497 Contribution Report 97 Contribution Re ort
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497 CONTRIBUTION REPORT
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AREA CODEIPHONE NUM R LD. NUMBER (ilapplicable) Z I
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STREET ADDRESS
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CITY STATE ZIP CODE
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1. Contr bution(s) Received
DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR
' IF AN INDIVIDUAL,
ENTER OCCUPATION AND EMPLOYER AMOUNT
RECEIVED (IFCOMMITTEE.ALSOENTERI.D.NUMBER) CODE
'
(IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) RECEIVED
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^ OTH ^ Check if Loan
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/ ~ l rrowoe interest rate
^ IND ~
^ COM
^ OTH ^ Check if Loan
^ PTY
^ SCC
Provide interest rate
^ IND
^ COM
^ OTH ^ Check if Loan
^ PTY
^ SCC
Provide interest rate
Reason for Amendment:
'Contributor Codes
IND-Individual
COM -Recipient Committee (other than PTY or SCC)
OTH -Other (e.g., business entity)
PTY-Political Party
SCC-Small Contributor Committee
FPPC Form 497 (November/07)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866!275-3772)