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497 Contribution Report - Contributions Received on 8-31-16 �r�t� �i��'l�f��U�9f$f� ��'�"s�e i"� d�mo.e�4s rrsay b�crsu�dec�!o wF�r,le do9lars. � SinkS f�or.. . ; _ g U9/01/20� : � � a� t0m� � �` @���°f�n�� , ;,, � NftM_vF FILER �akP O¢ � f�od Cit C�ouncil 2016 T�„� �"�"' � ' ' Y . � .�..�L�,_..._._LL. I.D.NUMBER(i�app/icable) 1 For Ofiicial Use:Only 408-446-3907 1387675 ���or��o. ,�„�: S E P - 1 ZO 16 �,am��,�men$ 10949 Maria Rasa V'�ay ����p°��°. _ CITI' STATE ZIPCODE (explainbelow) 1 C�IPERTINO CITY CLE�K Cupertino rA 95Q14 ��.�f Pa�e, , 1. �ontribution(�) Received IFAN INDIVIUUAL, qlvIOUNT UATF FULL NAME,STREET ADDRESS AND ZIP CODE-OF GONTRIBUTOR CONTRIBUT�R ENTER OCCl1PATION AND[MPLOYER RECEIVED (IF COh"MITTEE,ni_SO ENTER I.D.NUMRER) COUE * (IF SELF-EMPLOYEU,ENTFR NAh.^.F OF BUiINE55) RECEIVED ❑ conn CIJPER�"d1�9O, C/� Q5Q14 ❑ ��"�-� ❑ Checi<ifLoan ❑ PTY ❑ SCC � Pro�iide interest rate ❑ IND ❑ CON ❑ OTH ❑ Check if Loan ❑ PlY ❑ SCC �� Provide intarest rate ❑ �Na ❑ �oM ❑ OTH ❑ Check if Lcan ❑ P�v ❑ scc �' Provid�interest rate *'Contributor Codes IND -- Individual COPS— Recipient Committee(oiher than PTY or SCC) O'f F-I — Other(E.g.,business eniity) PTY — Politic�!Parly Reason for Amendment: SCC -- Small Convibutor Cornmittee fPPC form 497'{1u1/Z016) FP�PC AdvEGe:ad��ice@f�pc.c�.gov(II66/2"P5-3772) wesuw.fppe.c�.gc�v