410 Statement of Organization Recipient Committee - Initial Not Yet QualifiedR i p -7 1 / I r- /1 r- ----7
A
Statement of Organization U
Date Stamp
Recipient Committee ✓
'
M
Statement Type W1 Initial ❑ Amendment
❑ Termination - See Part 5
For Official Use Only
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Qf Not yet qualified
of #4 out* of o1Nfdrnis
of
0 Date qualificationn, threshold met Date qualification threshold met
Date of termination
JUL 15 2022
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CommitteeI.D. Number
Other
PrincipalOfficeLn
! o Ifeable
NAME OF COMMITTEE
NAME OF TREASURER
-
of the State Of CaffornlS
Cupertino Residents for Government Accountability
Alexandra Siliezar
Jul 2
STREETADDRESS (NO P.O: BOX)
STREET. ADDRESS (NO P.O. BOX)
CITY
STATE
ZIP CODE AREA CODE/PHONE
Oakland
CA
94605
CITY STATE ZIP CODE AREA CODE/PHONE
NAME OF Assis-rANT TREASURER, IF ANY ,
Cupertino CA 95014
,
�r
E-MAILA`D'DIRESS(REQUIRED)/FAX (OPTIONAL)
CITY
STATE
ZIP CODE AREA CODE/PHONE
COUNTY OF DOMICILE
JURISDICTION WHERE COMMITTEE15ACTIVE -�-�
NAME OFPRINCIPAL OFFICER(S)
Santa Clara County
Cupertino, CA.
F! C 1nnYC, \-0W"'Zv1tvN a i
STREET ADDRESS (NO Pot BOX)
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additional Mformation on appropriately'labeled continuation sheets.
`CITY
STATE
ZIP CODE AREA CODE/PHONE
Cvv'Q\r-hV, 0
C yr
11(; CA
I nave-usea all reasonaLNe a111642FILe%If] Prel.Jdl 1116' LIIIJ bLdle R11efIL dflU LU Ll le Ut:bL UPIIly K1IUWIt:7Ure LPIC If I I Ul I I Id LIU11 LUI I LCIII ICU IIt11CII1 12, Lr UCf CIIIU LLNI IF./ICUC. I LCI Llly under
penalty of perjury under the laws of the State of
TREASURER OR ASSISTANT 'IIREASU RER
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, ONSTATE MEASURE PROPONENT
Executed on __ By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, ORSTATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (AAugust/2018)
FPPC Advick: advic�.c@.gov (866/275-3772)
www.,gpc.ca. 0v
ADDRESS
CITY STATE ZIP CODE
• List the name of each controlling officeholder, candictate, or state measure proponent. If candidate or officeholder controlled,
also list the elective office sought or held,, and district number, ifany, and the yeav of the election.
• Lits't the politibal party with which each officeholder or candidate -is affillated or check "nonpartisan,,." Stating "No party preference' is acceptable
• If this committee acts jointly with another controlled corrlmIttee, list the name and identification nw, tuber of the other controlled committee.
ELECTIVE OFFICE SOUGHT OR HELD YEAR OF PARTY
NAME OF CANDIDATE/OF RICEHOkDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION CHECK ONE
Nonpartisan
Partisan
(list political party below)
Nonpartisan
Partisan
(list political party below)
C_
Primarily formed to SUpport. or op,pose specific carydidates or measures in a single election. List below-, orm. 1;0m
CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOU GHTf OR HEUD OR MEASURE(S) JURISDICTION
IF A RECALL, STATE "RECALLS' N FRONT OF 11H E OFFICEHOLIDERS NAME, (INCLUDE DISTRICT NO,CITY OR COUNTY, AS APPLICABLE) CHECK ONE
SUPPORT
OPPOSE
SUPPORT
OPPOSE
FPPC Form 410 (August/2018)
MCAdvice: advice jLfMc.ca. gov -3772)
(866/275
WViWJ[)1DC.0__99LV_
Statement of Organization
Recipient Committee
INSTRWCTIONS ON RE -VERSE
-(:QMMIT ME , TEE NA -
Cupertino Residents for Governrnent Accountability
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
To provi& awareness of issues irnpactfnig Cupertino Residents
J List additional sponsors on an attachment.
NAME OF SPONSOR
STREETADDRESS . NO, AND STRERT
CITY
NDUSTW GROUI:k'OR AFFILIATION OF SPONSOR
Page 31
I.D. NUMER
STATE 21P CODE- AREA CODE/PHONE
I
There are restrictions ort 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 palitical, legislative or governmental purposes under Government Code Sections 89511 -
89518, and are subject to Elections Code Section 18680 and FPPC Regulatio in 18521.5.
FPPC Form 410 (August/2018)
FPPC Advice: ad Ic (TfDRrCa,9ov-(866/275-3772)
W , PC-0-10