410 Statement of Organization Recipient Committee - Amendment 01-31-19 Statement of Organization � �o�ta�� � . , . . � '
Recipient Comrnittee ?� ' -
Statement Type �'n�f�a� X For Official Use Only
❑ Amendment ❑ Termination—See Part 5��� � �
Q Notyetqualified �� �f ��� '� '� �
or
Q Date qualified as conmittee � � � �
Date qualified as commiftee Date of termination � ����}�� ��� ��� �
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1. Committee Information s•D. Number 1299673 2. Treasurer and Other Principal OfFicers
(if applicable)
NAME OF COMMITTEE NAME OF TREASUREft
RICHARD ABDALAH
CIIPERTINO CHAMBER OF COMMERCE PAC
STREETADDRESS(NO P.O.BOX)
COUNN OF DOMICILE JURISDICfION WHERE COMMITI'EE IS ACiIVE NAME OF PRINCIPAL OfE10ER(S)
SANTA CLARA CITY OF CIIPERTINO KEVIN MCCI�EI,LAND
STREET ADDRESS{NO P.O.BOXJ
3. Verification
I have used a(I 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 Ca(ifornia that
Executed on gy
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
Executed on gy
DATE SIGNATURE DF CONTROLLING OFFICEHOtDER,CANDIDATE,�R STATE MEASURE PROPONENT
Executed on gy
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 •- � , �
. -
INSTRUCTIONS ON REVERSE
Page 2 of 4
COMMITfEE NAME I.D.NUMBER
CIIPERTINO CHAMBER OE COMN�RCE PAC
1299673
2a. Aciditionai Officers/Assistant Treasurers
NAME NAME
RICT3ARD ABDAT.AH
MAILING ADDRESS MAILING ADDRESS
NAME NAME
MAILING ADDRESS MAILING ADDRESS
C�n' STATE ZIPCODE AREACODEIPHONE CIIY STATE ZIPCODE AREACODE/PHONE
NAME NAME
MAILING ADDRESS MAILING ADDRESS I��
C�n STATE ZIP CODE AREA CODE/PHONE C�TY STATE ZIP CODE AREA COQElPHONE
NAME NAME
�!
MAILING ADDRESS MAILING ADDRESS
C�T�' STATE ZIPCODE AREACODE/PHONE CITY I� STATE ZIPCODE AREACODE/PHONE
�'
II,
FPPC Form 410{February/2018)
www.ne�le�com FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
Statemen#of Organization . � - .
Recipient Committee � . ' 1
INSTRUCTIONSON REVERSE
Page2 Page 3 of 4
COMMITTEE NAME
I.D_NUMBER
CIIPERTINO CHAMBER OE COMMERCE PAC 1299673
• All commitEees must list the financial institution where the campaign bank account is located.
NAME OF FINANQALWSTITUTION AREACODE/PHONE BANKACCOUNTNUMBER .
BANK OF THE WEST (
ADDRE55 CITY SiATE ZIP CODE
965 ANZA BOIILEVARD SAN JOSE CA 95129
4.Type o#Commit�ee Complete the appiicable sections.
• List the name of each controlling offiiceholder,candidate,or state measure proponent. If candidate or officeholder controlled,afso list the elective office sought or held,and
district number,if any,and the year ofthe election.
• List the polifical party with which each officeholder or candidate is affiliated or check"nonpartisan." Stafing"No party preference"is acceptab(e.
• If this committee acts jointly with another controlled committee,list the name and identification number of the other controfled committee.
ELECTIVE OFFICE SOUGHT OR HEiD YEAR OF PARTY
NAME OF CANDIDATE/OFFICEHOLDER/SfATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IFAPPLICABLE) ELECTION CHECKOnIe
Nonpartisan Partisan (list political party below}
Nonpartisan Partisan (list political party below)
� - Primarilyformed to support or oppose specific candidates or measures in a single elecfion. List below:
CANDIDATE(S)NAME OR MEASURE(5)FULLTITLE(INCLUDE BALLOT NO.OR LETTER} CANDIDATE(S}OFFICE SOUGHT OR HELD OR MEASURE(S}1URISDICTION
IP A RECALL,STATE"RECALL"IN FRONT OPTHE OPFICEHOLDER'S NAME. (INCLUDE DISTRICT NO.,CITY O�R COUNTY,AS APPLICABLE} CHECK ONE
� SUPPORT OPPOSE
SUPPORT OPPOSE
FPPC Form 41d(FebruaryJ2018)
FPPC Advice:advice@fppc.ca.go�(866/275-3772)
www.fppc.ca.gov
Statement of Organization . • _ .
Recipient Commit�ee � . � '
1NSTRUCTIONSON REVERSE
Page3 page 4 of 4
COMMITTEE NAME
f.D_NUMBER
CIIPERTINO CHAMBER OF COMNERCE PAC 1299673
4.Type of Committee {Continued)
•• � • - Not formed to support or oppose specific candidates or measures in a singfe e(ection. Check only one box:
0 CITY Committee ❑ CO11 NTY Corr�mittee❑ STATE Committee❑ Political Party/Central Cornmittee
PROVIDE BRIEF DESCRIPTION QF ACTIVITY
TO SIIPPORT LOCAL AND STATEWIDE CANDIDATES AND BALLOT MEASIIRES
� - -- List addifional sponsors on an attachment.
NAMEOFSPONSOR . INDUSTRY6ROUPORAFFILIATIONOFSPONSOR �
CIIPERTINO CHAMBER OF CONII�ERCE
STREETADDRE55 NO.AND SiREEf CRY STATE ZIP CODE AREA CODEfPHONE
20�55 SILVERADO AVENIIE CIIPERTINO CA 95014
-- � � �
Date qualified
5.Termination Requirernents Bysigningtheverification,thetreasurer,ass"istantireasurerand/orcandidate,officeholder,orproponentcertifythataflofthefollowingconditionshavebeenmet:
• This committee has ceased ta 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 Refiorm Act disclosing all reportable transactions.
— There are restrictions on the disposifion 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 govemmental purposes under 6overnment Code Sections 89511-89518,and are
subject to Elections Code Section 18680 and FPPC Regulation 18521_5.
FPPC Form 410(February/2018)
FPPC Advice:advice@fppc.ca.gov(866/2753772)
www.fppc.ca.gov