410 Statement of Organization Recipient Committee – Amendment 2Statement of Organization
Recipient Committee
Statement Type ❑ Initial �]x Amendment
Not yet qualified ❑ or List I.D. number.
# 1376937
0 Termination — See Part 8
List LD, number
4E
I �, C� I �; �v/
FEB - 1 2018
1 8 _33 1 2015 1 I T. 01 1
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Datequalifled as committee Da qualified as committee Date afTerminaiion U, I L; : > I r . sY r
(If aPPIIr be)
1. Committee Information 2. Treasurer and Other Principal Officers
NAME OF COMMITTEE NAME OF TREASUREP.
Barry Chang for Assembly' 2016 Barry Chang
STREET ADDRESS (NO P.O_ BOX) STREET ARRRESS (NO P.O. BOX)
CFy STATE ZIP CODE AREACODEIPHONE
MAIL;NG ADDRESS (IF DIFFERENT)
FAX/ E-MAIL ADDRESS
COUNTY OF DOMICILE JUR€SDICTION WHERE COMWI TTEE IS ACTIVE
Santa Clara
For Official use Only
CFTY STATE ZIP CODE AREACODEIPHONE
NAME OF ASSISTANTTREASURER, IF ANY
STREET ADDRESS (NO P,O. BOX)
CrTy STATE ZIP CODE AREA CODEIPHONE
NAME OF PRINCIPALOFFICER(S)
Attach additional information on appropriately labeled continuation sheets. STREET ADDRESS (NO P.O, BOX)
CITY STATE ZIP CODE AREA CODEJPHONE
I Verification
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 fore"ng is true and correct.
Executedon 1/15/2018 By
OFFICEHOLDER, CANDIDAVE, OR STATE WFAStlPE PROPONENT
ImXeC3lted OR ./`
BATF siGwTUE OF CONTROLLCONTROLLINGOFFiCE"OLBF.R, CANDIDATE. OR STATE MEASURE FROPONaNT
Executed on
DATE
W SIGNATURE OF: CONTROLLING OFFTGEHOLDER, CANDIDATE. OR STATE MEASURE PROPONENT
FFPC Form 410 (Jan/2016j
www.neflexom FPPC Advice- advice@€ppe.ca_gov, (8661275-3772)
uuww.fppc_ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Page 2 of 3
COMMITTEE NAME I.D. NUMBER
BarrY Chang for Assembly 2016 1378937
All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREACODEIPHONE SANK ACCOUNT NUMBER
First Foundation Bank (
ADDRESS CITY STATE 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
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."
e If this committee acts jointly with another Controlled committee, list the name and identification number of the other controlled committee.
ELECTIVE OFFICE SOUGHT OR HELD
NAME OF CANDIDArElOFFICEHOLDERlSTATE MEASURE PRpPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
Primarily formed to support or oppose specific candidates or measures in a single election. Listbelow:
CANDIDATE(S) NAME OR MEASURES FULL TITLE INCLUDE BALLOT NO. OR LETTER} CANDI (INCLUDE
OFFICE SOUGHTOR HELD OR COUNMFATY,
A APP CABLEICTIQN
O ( (INGLIIDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE
OPPOSE
FPPC Form 490 (Jan/2016)
www.netfile_com FPPC Advice: advice@fppc_ca.gov (8661276-3772)
www.fppc.ca.gov
Assembly District 24
❑ Nonpartisan
Bary Chang
2016
Democratic Party
❑ Nonpartisan
Primarily formed to support or oppose specific candidates or measures in a single election. Listbelow:
CANDIDATE(S) NAME OR MEASURES FULL TITLE INCLUDE BALLOT NO. OR LETTER} CANDI (INCLUDE
OFFICE SOUGHTOR HELD OR COUNMFATY,
A APP CABLEICTIQN
O ( (INGLIIDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE
OPPOSE
FPPC Form 490 (Jan/2016)
www.netfile_com FPPC Advice: advice@fppc_ca.gov (8661276-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Page 3 of 3
COMMITTEE NAME LID. NUMBER
Barry Chang for Assembly 2016 1378937
4. Type of Committee (Continued)
Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
0 CITY Committee ❑ COUNTYCommittee ❑ STATECommittee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
List additional sponsors on an attachment.
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREET ADDRESS NO AND STREET CITY STATE ZIP CODE
• . ❑ /
Date qualified
5.Termination Requirements By signing the verification, the treasurer, assfstanttreasurer and/or candid ate, officeholder, or proponent certify that all ofthe following 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
Govemment 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 18684 and FPPC Regulation 18521.5.
FPPC Form 410 (Jan/2016)
www.netFile.com FPPC Advice: advice@fppe.ca,gov (8661275-3772)
www.fppc.ca.gov