497 Contribution Report - Contributions Received on 09-22-2016 497 Contribution Report Amounts may be rounded to whole dollars.
NAME OF FILER Date of Date Stamp
Parth Bharwad � This Filing 09/22/2016 � � � n �r . � �' � •
C) 11 1�
AREA CODE/PHONE NUMBER I.D.NUMBER(i/applicable) � ICIB S2 Il y
1386483 Report No. �
STREET ADDRESS ❑qmendment S E P 2 3 2016 U
to Report No.
CITY STATE ZIP CODE (explain below)
Cupertino CA 95014 No.of PageS CU.PE�iTINO CI� �LE�a�
1. Contribution(s) Received �
DATE FULL NAME,STREETADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL,
RECEIVED QF COMMITTEE.ALSO ENTER I.D.NUMBER) * ENTER OCCUPATION AND EMPLOYER AMOUNT
CODE (IF SELF-EMPLOYED,ENTER NAME OF BUSINESS) RECEIVED
Shobana Nandakumar � �Np Self-employed
❑ coM
❑ OTH ❑ Check if Loan
❑ PTY
❑ SCC %
Provide interest rate
Jonathan Wong � �Np Pacific Breeze Mechanical
En ineer
❑ OTH g ❑ Check if Loan
❑ PTY
❑ SCC i
Provide interest rate
❑ IND
❑ COM
❑ OTH ❑ Check if Loan
❑ PTY
❑ SCC i
Provide interest rate
'"Contributor Codes
IND — Individual
COM— Recipient Committee(other than PTY or SCC)
OTH — Other(e.g.,business entity)
PTY — Political Party
Reason forAmendment: SCC — Small Contributor Committee
FPPC Form 497(1ul/2016)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov