460 Recipient Committee Campaign Statement - Semi Annual 7-1-21 to 12-31-21Recipient Committee COVER PAGE
Campaign Statement Date Stamp CALIFORNIA
I
Cover Page '
RM
SEE INSTRUCTIONS ON REVERSE
Statement covers period
from 07/01/2021
through 12/31/2021
1. Type of Recipient Committee: All Committees— Complete Parts 1, 29 3, and 4.
Officeholder, Candidate Controlled Committee
❑ Primarily Formed Ballot Measure
3 State Candidate Election Committee
Committee
3 Recall
0 Controlled
(Also Complete Part 5)
O Sponsored
❑ General Purpose Committee
(Also Complete Part 6)
3 Sponsored
❑ Primarily Formed Candidate/
3 Small Contributor Committee
Officeholder Committee
3 Political Party/Central Committee
(Also Complete Part 7)
3. Committee Information
I I.D. NUMBER 1369332
COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE)
Robert McCoy for Council 2020
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREACODE/PHONE
Cupertino CA 95014
MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX
CITY
OPTIONAL: FAX / E-MAIL ADDRESS
STATE ZIP CODE AREACODE/PHONE
Date of election if applicable:
(Month, Day, Year)
11 /03/2020
Filed Date-
01/10/2022 06:51
PM
Page 1 of 3
For Official Use Only
2. Type of Statement:
❑ Preelection Statement ❑ Quarterly Statement
./❑ Semi-annual Statement ❑ Special Odd -Year Report
❑ Termination Statement
(Also file a Form 410 Termination)
❑ Amendment (Explain below)
Treasurer(s)
NAME OF TREASURER
Blossom McCoy
MAILING ADDRESS
CITY STATE
Cupertino CA
ZIP CODE AREACODE/PHONE
95014
NAME OF ASSISTANT TREASURER, IF ANY
MAILING ADDRESS
CITY STATE
ZIP CODE AREACODE/PHONE
OPTIONAL: FAX / E-MAIL ADDRESS
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 01/10/2022 By
Date Signature of Treasurer or Assistant Treasurer
Executed on
01 /10/2022
Date
Executed on
Date
Executed on
Date
By
Signature of Controlling Officeholder, Candidate, State Measure Proponent or Responsible Officer of Sponsor
By
Signature of Controlling Officeholder, Candidate, State Measure Proponent
By
oignacure or uoncrouing urncenoiaer, uanamace, ocace measure rroponenc FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
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 LOCATION AND DISTRICT NUMBER IF APPLICABLE)
RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP
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?
❑YES ONO
COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
COMMITTEE NAME I.D. NUMBER
NAME OF TREASURER CONTROLLED COMMITTEE?
❑YES ONO
COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
COVER PAGE - PART 2
Page 2 of 3
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
Summary Page
Amounts may be rounded
to whole dollars.
Statement covers period
from 07/01/2021
SUMMARY PAGE
SEE INSTRUCTIONS ON REVERSE
through
12/31/2021
Page 3 of 3
NAME OF FILER
I.D. NUMBER
Robert McCoy for Council 2020
1369332
Column A
Column B
Calendar Year Summary for Candidates
Contributions Received
TOTAL THIS PERIOD
CALENDAR YEAR
Running in Both the State Prima and
g Primary
(FROM ATTACHED SCHEDULES)
TOTAL TO DATE
General Elections
1. Monetary Contributions ................................................
Schedule A, Line 3
$
0.00
$
0.00
1/1 through 6/30 7/1 to Date
2. Loans Received............................................................
Schedule a, Line 3
0.00
0.00
3. SUBTOTAL CASH CONTRIBUTIONS .............................
Add Lines 1 +2
$
0.00
$
0.00
20. ContributionsReceived $ $
4. Nonmonetary Contributions .........................................
Schedule C, Line 3
0.00
0.00
21. Expenditures
5. TOTAL CONTRIBUTIONS RECEIVED ............................
Add Lines 3+4
$
0.00
$
0.00
Made $ $
Expenditures Made
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 ...............................
Add Lines 8 + 9 + 10 $
current casn 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 $
0.00 $
385.00
0.00
0.00
0.00 $
385.00
0.00
0.00
0.00
0.00
0.00 $ 385.00
181.00
To calculate Column B,
0.00
add amounts in Column
A to the corresponding
0.00
amounts from Column B
0.00
of your last report. Some
amounts in Column A may
181.00
be negative figures that
should be subtracted from
previous period amounts. If
this is the first report being
filed for this calendar year,
0.00
only carry over the amounts
from Lines 2, 7, and 9 (if
any).
0.00
In
Expenditure Limit Summary for State
Candidates
22. Cumulative Expenditures Made"
(If Subject to Voluntary Expenditure Limit)
Date of Election Total to Date
(mm/dd/yy)
*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