410 Statement of Organization Recipient Committee – Initial Not Yet QualifiedStatement of Organization
Recipient Committee __
Statement Type Ill! Initial I I Jj ~J,iJ I 0 Amendment D Tennination -S
CALIFORNIA 41 0
FORM
For Official Use Only
0 Not yet qualified
or 2 , .. 20 22
0 Date qualification threshold met I Date qualification threshold met
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NAME OF COMMITTEE
Sheila Mohan fur Cupertino City Council 2022
STREET ADDRESS (NO P.O . BOX)
CITY
Cupertino
FULL MAILING ADDRESS (IF DIFFERENT)
E-MAIL ADDRESS (REQUIRED)/ FAX (OPTIONAL)
COUNTY OF DOMICILE
Santa Clara
STATE ZIP CODE
CA 95014
JURISDICTION WHERE COMMITTEE IS ACTIVE
Cupertino
AREA CODE/PHONE
NAME OF TREASURER
RamPMohan
STREET ADDRESS (NO P.O. BOX)
CITY
Cupertino
NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS (NO P.O. BOX)
CITY
NAME OF PRINCIPAL OFFICER(S)
STREET ADDRESS (NO P.O. BOX)
CITY
Attach additional information on appropriately labeled continuation sheets .
I have used all reasonable diligence in
MEASURE PROPONENT
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
STATE ZIP CODE AREA CODE/PHONE
CA 95014
STATE ZIP CODE AREA CODE/PHONE
STATE ZIP CODE AREA CODE/PHONE
FPPC Form 410 (August/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.f~ov
Statement of Organization
Recipient Committee
CALIFORNIA 41 0
FORM
INSTRUCTIONS ON REVERSE
Page2
COMMITTEE NAME I.D.NUMBER
Sheila Mohan fur Cupertino City Council 2022
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER
Wells Fargo Bank
ADDRESS CITY STATE ZIP CODE
Cupertino CA 95014
Controlled Committee
• List the name of each controlling officeholder, candidate, or state measure proponent. If candidate or officeholder controlled,
also list the elective office soug ht or held, and district number; if any, and the year of the election.
• Li st 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.
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT
ELECTIVE OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE)
YEAR OF
ELECTION
PARTY
CHECK ONE
Sheila Mohan Cupertino City Council 2022 Nonpartisan .,
Nonpartisan
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 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)
Partisan
Partisan
(list political party below)
(list political party below)
CHECK ONE
SUPPORT OPPOSE
SUPPORT SUPPORT OPPOSE
FPPC Form 410 (August/2018)
FPPC Advice: advi ce @fppc.ca.gov (866/275-3n2)
www.fppc.ca .gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
CALIFORNIA 410
FORM
General Purpose Committee Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
0 CITY Committee O COUNTY Committee O STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
Sponsored Committee 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/PHONE
Small Contributor Committee □-1-1--
Date qualified
5. Termination Requirements By signing the verification, the treasurer, assistant treasurer and/or candidate, officeholder, or ponent certify that all ofthe 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, legi sla tive 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: advic e@fpp c.ca .gov (866/27S-3772)
www.fppc.ca .gov