497 Late Contribution Report
Late Contribution Report
Type or print In Ink.
Amounts may be rounded to whole dollars.
LATE CONTRIBUTION REPORT
Report No.
/
NAME OF FILER
G///?e,..1 !-/ dr; /',.r
AREA CODE/PHONE NUMBER
(1f(J!/ 731- j8 ,/
STREET ADDRESS
J 07 ! s t ~,,/1 .1 vi It/" /l /-<-
CITY 1
(;t/4/1'
Late Contribution(s) Received
['-11 Cd", 'It;'"}
1.0. NUMBER (/fappllcable)
/2 fl/!/j
Date of J J
This Filing
STATE
C4-
ZIP CODE
?5 () IV
o Amendment
to Report No.
(explain below) .
No. of Pages
FUll NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, AMOUNT
DATE ENTER OCCUPATION AND EMPLOYER
RECEIVED (IF COMMITTEE. AlSO ENTER 1.0. NUMBER) CODE * (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) RECEIVED
Sa,,? C 04 " glNO 'e;o ec,.l7~ 12 tJ pC;
Ii eOM
7 If t,.Jr J... ~ ~C1 */, / o OTH A-c ~"''1 tAM//1 ~
L ~ J Ii~) --/ /1/\/ ~ fj 1/ / o PlY
osee o Check if Loan
1~ C~b /,4 G o .INO
~2..:r /. {//YJ/ J IJ~ ..9 eOM FII(;.# 8,0/tJ(P I'S()O
o OTH
LI"i IhJ)J n if tjvcJ '"&0 o PlY
osee o Check if Loan
o INO
o eOM
o OTH
o PlY
osee o Check if Loan
.Contributor Codes
INO -Individual
COM - Reclpienl Committee (other than PTY or SCC)
OTH - Other (e.g., business entity)
PTY - Political Party
SCC - Small Contributor Committee
Reason for Amendment:
FPPC Form 491 (January/OS)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/215-3172)