460 Recipient Committee Campaign Statement - Semi-Annual 10-23-16 - 12-31-16 Recipient: Committee COVER PAGE
m r(7, 1 . -Campaigit'i Statement
Cover Page
SEE INSTRUCTIONS ON REVERSE
Statement covers period Date of election if applic061 JAN „ 2017 I P.ge ' of
from
10/23/2016 (Month,Day,Year For Official"Use Only
12/31/2016 11108/ :'016 CU E�� r` , CST
through _ Y CLERK 1
I. Type of Recipient Committee: All Committees Complete Parts 1,2,c.,and 4.
Officeholder,Candidate Controlled Committee ❑ Primarily Formed Ballot Measure
O State Candidate Election(_':ommittee Committee
O Recall O Controlled
(AlsoComplee Part 5) O Sponsored
❑ General Purpose Committee (Also Complete Part 6)
O Sponsored ❑ Primarily Formed Candidate/
O Small Contributor Committee Officeholder Committee
0 Political Party/Central Committee (Also Complete Part 7)
3. Committcle Information I I.D.NUMBER
136933:
MC COY FOR COUNCIL;,'016, ROBERT
STREETADDP'.:ESS(NO P.O.BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
MAIL]NGADDTtESS(IF DIFFERENT)NE AND STREET OR P.O.F37
CITY STATE ZIP CODE ARIA CODE/PHONE
OPTIONAL: F;'sX/E-MAIL ADDRESS
2. Type of:statement:
❑
Preelection Statement
(�
Semi-annual Statement
❑
Termination Statement
(Also fille a Form 410 Termination)
❑
Amendment(Explain below)
❑ Quarterly Statement
❑ Special Odd-Year Report
Treasurer(s)
NAME UTOF TRUSURER
Blossom McCoy
MAILING ADDRESS
CITY STATE ZIF-CODE AREA CODE/PHONE
NAME OF ASST:,TANTTREASURER,IFA-JY
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE
OPTIONAL: FA:>;/E-MAILADDRESS
4. Verificaticln
I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein
By __ ,
Signature of Controlling Offireholder,Candidate,State Measure Proponent
BY ..
Signature of Controlling Offiva holder,Candidate,State M2a5Ure Proponent
FPPC Form 460(Jan/2016)
FPPC Advice:advice @fppc.ca.gov(866/275-3772)
%&"MW.fnnr_ra.uov
Recipient Committee
Campaign Statement
Cover Nige — Part 2
5. Officeholder or Candidate. Controlled Committee
NAME OF OFFICEHOLDER OR CANDIDATE
ROBERT MCCOY
Ur-ICE SUUI iH I OR HELD(INCLUDE LOCATION AND DISTRICT NUMBER IF APPLII::ABLE)
CUPERTINO CITY COUN(1111-
RESIDENTIAL/BUSINESS ADDRESS (NO.AND STREET) CITY STATE ZIP
Related Committees Not Included in this.:statement: List any committees
not includes[in this statement thad.are controlled byyoj,l or are primarily formed to receive
contributions or make expenditur=.rs on behalf of your candidacy.
COMMITTEE
E
I.D.NUMBER
NAME OF TREASURER CONTROLLED COMMITTEE?
❑ YES [,] NO
COMMITTEEFtiDDRESS STREETADDRESS (NO P.O.BOX)
CITY STATE ZIP CO DE AREA CODE/PHONE
COMMITTEE NAME I.D.NUMBER
NAME OF TRhLASURER CONTROLLED COMMITTEE?
❑ YES 0 IVO
COMMITTEE RsDDRESS
STREET ADDRESS (NO P.G.BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
COVER PAGE-PART 2
Page 2 of 5
6. Primarily Formed Ballot Measure Committee
NAME OF BALU.DT MEASURE "
BALLOT NO.OF!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 AN"
7. Primarily Formed Candidate/Officeholder Committee List narries of
officeholder(sj or candidate(s)for which this committee h;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 CANDII:JATE
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)
w1Nw.fppc.ca.gov
Campaigrli Disclosure Statement
Summary Page
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
MC COY FOR COUNCIL 2016, ROBERT
Contributions Received
1. Monetary Contributions................................................... Schedule A,Line $
2. Loans Received................................................................ Schedule B,Line 3
3. SUBTOTAL,,CASH CONTRIBUTIONS................................. Add Lines I+2 $
4. Nonmoneta ry Contributions............................................ Schedule C,Line 3
5. TOTAL CONTRIBUTIONS RECEIVED...................................Add Lines 3+4 $
Amounts may be rounded
to whole daollars.
Column i#
TOTAL THIS PERIOD
(FROM ATTACHED SCHI::DULES)
4100.00
0
0 $
0
400.00 $
Statement covers period
from 10/23/2016
through
Column
CP.LENDAR YEAR
TOTAL TO DATE
400.00
0
0
0
400.00
Expenditures Made
6. Payments IMade................................................................
Schedule e,Line 4 $
98.00 $
462.88
7. Loans Made................................................................... ...
Schedule H,Line 3
0
0
8. SUBTOTAL.CASH PAYMENTE:............................................
Add Lines 6+7 $
98.00 $
462.88
9. Accrued Expenses (Unpaid Bilks).........................................
Schedule F Line 3
0
0
10. Nonmonetary Adjustment.........................................................
Schedule C,Line 3
0
0
11. TOTAL EXPENDITURES MADE.,......................................
Add Lines 8+9+10 $
98.00 $
462.88
If this is a te,mination statement, Line 16 must be zero.
Current Ci.i.sh Statement
12. Beginning Crash Balance............................ Previous Summary Page,Line 16
$
10,50.45
13. Cash Receipts........................................................... Column A,Line 3 above
400.00
To calculate Column B,
add amounts in Column
14. Miscellanec:Ius Increases to Cash.................................... Schedule 1,Line 4
0
Ato the corresponding
amounts from Column B
15. Cash Payments......................................................... Column A,Line 8 above
98.00
of your last report. Some
16. ENDING CASH BALANCE ..................Add Lines 12+13+14,then subtract Line 15
$
1352.45
amounts in Column A ma y
be negative figures that
If this is a te,mination statement, Line 16 must be zero.
should be subtracted from
previous period amounts. If
_
this is the first report being
17. LOAN GUARANTEES RECEI%I ED................................ Schedule B.Part 2
$
0
filed for this calendar year,
�.
Cash Equivalents and Outstanding Dt:.lbts
only carry over the amounts
from Line,:.2,7,and 9(if
18. Cash Equivalents..................... .......................... sev instructions on reverse
$
0
any),
19. Outstandinq Debts.............................. Add Line 2+line 9 in Column B above
$
0
SUMMARY PAGE
YID
12/31/2016 _ page 3 of 5
I.D.NUMBER
1369332
C-alendar Year Summary for Candidates
(Running in Both the State Primary and
General Elections
'11 through 6/30 7/1 to Date
20, Contributions
Received $., $_
21. Expenditures
Made $
I (Expenditure Limit Summary for:,`Rate
Candidates
22. Cumu Native Expenditures Made*
(If Subject to Voluntary Expenditurr,Limit)
Date of Election Total to Date
(mm/dd/yy)
Arnounts in this section may be different froim amounts
eported in Column B.
FPPC Form 460(Jan/2016)
FPPC Advice:advice @fppc.ca.gov 1866/275-3772)
%,lxw.fppc.ca.gov
Schedule A
■._
Amounts may be rounded
SCHEDULE A
mviiwi.cc11y L►vikriFJLIE10n5 Kecelv'ea
Statement covers period
IIII�
•
from 10/23/2016
SEE IINSTRUCTIONS NS ON REVERSE,
through 12/31/2016
.-
4
Page Of 5
NAME OF FILER
I.D.NUMBER
M C C0Y FOR COUNCIL 2016, ROBERT
1369332
DATE
FULL NAME,STREET ADDRESS AND 2:IP CODE OF CONTRIBUTOR
CONTRIBUTOR
IF AN INDIVIDUAL,ENTER
AMOUNT
CUMULATIVI!ii.TO DATE
PER E=LECTION
RECEIVED
(IF COMMITTEE,ALSO ENTER I.D.NUMBER)
CODE *
OCCUPATION AND EMPLOYER
RECEIVED THIS
CALENDAR YEAR
10 DATE
-.
(IF SELF-EMPLOYEE) ENTER NAME
OF BUSIN,I-iSS)
PERIOD
(JAN.1-I,EC.31)
(IF R L=QUIRED)
Fang Liu
IND
—
2016
501 Moorpark Way SPC. 12°3
0OTH Server
200.00
2(:10.00
Mountain View, CA 94041
❑PTY
Tokyo Sushi
❑SCC
Alice Cao
IND
11/3/2016
12301 Saraglen Drive
❑CoM
❑OTH
Dentist
200.00
2+:10.00
Saratoga, CA 95070
❑PTY
Terry Kinaga
❑SCc
❑IND
❑COM
❑OTH
❑PTY
❑SCC
❑IND
❑COM
❑OTH
❑PTY
❑SCC
❑IND
❑COM
❑OTH
❑PTY
❑SCC
SUBTOTAL$ 400.00
Jcneauie A Sufi mart'
1. Amount received this period—itemized monetary contributions.
(Include all Schedule A subtotals.)...........................................................................................................$
2. AmOLInt received this period—unitemized monetary contributions of less thraln $100............................$
3. Total monetary contributions received this period.
(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.)......................"!TOTAL $
400.00
I
400.00
*Contributor Codes
IKID—Individual
CIDM—Recipient Committee
(other than PTY or SCC)
O�'IFH—Other(e.g.,business entity)
P"I"Y—Political Party
S':;C—Small Contributor Committee
FPPC Form 1'60(Jan/2016)
FPPC Advice:a:Nice @fppc.ca.gov(13.66/275-3772)
wv,rw.fppc.ca.gov
Schedule
Payments IUlade
SEE INSTRUCTIONS.ON REVERSE
MC COY FOR COUNCIL 20118, ROBERT
Amounts may be rounded
to whole dollars.
Statement covers period
from__ 10/23/2016
through
12/31/2016
SCHEDULE E
Page 5 of 5
I.D.NUMBER
1369332
CODES: If one of the following codes accurately describes the i;aayment, you many enter the code.,
Otherwise, describe the paymenil—
CMP
CNS
campaign paraphernalia/misc.
campaign consultants
MBR
member communicalions
RAD
radii:.airtime and production costs
CTB
contribution(explain nonmonetary)*
MTG
OFC
meetings and appearances
office expenses
RFD
returned contributions
CVC
FIL
civic donations
candidate filling/ballot fees
PET
petition circulating
SAL
TEL
campaign workers'salarieS
t.v.or cable airtime and production costs
FND
fundraising events
PHO
POL
phone banks
polling and survey research
TRC
cawilidate travel,lodging,and meals
IND
independen-I expenditure supporting/opposing others(explain)*
POS
postage,delivery and messenger services
TRS
TSF
stafFspouse travel,lodging,and meals
transfer
LEG
legal defense
PRO
professional services(legal,accounting)
VOT
between committees of the same candidate/sponsor
p onsor
voter registration
LIT
campaign literature and mailings
PRT
print ads
WEB
information technology costs(internet,e-mail)
NAME P,ND ADDRESS OF FAYE E
(IF COMMI-ITEE,ALSO ENTER I.D.NUM_'ER) CODE:... OR DESCRIPTION OF PAYMENT Al%,IOUNT PAID
BANK OF AMERICA SERVICE FEES
48.00
SECRETARY OF STATE
*Payments that are contributions or independent expenditure:, must also be summarized on Schedule D. ;?UI3TOTAL$
98.00
Schedule E Summary
1. Itemized payments made this period. (Include III Schedule E sul:Itotals.)................. $ 98.00
2. Unitemized payments made this period of under$100.................. 0
3. Total interest:paid this period On loans. (Enter amount from Schedule B, Part 1, Cc)lumn (e).)............................................................................. $ 0
4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Cc 1umn A Line 6.)........................... ° OTAL $ 98.00
FPPC Form 460(Jan/2016)
FPPC Advice:at:Nvice @fppc.ca.gov(866/275-3772)
WM.F'w.ffppc.ca.gov