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497 Contribution Report Amounts may be rounded to whole dollars. <br />NAME OF FWER \ <br />e �►,� ,P.�Q <br />Date of 2 <br />This Filing *? Z2 <br />Report No. x <br />❑ Amen. merit <br />to Report No. <br />(explain below) <br />Date Stamp <br />RFC` <br />®Cr ®� y <br />�FFice <br />C17? <br />C���n <br />. • - . , <br />- <br />• f:1 <br />For Official Use Only <br />AREA CODEI HONE NUMBER <br />I.D. NUMBER (Wapplicable) <br />STREE ADDRESS <br />CITY STATE ZIP CODE <br /> � <br />No. of Pages <br />1. Contribution(s) Received <br />DATE <br />FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR <br />CONTRIBUTOR <br />IF AN INDIVIDUAL, <br />ENTER OCCUPATION AND EMPLOYER <br />AMOUNT <br />RECEIVED <br />(IF COMMITTEE, ALSO ENTER I.D. NUMBER) - <br />CODE' <br />(IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) <br />RECEIVED <br />I O <br />2 <br />�� �—C i� "�'��� CS <br />� � <br />❑ IND <br />❑ COM <br />� ,, <br />';Fc C,� ��3�. <br />P-OTH <br />o PTY <br />❑ Check if Loan <br />° <br />/° <br />Provide interest rate <br />❑ IND <br />❑ COM <br />❑ OTH <br />J <br />❑ Check if Loan <br />❑ PTY <br />❑ SCC <br />Provide interest rate <br />❑ IND <br />❑ COM <br />❑ OTH <br />[],Check if Loan <br />❑ PTY <br />❑ SCo' <br />Provide interest rate <br />Reason for Amendment: <br />J <br />* Contributor Codes <br />IND - Individual <br />COM - Recipient Committee (other than PTY or SCC) <br />OTH - Other (e.g., business entity) <br />PTY - Political Party <br />SCC - Small Contributor Committee <br />FPPC Form 497(Feb/2019) <br />FPPC Advice: advice@fppc.ca.gov (866/275-3772) <br />www.fppc.ca.gov <br />