497 Late Contribution Report (1)497 Contribution Report
Type or print in ink.
Amounts may be rounded to whole dollars.
NAME OF FILER
IF AN INDIVIDUAL,
ENTER OCCUPATION AND EMPLOYER
AMOUNT
I;VN I illtiU I ON REPORT
DLJIZ5
on Sun for Cupertino City Council 2014
Date of
Phis Filing G �`
t
LS
e =Uenly
AREACODElPHONE NUMBER
I D. NUMBER (ltappicabie)
4082021080
1365260
fieport No.
S�� _ 4 20i
&J,
STREETADDRESS
.
El Amendment
❑ Scc
1131 S. Stelling Rd.
to Report No.
(explain below)
/� C tn�
CUPER f T INO CITY
LERK
CITY STATE ZIP CODE
CA 95014
No. of Pages
❑ COM
❑ OTH
0 Check if Loan
DATE I FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR
RECEIVED (IF COMMITTEE, ALSO ENTER I.O. NUMBER)
17 ° l /� G1� >✓ I w� ( t d Cy
Reason forAmendment:
CONTRIBUTOR
CODE *
IF AN INDIVIDUAL,
ENTER OCCUPATION AND EMPLOYER
AMOUNT
COM —
(IF SELF-EMPLOYED, ENTER NAME OF BUSINESS)
RECEIVED
ICJ IND
' 6v S
$ ( oy v OD
❑ com
°"_�_
❑ OTH
l
l 1/+X v\l� Qr`!{ I t1 C'
D Check if Loan
El PTY
.
❑ Scc
Provide interest rate
❑ IND
❑ COM
❑ OTH
0 Check if Loan
❑ PTY
❑ SCC
1.
Provide interest rate
❑ IND
Cj COM
❑ OTH ❑ Check if Loan
❑ PTY
❑ SCC Ai
Provide interest rate
"Contributor Codes
IND —
Individual
COM —
Recipient Committee (other than PTY or SCC)
OTH —
Other (e.g., business entity)
PTY —
Poiitical Party
SCC —
Small Contributor Committee
FPPC Form 497 (March12011)
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