410 Statement of Organization Recipient Committee - Amendment Reassign for 2018 Statemeiii of Organizeiition
Recipient Committee
Statement"Type ❑initial 121 Amendment
Not yet qualified ❑ or List l.D.number:
# 1369332 y
7 /3 2.014
Date qualified as committee Date qualified as comrnittee
(If applicable)
I. Committee Information
NAME OF COMMITTEE
Robert McCoy for Council 2018
❑ Termination—See Part 5
List LD.number:
Date of Termination
STREET ADCli ESS(NO P.O.BOX)
CITY STATE 2IP CODE AREA CODE/PHONE
(
MAILING ADDRESS(IF DIFFERENT)
AA/t-MA I_AUUNES5
i.IU RISUICTION WHERE.COMMITTEE IS ACTIVE
Attach additional information on appropriately labeled continuation sheets.
2. Treasurer ali
NAME OF TREASURER
DaLLe Stamp
CSI \V/
[TI,
li
L` 2017
PER TINO CITY CLER
Principal Officers
For Official USE!Only
Blossom McCoy
STREET ADDRESS(NO RiD.BOX) •-
CITY
STATE ZIP CODE AREA•:ODE/PHONE
(
NAME OF ASSISTANT T=EASURER,IF ANY
STREET ADDRESS(NO R0.BOX) ' •'� •'
CITY STATE Z111 CODE AREA:O DE/PHONE
NAME OF PRINCIPAL O F FICER(S)
STREET ADDRESS(NO RO.BOX)
CITY STATE 2 1 P CODE AREA CODE/PHONE
3. Veri "ciation
I have used all reasonable dliligence in preparing this statement and to the best of mil knowledge the in'Formation contained herein is true anc:l complete. I certifi under
penalty of perjury under the laws of the State of California that the foregoing is true
CANDIDATE,>R STATE MEASURE PROPON[PJT
Executed on _ By
DATE SIoNATURE OF CONTROLLING nFFICEHOLDER,CANDIDATE,:7R STATE MEASURE PROPONENT
Executed on By
DATE• SIGNATURE OF CONTROLLING•CFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
li Form 410(Jan/2016)
FPPC Advice: advice @fppc.ca.gov 1;$66/275-3772)
w°Imw.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAMII.
Robert McCoy for Council 2018
• All committees must list the finnancial institution where the campaign bank account is located
NANIL Ur FINANCIAL INSTITUTION
Bank of Jkrnerica
ADDRESS
AREA CODE/PHONE
(
CITY --
BANK ACCOUNT HUMBER
STATE ZIP CODE
4Ty YP a of Committee Con-Iplete the applicable sections.
ons. LI
E
E
PEiRe 2
I.C.NUMBER
11369332
• List the name of each controlling officeholder, candidate,or state pleasure 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 idinntification number of the other controlled committee.
NAME OF CANDIDATE/OFFICEFIOLDER/STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
Robert KdcCoy City Council 2018 Nonpartisan
❑ Nonpartisan `
iPrimarily formed to support or"Iii �� oppose specific candidates or measures in a single election. List below:
CANL IDATE(S)NAME OR MEASURE(S)FULL TITLE(INCLUDE BALLOT NO.OR LETTE R) CANDIDATE(S)OFFICE.SOUGHT OR HELD OR MFASURE(S)JURISDICTION
(INCLUDE DISTRICT NO.,CITY OR COUNT",AS APPLICABLE)
-HECK ONE
i--�� SUPPOR"f OPPOSE
O
FPPC Form 410(1an/2016)
FPPC Advice:aidvice @fppc.ca.gov(866/275-3772)
wllvw.fppc.ca.gov