410 Statement of Organization Recipient Committee - Amendment Reassign for 2016Statement of Organization
Recipient Committee
Statement Type I] Initial
Not yet qualified ❑ or
NAME OF COMMITTEE
0 Amendment
Lest i.D number'
H1369332
0_? 30 1' 2014
Date qualified as committee Date qualified as committee
of aca!•caole)
Robert McCoy for Council 2016
❑ Termination — See Part 5
List I.D. number-
Date of'fermination
STREET ADDRESS {NO P.D. BOxj
MAII.INC ADDRESS (IF DIFFERENT)
FAM / E-MAIL ADDRESS
JF DOFA71 -Il E l JIJRf
WHGRE COMMITTEE IS AC'iVE
NAME OR TREASURER
Blossom McCo
C� TJ S'111 V/
JA N - 2 2015
FEATINQ CITY CLEI
For Official Use Only
STREET ADDRESS (NO PO BCX�
NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS SNo P O. 5Ox1
CITY iTATE ZIP CODE AREA COUE/P-ONE
NAME OF PRINCIPAL OFFICER($}
Attach additional information on appropriately labeled continuation sheets. STREET ADDRESS IND PO BOX)
CITY STATE ZIP CODE AREACODEPHONE
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' certify under
penalty of perjury under the laws of the State of California that the foregoing is true and
SrATE MEASURE FROPONFNT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PRJPONENT
Executed on By
DATE SIGNATL'REOF CCNTROUING OFFICEHOLDER, CANDIDATE. OR STATE MEASURE PROPONENT
FPPC Form 410 (Dec /2012)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME
ID NUM5ER
Robert McCoy for Council 2016 11369332
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FIN4NCIAE INSTJUTION
Bank of America
ADDRESS
AREA CODEi PHONE
(
STATE ZIP CODE
a
• 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"
• 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 SOOGHI OR HELD
11NCLUDF DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION
PARTY
Formed Primarily Primarily formed to support or oppose specific candidates or measures in a single election. List below;
CANDWATE(S) NAME OR MEASURE {S1 FULL TITLE (INCLUDE BALLOT NO. OR LETTER)
CANDIDATEISI OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
)INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLF)
CHECK ONE
T OPPOSE
FPPC Form 410(Dec /2012)
FPPC Advice: advice 9)fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov