410 Statement of Organization Recipient Committee – TerminationStatement of Organization
Recipient Committee
Statement Type z Initial
g Not yet qualified
or
0 Date qualified as committee
[1 Amendment
//
Date qualified as committee
.E C=e-=i-=V E
I
S Termination - See Part 5 JAN I ,Q 2018 i
l , IZ, t\ : I ,
D-t-ft-i-ti-CUPEFITINOCITYCIER'<
1.D. Number
(ifapplrcable) 1'3%' V 3
NAME OF TREASURER
Bharwad for City Council 2016 Jakshi Bharwad
STREET ADDRESS (NO P.O BOX)
STREET ADDRESS (NO P.O BOX)
CITY
Cupertino
MAILING ADDRESSIIF DIFFERENT)
STATE ZIP CODE
CA 95014
AREA CODE/PHONE
CITY
Cupertino
N AM E OF ASSISTANT TRE ASU RER, IF ANY
STREET AD[)RES5 iNO P.O BOX)
STATE ZIP CODE
CA95014
AREA CODE/PHONE
E-M All ADDRESS (REQUI RED) / FAX IOPTI ON AL)CITY
NAME OF PRINCIPALOFFICERIS)
STATE ZIP CODE AREA CODE/PHONE
STREET ADDRESS (NO P.0. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
Attach additional information on appropriately labeled continuation sheets.
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 th iing is true and correct
CANDIDATE. OR STATE MEASURE PROPONENT
Executed on Rv
SIG NATII RE O F CO NT ROII "" l T iZ E S u Ll) P )l ( " '! D:D!!TE, Ol"- STAT C M EAS U R L P RO P O N E NT
Executed on
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASIIRE PROPONENT
FPPC Form 410 (October/2017)
FPPC Advice: advice@fppc.ca.gov (8667275-3772)
www.fppc.ca.gov