410 Statement of Organization Recipient Committee -Amendment ' Statement of Organization DateStamp � � . �
Recipient Committee , �
• -
StatementType ❑�nitlal � Am�ndment ❑ Termination—SeePartS ����91f`�� ���'v�� '�'��,,,�,�
Not ye1 qualified ❑ or
List I.D.number: List I.D.number: in the��ffce of the Secr�tary of S�te For Official Use Only
1299673 ��f ihe State of California
# # �UV 14 20�6
--� i i--✓ i--�
Date qualified as committee Date qualified as committee Date of Termination
�!f applicable)
1. Committee Information - 2'. Treasurer and Otn�r Princfpal Officers �
NAME OF COMMITTEE . :..�.��. �:.-. � .:- ... :... — .. � .� � - � . .
NAME OF TREASURER � � � - � � - ��
Cupertino Chamber PAC Andrew Walters
STREET ADDRESS(NO P.O.BOX) STREET ADDRESS(NO P.O.BOX) '
CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE
MAILING ADDRE55(IF DIFFERENT) NAME OF ASSISTANT TREASUflER,If�NY •
fAX/E-MAIL ADDRE55 �
STREET ADDRESS�NO P.O.BO%) •
COUNTY OF DOMICILE IIURISDICTION WHERE COMMITTEE IS ACTIVE CITY STATE ZIV CODE AREA CODE/PHONE
NAME OF PRINCIPALOFFICER(S) '
Richard Abdalah
Attach additional information on appropriateJy Iabe/ed continuation sheers. sTReernooaessir,o P.o.eox� •
CITY STATE ZIP CODE AREA CODE/PHONE
3.: Verificat�on ;
:
I have used all reasonable diligence in preparing this s me e be fxaa. -
y-k� dge the informaticn contained herein is true and complete. I certify under
penalty of perjury under the laws of the State of C ' rn' hat t o ' true and correct.
Executed on �� � L/ ���,� gY ,-.
DATE r" NAT EOFTRE �AN7TREASURERI
Executed on j� I �/ � � IC/ By l ���y��,��-- �,/�
DATE � � (�/` I �
SIGNATURE Of CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE��TE�SR7RE PROPONENT �
Executed on g� I
DATE SIGNATURE OF CONTROILING OFFICEHOLDER,CANDIDATE,OR STATE ME.,SURE PROPONENT �
Executed on gY
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MNSURE PROPONENT �
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 2
COMMITTEE NAME �
1 D NUMBER
Cupertino Chamber PAC 1299673
• All committees must list the financial institution where the campaign bank account is located.
NAM[ OF FINANCIAL INSTITUTION AREA CODE/PHONE B 'NK ACCOUNT NUMBER
Bank of the West I �
AODRE55 CITY 5T TE ZIP CODE
4. Type of Committee Complete the applicable sections.
. . .
• 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
ciistrict 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 joint�y with another controlled committee, list the name and identification number of t�e other controlled committee.
ELECTIVE OFFICE SOUGHT OR HELD
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE D�STRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
I ❑ Nonpartlsan
II ❑ NonparHsan
� � � Primarily formed to support or oppose specific candidates or measures in a si igle election. List below:
CANDIDATE(5)NAME OR MEASURE(5)FULL TITLE(INCLUDE BAILOT N0.OR LETTER) CANDIDATE(5)OFFICE SOUGHT OR HELD OR MEASURE(5)JURISDICTION
(INCIUDE DISTRICT N�).,CITY OR COUNTY,AS APPLICABLE) cHECK ONE
ISUPPORT OPPOSE
I � ❑
5 u o�.J
FPPC Form 410(Dec/2012)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
i
i
Statement of Organization i � • • �
Recipient Committee i • - � �
INSTRUCTIONS ON REVERSE �
I Page 3
COMMITTEE NAME - I I.D.NUMBER
Cupertino Chamber PAC I 1299673
4:Type of Commitkee cco�n��ed� :
, ;,. . _ _ :
�
�
• • ' �• • • Not formed to support or oppose specific candidates or measures in a single eli ction. Check only one box:
0✓ CITY Committee ❑ COUNTY Committee❑ STATE Committee �
�
PROVIDE BRIEF DESCRIP710N OF ACTIVITY I
To support Iocal and statewide candidates and measures �
i
• . •• . List additional sponsors on an attachment. �
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR
Cupertino Chamber of Commerce Chamber of Commerce
STREET ADDRE55 NO.AND STREET CITY ( STATE ZIP CODE
20455 Silverado Ave Cupertino i Ca 95014
. . ,
i
�--/ /
Da[e quallfied
5.Terminafian Requirements By si�ning the verification,the treasurer,assistant treasurer and/or candldate,officeholder,c�r proponent certify that all of the following conditions have been met;
• This committee has ceased to receive contributions and make expenditures;
• ?his 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 reportab e transactions.
-- There are restrictions on the disposition of surplus campaign funds held by elected officers who are leavirig 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 purpo ses 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