' r ' ''ffin "x_ tutezut!: 'gc4,,�.,� w_,., v :n
controlled Committee •
• 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"nonpartisan:'
• If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee.
ELECTIVE OFFICE SOUGHT 0R HELD
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
Nonpartisan
GA-22.Jai atria 7CA/0 c rty otocrc/_ 2-0/eV
0 Nonpartisan
,Primarily Formed Committee Primarily formed to support or oppose specific candidates or measures in a single election. List below: .
CANDIDATE(S)OFFICE SOUGHT OR HELD OR MEASURE(S)JURISDICTION
CANDIDATE(S)NAME OR MEASURE(S)FULL TITLE(INCLUDE BALLOT NO.OR LETTER)
(INCLUDE DISTRICT NO.,CITY OR COUNTY,AS APPLICABLE) CHECK ONE
SUPPORT OPPOSE
n n
SUPPORT OPPOSE
FPPC Form 410(Dec/2012)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
Statement of Organization CALIFORNIA #
Recipient Committee FORM 41 0
INSTRUCTIONS ON REVERSE
Page 3
COMMITTEE NAME
I.D.NUMBER
1 3 Zt `pr
cgeFof` n.gttee i �R+'CORhnued s:P tt r gfi<TCySy*p w .�wv s. {xr 7
xS.yp.�.w�...mw....e_.o-.n,.,...,,.a�+,�.n�..aei ..vrl�:€��swu.'.,�. ,�':.��e,,..•�'�rw,nG„f...."'x..J.-a.Y„..1„2..t,' s2 at:�:.,.K�..:s,.a�„u@1»ax '+ $;�:,>�� d k+n ..i n, *rr° ret yre^4'r.;,z n.�,:t`,r„z n xl ¢='�'r-ro-+`"y`C nr ,.
' ..W..,, A ,�>r.>...-„..:.'Fba,,.aw_.4 h�.::.P.w,t..,�,. r,.r�M.......•.n c�.'x's.�.. ,; ... ..
General Purpose Committee Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
0 CITY Committee 0 COUNTY Committee❑ STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
Sponsored Committee List additional sponsors on an attachment.
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREET ADDRESS NO.AND STREET CITY STATE ZIP CODE
•
Small Contributor Committee ' -/-/
Date qualified .
•
5:Terrninatton`Re wrement�5�' =,,„�By.'s..,ign-;ingth�e�verficahon�e�reasurer assistant treasure and/Dyr�ca�ndida a Dffictehyolde�rs,`a�p�oponen�`t°c_ertT`y tha[a�Il oPthe'fDllowiog mndleons have been'mef ”'
• 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 officeand by defeated candidates. Refer to Government
Code Section 89519.
-- Leftover funds of ballot measure committees may be used for political,legislative or governmental purposes under Government Code Sections 89511-89518,and are
subject to Elections Code Section 18680 and FPPC Regulation 18521.5.
FPPC Form 410(Dec/2012)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov'