460 Recipient Committee Campaign Statement 10-1-14 to 10-18-14Recipient Committee
Campaign Statement
Cover Page
(Government Code Sections 84200- 8421 6.5)
SEE INSTRUCTIONS ON REVERSE
Type or print in ink.
Statement covers period I Date of election if applica
from
10/01/2014 (Month, Day, Year)
through
10/1812014
1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, s, and 4.
® Officeholder, Candidate Controlled Committee ❑
Ballot Measure Committee
O State Candidate Election Committee
O Primarily Formed
Q Recall
0 Controlled
(Also Complete Part 5)
Q Sponsored
F-1 General Purpose Committee
(Also Complete Pa# 6)
0 Sponsored ❑
Primarily Formed Candidate/
O Small Contributor Committee
Officeholder Committee
Q Political Party/Central Committee
(Also CompletePart7)
3. Committee Information I.D. NUMBER
1369332
COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE)
MC COY FOR COUNCIL 2014, ROBERT
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 1 E -MAIL ADDRESS
D N Cc [[ L � W
OCT 2 !.
COVER PAGE
1 of 7
F <Ir Official Use Only
11/04/2014
C CITY CLERK
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
Treasurer(s)
NAME OF TREASURER
Blossom McCoy
MAILING ADDRESS
NAME OF ASSISTANT TREASURER, IF ANY
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE /PHONE
VNIIUNAL: FAX I 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 foregoing is true and correct.
Executed on
10/20/2014
Date
Executed on 10/20/2014
Data
Executed on
Date
By
By
By
Signature of Controlling Officeholder, Candidate, State Measure Proponent
Executed an By
Date Signature ofControllIng Officeholder, Candidate, State Measure Proponent FPPC Form 460 (Junelol)
FPPC Toll -Free Helpline: 866/ASK-FPPC
State of California
Recipient Committee Type or print in ink, COVER PAGE - PART 2
Campaign Statement CALIFORNIA , � �
Cover Page — Part 2
5. Officeholder or Candidate ContrnllPd Cnmmil#cho
NAME OF OFFICEHOLDER OR CANDIDATE
Robert McCoy
OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE)
Cupertino City Council
RESIDENTIALIBUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP
Related Committees Not Included in this Statement: List any committees
not included in this statement that are controlled by you or are primarily formed to receive
contributions or make expenditures on behalf of your candidacy.
COMMITTEE NAME I.D. NUMBER
NAME OF TREASURER CONTROLLED COMMITTEE?
❑ YES ] NO
COMMITTEE ADDRESS STREET ADDRESS (NO P.O BOX)
CITY STATE ZIP CODE AREA CODE /PHONE
COMMITTEE NAME I.D. NUMBER
NAME OF TREASURER CONTROLLED COMMITTEE?
❑ YES r] NO
COMMITTEE ADDRESS STREETADDRESS (NORO,BOX)
Page 2 of 7
6. Ballot Measure Committee
NAMF OF BALLOT MEASURE
BALLOT NO. OR LETTER JURISDICTION ❑ SUPPORT
❑ OPPOSE
Identify the controlling officeholder, candidate, or state measure proponent, if any.
NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT
OFFICE SOUGHT OR HELD DISTRICT NO IF ANY
7. Primarily Formed Committee List names of officeholder(s) or candidate(s) for
which this committee is primarily formed.
NAME OF OFFICEHOLDER OR CANDIDATE
OFFICE SOUGHT OR HELD
❑ SUPPORT
❑ OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE
OFFICE SOUGHT OR HELD
❑ SUPPORT
❑ OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE
OFFICE SOUGHT OR HELD
❑ SUPPORT
❑ OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE
OFFICE SOUGHT OR HELD
❑ SUPPORT
❑ OPPOSE
-' ` -" " "" " "' " "` Attach continuation sheets if necessary
FPPC Form 460 (June /01)
FPPC Toll -Free Helpline: 866/ASK-FPPC
State of California
Campaign Disclosure Statement
Summary Page
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
MC COY FOR COUNCIL 2014, ROBERT
Type or print in ink.
Amounts may be rounded
to whole dollars.
SUMMARY PAGE
Statement covers period
from 10/01/2014
through 10/18/2014 Page 3 of 7
I.D. NUMBER
1369332
Calendar Year Summary for Candidates
Running in Both the State Primary and
General Elections
111 through 6130 711 to DatE
Contributions Received
Column
Column
TOTALTHIS PERIOD
CALENDAR YEAR
(FROM ATrACHEDSCHEDULES)
TOTALTO DATE
1. Monetary Contributions ......... ............................... schedule A, Line 3
$
4000.00
$ 15660.00
2. Loans Received .............................................. e, Line 3
3500.00
5500.00
3, SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines I +2
$
7500.00
$ 21160.00
4. Nonmonetary Contributions ..... ............................... Schedule C. Line 3
700.00
700.00
5. TOTAL CONTRIBUTIONS RECEIVED ........ ................... Add Lines 3 +4
$
8200.00
$ 21860.00
Expenditures Made
6. Payments Made..... .......... .................... .................. Schedule E, Line 4
$
8715.88
$ 14791.49
7. Loans Made ........................ ...................... Schedule x, Line 3
0.00
0.00
8. SUBTOTAL CASH PAYMENTS .... ............................... Add Lines 6 + 7
$
8715.88
$ 14791.49
9. Accrued Expenses (Unpaid Bills) ............................... Schedule F, Line 3
0.00
0.00
10. Nonmonetary Adjustment ........... ............................... Schedule C, Line 3
700.00
700.00
11. TOTAL EXPENDITU RES MADE . ............................... Add Lines s + 9 + 10
$
9415.88
$ 15916.49
Current Cash Statement
12. Beginning Cash Balance ....................... Previous Summary Page, Line 16
$
7584.39
To calculate Column B, add
13. Cash Receipts ........ .........................
.
........... ...... Column A, Line 3 above
7500.00
amounts in Column A to the
14. Miscellaneous Increases to Cash ........................... Schedule 1, Line 4
0.00
corresponding amounts
from Column B of your last
15. Cash Payments ...... ............................... Column A, Line a above
8715.88
report. Some amounts in
Column A may be negative
16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15
$
8358.51
figures that should be
If this is a termination statement, Line 16 must be zero.
subtracted from previous
period amounts. If this is
the first report being filed
17. LOAN GUARANTEES RECEIVED ........................... Schedule 6. Part
$
0.00
for this calendar year, only
carry over the amounts
from Lines 2, 7, and 9 (if
Cash Equivalents and Outstanding Debts
18, Cash Equivalents ......... ............................... See instructions on reverse
$
0.00
any)
19. Outstanding Debts ......................... Add Line 2 +Line 91n Column S above
$
0.00
20. Contributions
Received $ $
21. Expenditures
Made $ $
Expenditure Limit Summary for State
Candidates
22. Cumulative Expenditures Made"
l IfSobject to Voluntary Expenditure Limit)
Date of Election Total to Date
(mmlddlyy)
�./ $
-� $
"Since January t, 2001. Amounts in this section may be
different from amounts reported in Column B.
FPPC Form 468 (June/01)
FPPC Toll -Free Helpline: 866/ASK-FPPC
ScheduleA Type or print in ink.
Monetary Contributions Received Amounts may rounded
to whole dollars.
lars.
Statement covers period
from 10/01/2014
SCHEDULE A
SEE INSTRUCTIONS ON REVERSE through 10/1812014
Page 4 of 7
NAME OF FILER
I.D. NUMBER
MC COY FOR COUNCIL 2014, ROBERT
1369332
DATE
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR
CONTRIBUTOR
IF AN INDIVIDUAL, ENTER
AMOUNT
CUMULATIVE TO DATE
PER ELECTION
RECEIVED
{IF COMMIT FF,ALSOENTER�.D.NUMRER)
CODE *
OCCUPATION AND EMPLOYER
RECEIVED THIS
CALENDAR YEAR
TO DATE
FSELF- EMPLOYED ENTER NAME
of BUSiNEss)
PERIOD
(JAN. 1 - DEC. 31)
(IF REQUIRED)
10114/2014
Dominic Chan
KIND
❑ COM
Retired
2000.00
2000.00
19820 Portal Plaza
F] OTH
Cupertino, CA 95014
❑ PTY
❑ SCC
10/14/2014
Cathy Tsang
®❑COD
Homemaker
2000.00
5000.00
758 Loyola Drive
❑OTH
Los Altos, CA 94024
❑ PTY
❑ SCC
❑IND
❑ COM
❑ OTH
❑ PTY
❑ SCC
❑IND
❑ cOM
❑ OTH
❑ PTY
❑ scC
❑ IND
❑ COM
❑ OTH
El PTY
❑ SCC
SUBTOTAL $
Schedule A Summary 'Contributor
Codes
1. Amount received this period - contributions of $100 or more. IND - Individual
(Include all Schedule A subtotals.) ............ $ 4000.00 COM — RecipientCommittee
(other than PTY or SCC)
2. Amount received this period - unitemized contributions of less than $100 ...................... ... ._. $ 0 OTH —Other
PTY— Political Party
3. Total monetary contributions received this period. SCC -Small Contributor committee
(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1. ..... TOTAL $ 4000.00
FPPC Form 468 (Junel01)
FPPC Toll -Free Helpline: 8661ASK -FPPC
Schedule B - Part 1
Loans Received
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
MC COY FOR COUNCIL 2014, ROBERT
FULL NAME, STREET ADDRESS AND ZIP CODE
OF LENDER
(IFCOMMITTEE, ALSO ENTER. I.D, NUMBER)
Blossom McCoy
TX IND ❑ COM ❑ OTH ❑ PTY ❑ SCC
t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC
t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC
Type or print in ink.
Amounts may be rounded
to whole dollars.
Statement covers period
from 10/01/2014
through
10/18/2014
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(IF SELF-EMPLOYED, ENTER
NAME OF BUSINESS)
OUTSTANDING
BALANCE
BEGINNING THIS
PERIOD
AMOUNT
RECEIVED THIS
PERIOD
(Cl
AMOUNT PAID
OR FORGIVEN
THIS PERIOD
OUTS AdNDING
BALANCE AT
CLOSE OF THIS
PERIOD
(e)
INTEREST
PAID THIS
PERIOD
Manager
❑ PA'D
ORIGINAL
CUMULATIVE
Ben Shyy DDS
CONTRIBUTIONS
LOAN
$ 0
S 5500.00
0 y
❑ FORGIVEN
PER ELECTION`"
RATE
DATE INCURRED
$ 2000.00
3500.00
0
09/30/2015
5
PER ELECTION ""
DATE DUE
DATEINCURRED
CALENDAR YEAR
❑ PAID
PER ELECTION'"
S
DATE INCURfif =D
❑ FORGIVEN
RATE
DATE DUE
❑ PA0
$
$
h
❑ FORGIVEN
RATE
$
5
5
$
DATE DUE
SUBTOTALS $ 3500.00 $
Schedule B Summary
I. Loans received this period ........................ ...............................
(Total Column (b) plus unitemized loans less than $100.)
2. Loans paid or forgiven this period ...................................................... .... ......... ..................
(Total Column (c) plus loans under $100 paid or forgiven.)
(Include loans paid by a third party that are also itemized on Schedule A.)
3. Net change this period. (Subtract Line 2 from Line 1.) ................................ ...............................
Enter the net here and on the Summary Page, Column A, Line 2.
$
0 $ 5500.00 $ 0
(Enter (e) on
Schedule E, Line 3)
3500.00
0
NET $ 3500.00
(May be a negative number)
T Contributor Codes
IND— Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other PTY —Political Party SCC — Small Contributor Committee
SCH EDU LE B -PART I
5
7
Page
of
I.D. NUMBER
1369332
(91
ORIGINAL
CUMULATIVE
AMOUNT OF
CONTRIBUTIONS
LOAN
TO DATE
CALENDAR YEAR
$
PER ELECTION`"
S
DATE INCURRED
CALENDAR YEAR
$
5
PER ELECTION ""
5
DATEINCURRED
CALENDAR YEAR
PER ELECTION'"
S
DATE INCURfif =D
"Amounts forgiven or paid by
another party also must be
reported on Schedule A.
" If required.
FPPC Form 460 (Junel01)
FPPC Toll -Free Helpiine: 866/ASK-FPPC
Schedule C
Nonmonetary Contributions Received
SEE iNSTRLICTIONS ON REVERSE
IVh4IVIt: UII r ILtK
MC COY FOR COUNCIL. 2014, ROBERT
DATE FULL NAME, STREET ADDRESS AND
RECEIVED ZIP CODE OF CONTRIBUTOR
(IF COMMITTEE, ALSO ENTER E , NUMBEP,)
10/6/20141 Michael Zuc
Type or print in ink.
Amounts may be rounded
to whole dollars.
Statement covers period
from 10101/2014
10/18/2014
Through Page 6 of 7
CONTRIBUTOR
IFAN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
DESCRIPTION OF
CODE *
IF SELF - EMPLOYED, ENTER
GOODS OR SERVICES
AMOUNTi
NAME OF BUSINESS
PER ELECTION
®IND
DATE
TO DATE
❑ COM
Self Employed
Food for
MOTH
Zuc' Frontyard BBQ
fundraiser
❑ PTY
700.00
[]SCC
711 ND
❑ COM
❑ OTH
❑ PTY
❑ SCC
MIND
❑COM
❑ OTH
❑ PTY
❑ SCC
❑ IND
❑ COM
❑ OTH
❑ PTY
❑ SCC
Attach additional information on appropriately labeled continuation sheets.
Schedule C Summary
1. Amount received this period — nonmonetary contributions of $100 or more.
(Include all Schedule C subtotals.) ..................................................... ...............................
2. Amount received this period — unitemized nonmonetary contributions of less than $100 ....
3. Total nonmonetary contributions received this period.
(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.) ...
SUBTOTAL $
... TOTAL $
C
700.00
700.00
0
700.00
'Contributor Codes
IND— Individual
COM — Recipient Committee
(other than PTY or SCC)
OTH — Other
PTY-- Political Party
SCC —Small Contributor Committee
FPPC Form 460 (June/01)
FPPC Tall -Free Helpline: 866 /ASK -FPPC
I.D. NUMBER
1369332
AMOUNTi
CUMULATIVE TO
PER ELECTION
FAIR MARKET
DATE
TO DATE
VALUE
CALENDAR YEAR
(JAN 1 - DEC 31 )
(IF REQUIRED}
700.00
700.00
700.00
700.00
0
700.00
'Contributor Codes
IND— Individual
COM — Recipient Committee
(other than PTY or SCC)
OTH — Other
PTY-- Political Party
SCC —Small Contributor Committee
FPPC Form 460 (June/01)
FPPC Tall -Free Helpline: 866 /ASK -FPPC
Schedule E
8715.88
Type or print in ink.
SCHEDULEE
Payments Made
Amounts may be rounded
............ $
Statement covers p eriod
CALIFORNIA '
8715.88
to whole dollars.
10/01/2014
'
from
SEE INSTRUCTIONS ON REVERSE
through 10/18/2014
7 7
Page of
NAME OF FILER
I.D. NUMBER
MC COY FOR COUNCIL 2014, ROBERT
1369332
CODES: If one of the following codes accurately describes the payment, you may enter the code.
Otherwise, describe the payment.
CMP campaign paraphemalialmisc.
MBR
member communications
RAID radio airtime and production costs
CNS campaign consultants
MTG
meetings and appearances
RFD returned contributions
CTB contribution (explain nonmonetary)*
OFC
office expenses
SAL campaign workers' salaries
CVC civic donations
FIL candidate filing /ballot fees
PET
petition circulating
TEL t.v. or cable airtime and production costs
FND fundraising events
PHO
phone banks
TRC candidate travel, lodging, and meals
IND independent expenditure supporting /opposing others (explain)*
ROL
POS
polling and survey research TRS staff /spouse travel, lodging, and meals
postage, delivery and messenger services TSF transfer between committees of the same candidatelsponsor
LEG legal defense
LT
PRO
professional services (legal, accounting)
VOT voter registration
campaign literature and mailings
PRT
print ads
WEB information technology costs (internet, e-mail)
NAME AND ADDRESS OF PAYEE
(FCOMMITTEE,ArsOEnnEai0.NUMSSt CODE OR DESCRIPTION OF PAYMENT
Akido Printing
Target
* Payments that are contributions or independent expenditures must also be summarized on Schedule D.
Schedule E Summary
1. Payments made this period of $100 or more. (include all Schedule E subtotals.) ........................................ ............................... .
2. Unitemized payments made this period of under $100 .................................................................................. ................... ............
3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column ( e).) ....................... ...............................
4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) .................
AMOUNT PAID
8315.98
399.90
SUBTOTAL $
8715.88
$
8715.88
$
0
............ $
0
TOTAL $
8715.88
FPPC Form 460 (June /01)
FPPC Toll -Free Helpiine: 866/ASK-FPPC