410 Statement of Organization Recipient Committee - Amendment Reassign for 2020 Statemerat of Organization � t m � e ,
Recipient Committee + • _ d �
Statement Type ��nitial �
� Amer�dmenf ❑ Yermir�ation—See Part � '14'� „n, f ForOfficial Use Only
Q Not ye#qualified �� ''� `�'``f - l��'�
or
Q Date qualification threshoid met Date qualification threshold mef Dafe of termination g�������a� �¢� �� ��
� j Q7 � 30 � 20�4 � � `� °� �
' I.D. I�umber � �
1: Comrnittee Informat�on � : 2� Treasurer and Other Pr�nci al OfFicers , �
; ; , ; . .,' lif applicable) 1369332 p
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NAME�FCOMMiTTEE NAME OF TREASURER
ROBERT MCCOY FOR COUNCIL 2020 BLOSSOM MCCOY
STREET AD D RESS{NO P.D.BOX)
CQUNTY OF DDMIQLE JURISDICTION WHERE COMMITTEE IS ACTIVE NAME�F PRINCIPAL OFFICER(S)
STREEf A�DRESS(NO P.O.BOX) -
��T�' STATE ZIPCODE AREACODE/PHDNE
Attach additiona!information on apprapriately labeled continuation sheets.
3,.verificafion___�,. . - - .�.� � � . ��. _ � � .�._ � .. ..w.. , .
1 have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is�true and complete. I certifiy under
penafty of perjury under the laws of the State of
CANDIDATE,ORSTATEMEASUREPROPONENT
6cecuted on gy
DATE SIGNATURE OF CONTROLLIN6 OFFICEHOLDER,CANDIDATE,OR STATE MEASLIRE AROPONENT
Executed on By
�ATE � SIGNATUREOFCONTROLtINGOFF{CEHOLDER,CANDIDATE,ORSTATEMEASUREPROPONENT
FPPC Form 410(August/2D18)
FPPC Advice:advice@fppc.ca.gov(866j2753772)
www.fppc.ca.gov
Stafement o#Organization , / _ ,
Recipient Committee I '
• -
INSTRUCTiONS ON REVERSE
Page 2
COMMf7TEE NAME
I.D.NUMBER
ROBERT MCCOY FOR COUNCIL 2020
1369332
• A!t committees must list the financial institution where the campaign bank account is located.
NAME OF FINANpALINSTITUTION
4 Type�ofComm�ttee_�Cornpletetheappficable�ect�ons . � w`.`.. ._..J,_.�.� �.�..W.�._��.._,._.��._.�..��uu...�__.._�„�..___,......�....� ��.._ ..�w.._..N.�_.� �,...W __.._�..�.. '
• 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 electlon.
• List the pofitical party with which each officeholder or candidate is affiliated or check"nonpartisan:' Stating"No party preference"is acceptable.
� If this committee acts jointly vuith another controlled committee,list the name and identification number of the other controlled committee.
ELECTIVE QFFICE SOUGHT OR HELD YEAR OF PARTY
NAME OP CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER iF APPLICABLE) ELECTION cHeCK ONE
Nonpartisan Partisan (list political party below)
❑ ❑
Nonpartisan Partisan (list political party below)
❑ ❑
Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(5)NAME OR MEASURE(S)FULLTITLE(INCLUDE BALtOT NO.OR LETTER) CANDIDATE(5)OFFICE SOUGHT OR HELD OR MEASURE(5)JURISDICTION
IF A RECALL,STATE"RECALL"W PRDNT OF THE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO.,CfTY OR COUN7Y,AS APPLICABLE) crieCK ONE
SUPPORT OPPOSE
❑ ❑
SUPPORT OPPOSE
❑ ❑
FPPC Form 410(August/2018)
FPPC Advice:advice@#ppc.ca_gov(866/275-3772)
www.fppc.ca_gov