497 Contribution Report - Contributions received 10-07-24497 Contribution Report Amounts may be rounded to whole dollars.
NAME OF FILER Date of ~ -,::.C,JZ, -, c,,u.Jc,,--J:.l, 2-0 ,c./-Th is Filing tb/~/']A)v</,
ARE I .. NUMBER (if applicable)
-I 46 9f3-Y-Report No. _____ _
STREET ADDRESS
I □ Amendment
C ITY • to Report No. -----
STATE ZIP CODE (explain below)
No.of Pages ____ _ ~ -re---;J () cA 9h> !Cf
1.
DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR
RECEIVED (IF COMMITTEE. ALSO ENTER 1.0. NUMBER) CODE"
"' /7 I "yi) -xf
f3 All 12-/ CH ,e-A{ &, (m'IND
~ □COM
0 0 TH
Cu-f e'fl 1:?-J.i 0, CA\ 9nry 0 PTY
□ sec
0 IND
0 COM
0 0TH
0 PTY
□ sec
0 IND
0 COM
0 0TH
0 PTY
□ sec
Reason for Amendment: ________________________________ _
Date Stamp CALIFORNIA 497
FORM
For Official Use O nly
IF AN INDIVIDUAL,
ENTER OCCUPATION AND EMPLOYER
(IF saF-EMPLOYEO, ENTER NAME OF BUSINESS)
f2 £--r v (2.~
* Contributor Codes
IND -Individual
AMOUNT
RECEIVED
4$1t"oOO.
I
QC Check if Loan
%
Provide interest rate
D Check if Loan
%
Provide interest rate
D Check if Loan
%
Provide interest rate
COM -Recipient Committee (other than PTY or SCC)
0TH -Other (e.g., business entity)
PTY -Political Party
sec -Small Contributor Committee
/
FPPC Form 497 (Feb/2019}
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov