Loading...
410 Statement of Organization Recipient Committee - Initial not yet qualified Stamped by SOSU3 Statement of Organization Recipient Committee Statement Type ® Initial Not yet qualified ® or %Fr �3�Ib�15 ❑ Amendment List I.D. number: ❑ Termination — See Part 5 List I.D. number: /---t - /-/ --/ / Date qualified as committee Date qualified as committee Date of Termination (If applicable) +.. wmMIUM IFIT0rmanon 2. NAME OF COMMITTEE Committee supporting Cupertino Citizens' S"'5'ble. Crroah -, j')'t7-af7'V STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE Cupertino CA 95014 MAILING ADDRESS (IF DIFFERENT) Cupertino, CA 95015 - FAX / E -MAIL ADDRESS COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE 15 ACTIVE Santa Clara Cupertino, CA Attach additional information on appropriately labeled continuation sheets. Date Stamp Rf CEIVED AND FILE in a office of the Secretary of St. of the State of California DEC .16 2015 JAN 1 1 2016 Treasurer and Other Principal Officers � RK NAME OF TREASURER Xiaowen Wang STREET ADDRESS (NO P.O. BOX) I'll STATE ZIP CODE AREA CODE /PHONE Cupertino CA 95014 NAME OF ASSISTANT TREASURER, IF ANY STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE NAME OF PRINCIPAL OFFICER(S) Xiangchen Xu STREET ADDRESS (NO P.O. BOX) I'll STATE ZIP CODE AREA CODE /PHONE Cupertino CA 95014 ..::,Vert cation 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 of California that the foregoing is true and correct. Executed on 12 / U- J 7 V (J OR STATE MEASURE PROPONENT Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT Executed on DATE By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410(Dec /2012) FPPC Advice: adviceLWfppc.ca.gov (866/275 -3772) www.fppc.ca.gov Statement of Organization CALIFORNIA Recipient Committee . 4V IT 4 INSTRUCTIONS ON REVERSE Page 2 COMMITTEE NAME I.D. NUMBER Committee supporting Cupertino Citizens' S'ell[5�pe- Crow-r, /M fiiYf -)L)e • All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION AREA CODE /PHONE BANK ACCOUNT NUMBER pending ID # ADDRESS 4. Type of Committee' Complete the applicable sections Controlled Committee Wkh'l STATE ZIP CODE • 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. NAME OF CANDIDATE /OFFICEHOLDER /STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY Primarily Formed Committee Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATES) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) ,�/ Cupertino Citizens' �5; j71e C7)j;JL✓ 1 �1 �n%�xNi`(� ? Cupertino, CA SUPPORT P/ OPPOSE El SUPPOR l OL1 FPPC Form 410 (Dec /2012) FPPC Advice: advice@fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE Page 3 COMMITTEE NAME I.D. NUMBER Committee supporting Cupertino Citizens' Se�r5;ble ( =ruwth Ini-ill-;at,oe 4. Type of Committee (continued) General Purpose Committee Not formed to support or oppose specific candidates or measures in a single election. Check only one box: ❑ CITY Committee ❑ 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 STREETADDRESS NO. AND STREET CITY STATE ZIP CODE Small • • r Committee li ❑ Date qualified S Termina1tion Requiremerft Sy signing the verification, the treasurer, assistant treasurer and /or candidate, officeholder, or proponent certify that all of the foNoWng conditions have been met: • 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 office and 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.g0v