410 Statement of Organization Recipient Committee – Amendment Stamped by SOSStatement of Organization
Dale Stamp
CALIFORNIA
Recipient Committee
R E -C E I V E D A N D 1'4
FORM
Statement Type El initial 0 Amendment 0
Termination — See Part 5
in the office of the Socreahl,
State of Callfell
of tho St
or
as se "Y
0 Not yet qualified
08 06 2018
AUG 15 201
U,
202
0 Date qualified alified as committee
E
L
Date qualified as committee
Date of termination
08 06 2018
L,"--,,.,',,,Commi ee� n oirriatil?
I.D. Number
�2.,,Treas'u'ier,"and'O't'h'O"-t","P-rihci, h e i
(if applicable) 1408452
NAME OF COMMITTEE
NAME OF TREASURER
Jon Willey for Cupertino Council 2018
Joan Lawler Chin
STREET ADDRESS (NO P.O, BOX)
STREET ADDRESS (NO P.O. BOX)
71Ty- STATE ZIP CODE
AREA CODE/PHONE
CITY STATE ZIP CODE AREA CODE/PHONE
NAME OF ASSISTANT TREASURER, IF ANY
Eric Shaefer
MAILING ADDRESS (IF DIFFERENT)
STREET ADDRESS (NO P.O. BOX)
E-MAIL ADDRESS(REQUIRED)/FAX(OPTIONAL)
71 -TY STATE ZIP CODE
AREA CODE/PHONE
COUNTY OF DOMICILE JURISDICTION 1VH111 COMMITTEE 11 ACTIVE
NAME OF PRINCIPAL OFFICER(S)
Santa Clara ity of Cupertino
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE
AREA CODE/PHONE
Attach additional information on appropriately labeled continuation sheets.
ifiGationAN'
I have usedallreasonable 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
MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING
OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form
410 (February/2018)
FPPC Advice: advice@fppc.ca.gov
(866/275-3772)
www.fppc.ca.gov
Statement of Organization • -
Recipient Committee FORM
INSTRUCTIONS ON REVERSE
SUPPORT
Page 2
COMMITTEE NAME
I.D. NUMBER
Jon Willey for Cupertino Council 2018
1408452
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION I AREA CODE/PHONE I BANK ACCOUNT NUMBER
Wells Fargo
ADDRESS
CITY
STATE ZIP CODE
4 Type of Committee Complete the applicable sections
, e _ . , R
• 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." Stating "No party preference' is acceptable.
• 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 YEAR OF PARTY
NAME OF CAN MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION
CHECK ONE
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)
IF A RFCAL L_ STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME.
CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) rHFCK ONE
SUPPORT
Nonpartisan
Partisan
(list political party below)
Jon Willey
Cupertino City Council
2018
SUPPORT
El
':OPPOSE
EL
Nonpartisan
Partisan
(list political party below)
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)
IF A RFCAL L_ STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME.
CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) rHFCK ONE
FPPC Form 410 (February/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
SUPPORT
OPPOSE
El
El
SUPPORT
El
':OPPOSE
EL
FPPC Form 410 (February/2018)
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. NU'.
)mmittee (Continued);. ..
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
❑ CITY Committee ❑ COUNTY Committee ❑ STATE Committee ❑ Political Party/Central Committee
List additional sponsors on an attachment.
NAME OF SPONSOR _ IiNDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE AREA CODE/PHONE
-Small Contributor Committee El
Date qualified
5.Termination`Requirements By signing the verification, the treasurer, assistant treasurer and/or candidate, officeholder, or proponent certify that all of the 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 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 (February/2018)
Clear Page; Print FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov