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460 Recipient Committee Campaign Statement - Semi Annual 1-1-17 to 6-30-17Recipient Committee Campaign Statement Corner Page SEE INSTRUCTIONS ON REVERSE Statement covers period from 01/01/2017 through 06/30/2017 1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure O State Candidate Election Committee Committee O Recall O Controlled (AW C-Ompial?Pan5) O Sponsored (Also C-pfefe Part 6) ❑ General Purpose Committee O Sponsored ❑ Primarily Formed Candidate/ O Small Contributor Committee Officeholder Committee O Political Party/Central Committee (AW CO PiLlPan7) 3. Committee Information LD_ NUMBER 1309332 MC COY FOR COUNCIL 2018, ROBERT STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE MAILING ADDRESS (IF DIFFERENT) NO, AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODEIPHONE OPTIONAL FAX / E-MAILADDRESS 4. Verification COVER PAGE Date Stamp Date of election if applicab ! ' of (Month, Day, Year) �ff For Official Use Only JUL� J 2m7 —• •—• ri � .oyt3 Lit I r CJ�[i'€� 2. Type of Stateme ❑ Preelection Statement ❑ Quarterly Statement 2 Semi-annual Statement ❑ Special Odd -Year Report ❑ Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) 4 Treasurer(s) NAME OF TREASURER BLOSSOM MCCOY MAIL€NG ADDRESS CITY STATE ZIP CODE AREA CODEIPHONE NAME OFASSISTANTTREASURER, IFANY MAIUNGADDRESS CITY STATE ZIP CODE AREACODE/PHONE OPTIONAL FAX! E-MAILADDRESS I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained certify under penalty of perjury under the laws of the State of California that the foregoing is true and By - Signature ofContrnlling Oifieehplder, Candidate, State Measure Proponent By Signature of COnfroBing Officeholder, Candidate, State Measure Proponent FPPC Form 460 (Jan/2016) FPPC Advice: advlceOfppc.ca.gov (866/275-3772) U#WW.fnnr_ra-0eV Recipient Committee Campaign Statement Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE ROBERT MCCOY OFFICE SOUGHT OR HELD (INCLUDE LOCATIONAND DISTRICT NUMBER IFAPPLICABLE) 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 con tTofie d by you or are primarily fonned to receive contributions or make expenditures on behaff of your candidacy. COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODEIPHONE COMMITTEE NAME LU, NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ ND COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODEIPHONE 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 CandidatelOfficeholder 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.fppe.ca.gov Campaign Disclosure Statement Amounts may be rounded to whole dollars. Summary Page Statement coders period from 01/0112017 SUMMARY PAGE Expenditures Made 6. Payments Made................................................................ Schedule E, Line 4 06/30/2017 3 4 $ 96.00 7. Loans Made, ...................................................................... schedule H, Line 3 0 through S. SUBTOTAL CASH PAYMENTS .......................................... Add Lines e+7 Page of SEE INSTRUCTIONS ON REVERSE $ 96.00 9. Accrued Expenses (Unpaid Bills) ......................... ...... schedule F tine 3 0 0 10_ NOnmonetary Adjustment......................................................... Schedule C, Line 3 NAME OF FILER 0 0 11. TOTAL EXPENDITURES MADE ........................................ Add Limes s + 9 + 10 $ I.D. NUMBER MC COY FOR COUNCIL 2018, ROBERT Current Cash Statement, 1369332 Contributions Received 1352.45 Column A TOTALTHIS PERIOD Column B Calendar Year Summary for Candidates 0 add amounts in Column (FROM ATTACHED SCHEDULES) CALENDAR YEAR TOTAL TO DATE Dunning in Both the State Primary and A to the corresponding 14. Miscellaneous Increases to Cash .................................. schedule 1, Line 4 General Elections 15. Cash Payments ......................................................... Column A, Line 8 above 0 0 1. Monetary Contributions.... ... ........................................... Schedule A, Line 3 $ $ 16. ENDING CASH BALANCE ..................Add Lines 12+ 13 + 14, then subtract Line 15 $ 1256.45 be negative figures that 0 O 111 through 6130 711 to Date 2. Loans Received ......................... .. Schedule B, Line 3 previous period amounts. If 0 0 20. Contributions 3. SUBTOTAL CASHCONTRIBUTIONS—........................... Add Lines l+2 $ $ 0 Received $ $ 0 0 Cash Equivalents and Outstanding Debts 4. Nonmonetary Contributions ............................................ schedule C, Line 3 0 any)' 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ........................... ......... Add Lines 3+4 $ 0 $ 0 Made $ $ 0 Expenditures Made 6. Payments Made................................................................ Schedule E, Line 4 $ 96.00 $ 96.00 7. Loans Made, ...................................................................... schedule H, Line 3 0 0 S. SUBTOTAL CASH PAYMENTS .......................................... Add Lines e+7 $ 96.00 $ 96.00 9. Accrued Expenses (Unpaid Bills) ......................... ...... schedule F tine 3 0 0 10_ NOnmonetary Adjustment......................................................... Schedule C, Line 3 0 0 11. TOTAL EXPENDITURES MADE ........................................ Add Limes s + 9 + 10 $ 96.00 $ 96.00 Current Cash Statement, 12. Beginning Cash Balance""""""""""........ Previous summary Page, Line 16 $ 1352.45 To calculate Column B, 13. Cash Receipts........................................................... Column A, Line 3 above 0 add amounts in Column 0 A to the corresponding 14. Miscellaneous Increases to Cash .................................. schedule 1, Line 4 amounts from Column B 15. Cash Payments ......................................................... Column A, Line 8 above 96.00 of your last report. Some amounts in Column A may 16. ENDING CASH BALANCE ..................Add Lines 12+ 13 + 14, then subtract Line 15 $ 1256.45 be negative figures that should be subtracted from if this is a termination statement, fine 16 must be zero, previous period amounts. If this is the first report being 17. LOAN GUARANTEES RECEIVED.. ............................. Schedule B, Part 2 $ 0 filed for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if Cash Equivalents and Outstanding Debts 0 any)' 18. Cash Equivalents ................................................ see instructions on reverse $ 19. Outstanding Debts .......... ,................... Add Line 2 + Line 9 in Column B above $ 0 Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (if Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mmfddfyy) I I $ Amounts in this section may be different from amounts reported in Column S. 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 MC COY FOR COUNCIL 2018, ROBERT Amounts may be rounded to whole dollars. SCHEDULE E Statement covers period CALIFORNIA from 01/01/2017 FORM through 06/30/2017 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 campaign paraphernalia/mist. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonrnonetary)* OFC office expenses SAL campaign workers'salaries CVC civic donations PET petition circulating TEL t.v, or cable airtime and production costs FIL candidate filing/ballot fees PHO phone banks TRC candidate travel, lodging, and meals FND fundraising events POL palling and survey research TRS staftlspouse travel, lodging, and meals IND independent expenditure supportinglopposing others (explain)* POS postage, delivery and messenger services TSF transfer between committees of the same candidatefspansor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads VVEB information technology costs (internet, e-mail) NAME AND ADDRESS OF PAYEE i[F COMMITTEE, ALSO ENTER I.D. NUMBER) BANK OF AMERICA CODE OR DESCRIPTION OF PAYMENT SERVICE FEES * 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.). ....•................................ $ ....................................... $ ....................................... $ AMOUNT PAID •. 8 3 TOTAL $ 96"00 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov