The URL can be used to link to this page

460 Recipient Committee Campaign Statement 7-1-15 to 12-31-15Recipient Committee Campaign Statement Cover Page Statement covers period from 07/01/2015 SEE INSTRUCTIONS ON REVERSE through 12/31/2015 1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. W1 Officeholder, Candidate Controlled Committee O State Candidate Election Committee O Recall (Also Complete Part 5) ❑ General Purpose Committee O Sponsored O Small Contributor Committee O Political Party /Central Committee ❑ Primarily Formed Ballot Measure Committee O Controlled O Sponsored (Also Complete Part 6) ❑ Primarily Formed Candidate/ Officeholder Committee (Also Complete Part 7) 3. Committee Information I 136933 I.D. NUMBER ' COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) MC COY FOR COUNCIL 2016, ROBERT STREETADDRESS (NO P.O. CITY STATE ZIP CODE AREA CODE /PHONE Cupertino CA 95014 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODE /PHONE OPTIONAL: FAX/ E- MAILADDRESS Date Stamp L -(( II-1>dW Date of election if appli (Month, Day, Year) COVER PAGE 1 of 4 Official Use Only U U JAN 1 9 2016 U 11!08/2016 2. Type of Statement' tatemen n i ,, i I cttm ❑ Preelection Statement ❑ Quarterly Statement 2 Semi - annual Statement ❑ Special Odd -Year Report ❑ Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) Treasurer(s) NAME OFTREASURER Blossom McCoy MAILING ADDRESS CITY STATE ZIP CODE AREA CODE /PHONE Cupertino CA 95014 ( NAME OF ASSISTANT TREASURER. IFANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX/ E- MAILADDRESS 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 January 13, 2016 B Date y Soonsor Executed on By Date Signature of Controlling Officeholder, Candidate, State Measure Proponent Executed on By Date Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (Jan/2016) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fnnc.ca.onv Recipient Committee Campaign Statement Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee JAME OF OFFICEHOLDER OR CANDIDATE Robert McCoy OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) Cupertino City Council RESIDENTIAL/BUSINESSADDRESS (NO.ANDSTREET) CITY STATE ZIP Cupertino CA 95014 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? El YES El NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODE /PHONE UUMMI I I LE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? [:]YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE COVER PAGE - PART 2 Page 2 of 4 6. Primarily Formed Ballot Measure Committee NAME 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 Candidate /Officeholder Committee Listnames 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 (Jan/2016) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Campaign Disclosure Statement Amounts may be rounded Summary Page to whole dollars. from Statement covers period 07/01/2015 SUMMARY PAGE Expenditures Made 798.87 6. Payments Made ................................. ............................... Schedule E, Line 4 $ 7. Loans Made ........................................ ............................... 12/31/2015 3 4 SEE INSTRUCTIONS ON REVERSE 9. Accrued Expenses (Unpaid Bills) ........... ............................... Schedule F Line 3 10. Nonmonetary Adjustment .......................... ............................... through 11. TOTAL EXPENDITURES MADE ....................... .................AddLines8 Page of NAME OF FILER I.D. NUMBER MC COY FOR COUNCIL 2016, ROBERT 1369332 Contributions Received Column A Column B Calendar Year Summary for Candidates TOTALTHIS PERIOD (FROM ATTACHED SCHEDULES) CALENDAR YEAR TOTAL TO DATE Running in Both the State Primary and 1. Monetary Contributions 0 5000.00 General Elections .................... ............................... schedule A, Line 3 $ $ 2. Loans Received ................................. ............................... Schedule B, Line 3 0 - 3500.00 1/1 through 6/30 7/1 to Date 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 +2 0 $ $ 1500.00 20. Contributions Received $ $ 4. Nonmonetary Contributions ............. ............................... Schedule C, Line 3 0 0.00 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ........ ............................Add Lines 3 +4 $ 0 $ 1500.00 Made $ $ Expenditures Made 798.87 6. Payments Made ................................. ............................... Schedule E, Line 4 $ 7. Loans Made ........................................ ............................... Schedule H, Line 3 8. SUBTOTAL CASH PAYMENTS ........... ............................... Add Lines 6 +7 $ 9. Accrued Expenses (Unpaid Bills) ........... ............................... Schedule F Line 3 10. Nonmonetary Adjustment .......................... ............................... schedule C, Line 3 11. TOTAL EXPENDITURES MADE ....................... .................AddLines8 +9 +10 $ Current Cash Statement 12. Beginning Cash Balance ............................ Previous summary Page, Line 16 $ 13. Cash Receipts ............................ ............................... column A, Line 3 above 14. Miscellaneous Increases to Cash ... ............................... schedule 1, Line 4 15. Cash Payments .......................... ............................... Column A, Line 8 above 16. ENDING CASH BALANCE ..................Add Lines 12 + 13 + 14, then subtract Line 15 $ If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED . ............................... Schedule B, Part 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................. ............................... See instructions on reverse $ 19. Outstanding Debts .............................. Add Line 2 + Line 9 in Column B above $ 130.00 $ 798.87 0 0 130.00 $ 798.87 0 0 0 0 130.00 $ 798.87 1545.33 0 0 130.00 1415.33 I U A To calculate Column B, add amounts in Column Ato the corresponding amounts from Column B of your last report. Some amounts in Column A may be negative figures that should be subtracted from previous period amounts. If this is the first report being filed for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if any). IExpenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (If Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mm /dd /yy) -I J $ 1 1 $ *Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (Jan /2016) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER MC COY FOR COUNCIL 2016, ROBERT Amounts may be rounded to whole dollars. Statement covers period from 07/01/2015 through 12/31/2015 SCHEDULE E Page 4 of 4 I.D. NUMBER 1369332 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP CNS campaign paraphernalia /misc. campaign consultants MBR member communications RAD radio airtime and production costs CTB contribution (explain nonmonetary)* MTG OFC meetings and appearances RFD returned contributions CVC civic donations PET office expenses SAL campaign workers' salaries FIL candidate filing /ballot fees PHO petition circulating TEL t.v, or cable airtime and production costs FND fundraising events POL phone banks TRC candidate travel, lodging, and meals IND independent expenditure supporting /opposing others (explain)* POS polling and survey research postage, delivery and messenger services TRS TSF staff /spouse travel, lodging, and meals LEG legal defense PRO professional services (legal, accounting) VOT transfer between committees of the same candidate /sponsor LIT campaign literature and mailings PRT print ads voter registration WEB information technology costs (internet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMM ITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT Bank of America Service Fees Cupertino, CA 95014 Secretary of State FIL Sacramento, CA 95814 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ Schedule E Summary 1. Itemized payments made this period. (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.) ........................... TOTAL $ AMOUNT PAID :I IM 50.00 130.00 130.00 0 0 130.00 FPPC Form 460 (Jan /2016) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov