410 Statement of Organization Recipient Committee - Amendment Stamped by SOSStatement of Organization
Recipient Committee
Statement Type
❑ Initial Q Amendment
Q Not yet qualified
or
O Date qualification threshold met Date qualification threshold met
Date Stamp do T1
RECEIVED AND FIL • -
❑ Termination —See Part 5 n the of ice of the Secretary of S For Official Use Only
of the State of California
APR 2 3 2019 NAY 6 2019
Date of termination
/—/— 10 / 11 / 2018 // II ICUPERTINO CITY CLERK
1. Committee Information I.D. Number 1412139 2. Treasurer and Other Principal Officers
(if applicable)
NAME OF COMMITTEE NAME OF TREASURER
Cupertino Residents for Local Ethical Government Michael Malik
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
FULL MAILING ADDRESS (IF DIFFERENT) ---
E-MAIL ADDRESS (REQUIRED)/ FAX (OPTIONAL)
S I BEET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
NAME OF ASSI5TANT TREASURER, IF ANY
Nancy L Warren
STREET ADDRESS (NO RO. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
COUNTY OF DOMICILE I JURISDICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OFFICER(S)
Santa Clara County Cupertino Oscar Hur
STREET ADDRESS (NO P.O. BOX)
Attach additional information on appropriately labeled continuation sheets. CITY STATE ZIP CODE AREA CODE/PHONE
3. Verification
I have used all reasonable diligence in
Executed on
DATE
Executed on
DATE
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed an By
GATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (August/2018)
FPPC Advice:.advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
nplfrla rnm
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Page 2 of 3
COMMITTEE NAME
LD. NUMBER
Cupertino Residents for Local Ethical Government 1412139
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER
Bank of San Francisco (
ADDRESS CITY STATE ZIP CODE
4. Type of Committee Complete the,applicable sections.
4ntrolled Committee
• 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 CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION CHECK ONE
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) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE
SUPPORT I OPPOSE
OPPOSE
FPPC Form 410 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
Cupertino Residents for Local Ethical Government
Page 3 of 3
I.D. NUMBER
J 141'l -1 lU
4. Type of Committee (continued)
I General Purpose Committee Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
Q CITY Committee ❑ COUNTY Committee ❑ STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
To support and oppose candidates and measures of interest to residents of Cupertino who are comitted to Ethical government
Sponsored Committee List additional sponsors on an attachment.
NAME OF SPONSOR
CITY
Small Contributor Committee
INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STATE ZIP CODE AREA CODE/PHONE
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 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov