HomeMy WebLinkAboutForm 497 Atascadero Shield Initiative Yes on Measure D08x
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497Contributibn Report Amounts may berounded-to whole dollars.
E _ NAME OF FILER Date Of
This Filinga Z �r-L :,-'
.` .R (Ll
AREA`CODE/PHONENUMBER, I:D:'NUMBER a applicable)
Report No.
STREET ADDRESS
- � Amendrnen4
to Report No.
Y P CODE (explain below)
CITY STATE ZI
C r� � C 112— �- % Z
No. of Pages- f
1. Contribution(s)'Received
lL
497CONTRI13UTIONREPORT ;.
late Sr 4
;ECEIVE' om
rForO cial, ; se Only
I`
CI' `� 4� 200 T
CITY OF ATASCAMRO
CITY CLERK'S OFFICE
DATE
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR
CONTRIBUTOR
"
IF AN INDIVIDUAL,
ENTER IFAND EMPLOYER
AMOUNT
RECEIVED
RECEIVED
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
CODE
(IF SELF -EMPLOYEE), ENTER NAME OF BUSINESS)
IND
O
1:1 Conn'
®OTH'
C] Check if Loan
[j, PTY
SCC
Provide interest rate
❑<,IND
'
❑ CONI
OTH
❑ Check if Loan
PTY
F1 SCC
Provide interest rate
[] IND
COM.
❑ OTH
❑ Check if Loan
PTY
SCC
Provide interest rate
'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
FPPCForm 497•(Novemberl07)
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