497 Late Contribution Report (4)497 Contribution Report
NAME OF FILER
_ SuA)
AREA CODElPHONE NUMBER
_
STREETADDRESS
CITY
1. Confribution(s) Received
Type or print in ink.
Amounts may be rounded to whole dollars.
Date of
This Filing D 3 1
I.D. NUMBER (d appficavfe)
Report Iva. U U OCT 2 3 ��I
❑ Amendment
to Report No.
_ — - CUPERTiNO CITY
P )
(ex plan beiow
No. of Pages — 1.
Ri6UTION REPORT
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR
(IF COMMITTEE, ALSO ENTE€.1,0.NUMBER)
CONTRIBUTOR
:
CODE
IF AN INDIVIDUAL,
ENTER OCCUPATION AND EMPLOYER
AMOUNT
(IF SELF- FMPLOY,ED,,,E,N7FR NAME OF BUSENESS)
RECEIVED
e l` � —_
1JL I N C3
r cal J � S �
/ oi%O�
❑ CONI
❑ OTH
El Check if Loan
❑PTY
9SD
❑ SCC
_.. - - - --
Provide interest ra €e
❑ IND
❑ CDM
❑ OTH
❑ Check if Loan
E] 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 f=orm 497 (March/2011)
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