410 Statement of Organization Recipient Committee - Amendment 2-25-19 Stat�ment of Organization a
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Staternent Type ❑'n�$;a' , #
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Q Date qualification threshoid met Dafe quafification threshold met Dafe o€termination �
-� 1 07 , 30 , 20�4 , , ����R�"1Na C!-C�' ��,E K
1. Committee Information �•D• �umber 2 Treasurer and Other Princi al Officers
(i�applicabte) 1369332 �� ,, � � � ���
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NAME�PCOMMITTEE�� �� NAME OP TREASURER � ��� �
ROBERT MCCOY FOR COUNCIL 2020 BLOSSOM MCCOY
SfREET ADDRESS(NO P.O.$OX)
STREET ADDRE55(At0 P.O.60X)
E-MAILADDRESS(REQUIRED)/FAX(OPTIONAL) CITY STATE ZtPCODE AREACODE/PHONE .
COUNTY OF DOMIQLE JURISDICTION WHERE COMMiTTEE IS ACTIVE NAME OF PRINCIPAL OFFICER(5)
STREET ADDRESS(NO P.O.60X)
CIT.' STATE ZlPCO�E qREACODE/PHONE
Aitach qdditionai information on appropriately labeled continuation sheets.
3. Verification ; , ;
f have used all reasonable diliger�ce in preparing this statement an�to the best of my knowledge the information contained herein is true and complete. I certify under
penalty of perjury under the laws oi the State
CANDIDATE,ORSTATEMEASUREPROPONENT
Executed on gY
DATE 516NATURE OF CONTROLLING OFFICEHOLDER,CANDiDATE,OR STATE MEASURE PROPONENT
Execuied on gy
DATE SIGNATURE OF CO(VTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
���e Form 410{AugU�/2oasa
FRPC Advice:advice@fippc.ca.gov(866/275-3772}
www.�ppc.ca.gov
Statement �f Organization , � . ,
I�e�apient Ca�rrraai�tee e b / 1
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME I.D.NUMBER
ROBERT MCCOY FOR COUNCIL 2Q20
1369332
• RI!co►nmittees must tist the financial insti#ufian where the carzpaigst banlc account is located.
NAME OF FINANQALINSTITUTION
__ _ _. - -_ _ _ - - - _ ;, , ... _�_ .._
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4.T,yp2'O �Comtl7ittee Gornplete the applicabl'e sections.
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• List the name of each controlling officeholder,candidate,or state measure proponent. ff candiaate or ofiiceholder controfled,aiso list tne elective office sought or held,and
district number,if any,and the year ofithe election.
= List the poliiical party with which each officeholder or candidate is aifiiiated or check"nonpartisan:' Stating"[Uo party preference"is acceptable.
• if this committee acts jointly with another cantrolled committee,list the name and ideniification number of the other controlled committee.
ELECTIVE OFFfCE SOUGHT OR HELD YEr^,R OF PARTY
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLEj ELECTION CHECK ONE
Nonpartisan Partisan (lis:political parry below)
ROBERT MCCOY CITY COUNC9� 2020 �✓ �
Nonpartisan Pariisan (list poiitical party below)
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• � • Primarily formed to support or oppose specific candidates or measures in a sing9e election. List�elow:
CANDIDATE(5)NAME OR MEASURE(Sj FULLTITLE(INCLUDE BALLOT NO.OR LETTER) CANDtDATEjS)OFFICE SOUGHT OR HELD OR MEASURE(5)JURISDICTION
IF A RECALL,STATE'RECALL"IN FRONT OF THE OFFICEHOLDER'S NAME. {WCLUDE DISTRItT NO.,CITY OR COUNTY,AS APPLICABLE) criecK ONE
SUPPORT OPPOSE
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SU�T OP�
FPPC Forrta 414(August/2�1&)
GPPC Arlvice:adeeice@fppc.ca.gov(866/2753772)
. www.fppc.ca_gov