410 Statement of Organization Recipient Committee - AmendmentStatement of Organization
DJI.,Sr mp
CALIFORNIA
Recipient Committee
410
FORM
Statement Type El initial ® Amendment ❑Termination —See Part 5
rornfflrlaIU-onlf
Q Not yet qualified
01
0 Date threshold
ECEI VED
qualificaiion met Date qualification threshold met Date of termination
yKirsten Squarcia at 2:57 pm, Oct 19, 202
- I.D. Number
2. Treasurer and Other PrincipalOfficers
R BBERT MCCOY FOR COUNCIL 2020
BLOSSOM MCCOY
srRl I r nncRr ,s (Nn roc ruxl
CUPERTINO CA 95104
- " Slf.:r /IF WD[ ARIA, OIJTIPHONL
3VAMr or As S'S,ANr 1p'A. Jkl P., IF ANV
CUPERTINO CA 95014
1IA, IN, 1,, pLl-!,i
STRrf1ADF)%t r1DPo FOX)
CITY .i',IF .'Ii, .__.A A r-_i I, %
.. !'„I• �,, r�I; 11F lllklsol; 11011 WIiTRL LOMMI I IFL SAC 1111
NAME OF PFINLIPAk OF FI( E Ri Si
STP F ET ADDRESS (No P D B(7RI
Attach additional information on appropriately labeled continuation sheets.
3. Verification
SDIT .
CIrY i. :IPIL.)I A-11A1ODL PI _�NI
1 have used an reasonaoie diligence In pr
penalty of perjury under the laws of the
October 19, 2020
EsecutF-d a❑ By
rfe�I�tcd an
LRec,t,J on
F«•oJ'ed cn
UnIE
October 19, 2020
By
Dail
By
ML-NAiLI910I LUNIROLIINC, DFFICi110LDl 11 1ANOIDAII, l 1R 1TAIr 191A5UkL 1'Rll�Oi:GNI
By
SIGNATLIHF NI CGNTROI IN( C,1 W I wl ill H, ( ANI)II),7: 4, OR STATL MCAiu R; RROFCNFNS
plete. I certmfy under
FPPC Form 410 (August/2018)
FPPC Advice: advicePfppc.ca.gov (866/275-3772)
www.fppc.ca.gov