497 Contribution Report 4 - Contributions Received on 10-17-24497 Contribution Report
NAME OF FILER
AREA CODE/PHONE NUMBER I.D. NUMBER (if applicable)
Amounts may be rounded to whole dollars.
STREET ADDRESS
CITY
DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR
RECEIVED
Reason for Amendment:
IF COMMITTEE, ALSO ENTER I.D. NUMBER)
1. Contribution(s) Received
STATE ZIP CODE
CONTRIBUTOR
IF AN INDIVIDUAL,
AMOUNT
Check if Loan
Check if Loan
Check if Loan
Provide interest rate
Provide interest rate
Provide interest rate
RECEIVED
ENTER OCCUPATION AND EMPLOYER
IF SELF-EMPLOYED, ENTER NAME OF BUSINESS)CODE*
IND
COM
OTH
PTY
SCC
Date of Date Stamp
For Official Use Only
This Filing
Report No.
Amendment
to Report No.
No. of Pages
explain below)
CALIFORNIA
FORM 497
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 (Feb/2019)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
IND
COM
OTH
PTY
SCC
IND
COM
OTH
PTY
SCC