HomeMy WebLinkAboutKeen, Tori - 497 Form 090524497 Contribution Report Amounts may be rounded to whole dollars.
AMOUNT
RECEIVED
IF AN INDIVIDUAL,
ENTER OCCUPATION AND EMPLOYER
(IF SELF-EMPLOYED, ENTER NAME OF BUSINESS)
DATE
RECEIVED
497 CONTRIBUTION REPORT
CALIFORNIA
FORM
Date Stamp
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
CONTRIBUTOR
CODE *
For Official Use Only
497NAME OF FILER
AREA CODE/PHONE NUMBER
STREET ADDRESS
CITY STATE ZIP CODE
I.D. NUMBER (if applicable)
1. Contribution(s) Received
IND
COM
OTH
PTY
SCC
Date of
This Filing
Report No.
Amendment
to Report No.
No. of Pages
IND
COM
OTH
PTY
SCC
IND
COM
OTH
PTY
SCC
*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
(explain below)
Reason for Amendment:
Check if Loan
%
Provide interest rate
Check if Loan
%
Provide interest rate
Check if Loan
%
Provide interest rate
FPPC Form 497 (Feb/2019)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Tori Keen for Atascadero City Council 2024
(916)348-9100 1470439
5445 Madison Avenue
Sacramento CA 95841
09/05/2024
09052024-1
1
09/05/2024 Shatter PAC5445 Madison AveSacramento, CA 95841Committee ID # 1439036 X
2,500.00