460 Recipient Committee Campaign Statement 7-1-14 to 9-30-14 AmendmentRecipient Committee
Campaign Statement
Cover Page
(Government Code Sections 84200 - 8.4216.5)
SEE INSTRUCTIONS ON REVERSE
Type or print in ink.
Statement covers period
from 01/01/2014
through
09/30/2014
1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4.
® Officeholder, Candidate Controlled Committee ❑ Ballot Measure Committee
Q State Candidate Election Committee O Primarily Formed
0 Recall 0 Controlled
(AlsoCcmpletc Rift 5) O Sponsored
(Also Complete Part 6)
❑ Generai Purpose Committee
0 Sponsored
Q Small Contributor Committee
O Political Party /Central Committee
3. Committee Information
COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COM
MC COY FOR COUNCIL 2014, ROBERT
n Primarily Formed Candidate/
Officeholder Committee
(ALso Complete Part 71
I.Q. NUMBER
1369332
STREET ADDRESS (NO P.O. BOX)
MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX
CITY STATE ZiP CODE AREA CODEIPHONE
OPTIONAL: FAX I E -MAIL ADDRESS
COVER PAGE
Date Stamp
W d V `�I
Date of election if applic 1
(Month, Day, Year) 1[OCT 1 Q 2014 of
For Official Use Only
111D412014
P�RT�NO c�nc��
2. Type of Statement:
❑ Preelection Statement Quarterly Statement
❑ Semi - annual Statement Special Odd -Year Report
❑ Termination Statement ❑ Supplemental Preelection
Amendment (Explain below) Statement - Attach Form 495
Amending the statement period cover elate
Treasurer(s)
NAME OF TREASURER
Blossom McCoy
MAILING ADDRESS
NAME OF ASSISTANT TREASURER, IF ANY
MAILING ADDRE
CITY STATE ZIP CODE AREA CODE /PHONE
OPTIONAL; FAX ( E -MAIL ADDRESS
4. Verification
I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein and in the attached schedules is true and complete. I
certify under penalty of perjury under the laws of the State of California that the forepoina is true and correct n
Executed on
10/08/2014
Date
Executed on 10/08/2014
Date
Executed on
Date
By
By
By
Signature of Controlling Officeholder, Candidate, State Measure Proponent
Executed on 13y
Date Signature ofControllmgOffmholder, Candidate, State Measure Proponent FPPC Form 460 (Junef01)
FPPC Toll -Free Helpllne: 866/ASK-FPPC
State of California