410 Statement of Organization Recipient Committee – Initial Not Yet Qualified Stamped by SOS (2)Statement of Oraanization
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Recipient Committee
Statement Type ® initial ❑ Amendment
❑ Termination —see Parfr6t
CEIVEDI AND Fit
e office of the Secret®ry
For Offidal Use Only
®f
Qj Not yet qualified
of the State of CalifoMia
or
N 0 V 1 2020
p Date qualification threshold met Date qualification threshold met
Date of termination
OCT 14 2020
• I I.D. Number
a .. e
ifa licoble)
OF COMMITTEE
NAME OF TREASURER
7AME
CHARLENE LEE FOR CUPERTINO CITY COUNCIL 2020
CHARLENE SHULIEN LEE
STREET ADDRESS
STREET ADDRESS (NO P.D. BOX)
CITY - _ - STATE
ZIP CODE AREA CODE/PHONE
CUPERTINO CA
95014
CITY STATE ZIP CODE AREA CODE/PHONE
NAME OF ASSISTANT TREASURER, IF ANY
CUPERTINO CA 95014
FULL MAILING ADDRESS (1F DIFFERENT)
STREETADDRESS (NO P.O. BOX)
E-MAIL ADDRESS (REQVIR£D)/FAX (OPTIONAL)
CITY STATE
ZIP CODE AREACODE/PHONE
COUNTY OF DOMICILE
JURISDICTION WHERE COMMITTEE 15 ACTIVE
NAME OF PRINCIPAL OFFICER(51
SANTA CLARA
CITY OF CUPERTINO
STREET ADDRESS (NO P.O. BOXI
Attach additional information on appropriately labeled continuation sheets.
CITY STATE
ZIP CODE AREA CODE/PHONE
I have used all reasonable diligence in preparing tnls 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 correct.
Executed on By
DATE EASURER OR ASSISTANT TREASURER
Executed on By
DATE
Executed on
DATE
Executed on
DATE
SIGNATURE OF CO
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410(August/2018)
FPPC Advice; advicePfppc.ca.gov (866/275-3772)
www.fppc.ca.eav
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Page 3
COMMITTEE NAME I I.D. NUMBER
CHARLENE LEE FOR CUPERTINO CITY COUNCIL 2020
Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
® CITY Committee ❑ COUNTY Committee ❑ STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
RUN FOR CUPERTINO CITY COUNCIL
List additional sponsors on an attachment.
NAME OF SPONSOR
INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE AREA CODE/PRONE
❑ / /
Date qualified
• 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: advicet@fpoc.ca.eov (866/275-3772)
www.fPPc.ca.aov
Statement of Organization
CALIFORNIA
Recipient Committee
FORM
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME
I.D. NUMBER
CHARLENE LEE FOR CUPERTINO CITY COUNCIL
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION
AREA CODE/PHONE
HANK ACCOUNT NUMBER
ADDRESS CITY STATE 21PCODE
s s s s 0 s s se 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." 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
CHARLENE LEE
2020
Partisan
(list political party below)
CUPERTINO CITY COUNCIL
Eon
Partisan
(list political party below)
FormedPrimarily 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 RECALL, 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)
CHECK ONE
SUPPORT OPPOSE
SUPPORT OPPOSE
FPPC Form 410 (August/2018)
FPPC Advice: adviceCJfonc.ca.eov (866/275-3772)
www.fPPc.Ca.eov