HomeMy WebLinkAboutForm 497 Heather Newsom 091718 Amendment497 Contribution Report Amounts may be rounded to whole dollars.
N E OF FILER
+
{ n q.&fin UL�/� . 2 a _(M�
Date Of J
This Filing l
Report No.
® Amendment +
to Report No. 1
(explain below)
No. of Pages
D�atte Stamp
9".ECE.:��ED
SEP 1 8 2018
CITY OF ATASCADER
CITY CLERK'S OFFICE
.
0.
NE NUMBER
I.D. NUMBER (if applicable)
3 /
For Official Use my
iWo
STREET DDRESS
STATE ZIP CODE
CITY �y �
(iiSC=GL[ P116 �% - �'.� �.3
1. Contribution(s) Received
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
CONTRIBUTOR
CODE *
IF AN INDIVIDUAL,
ENTER OCCUPATION AND EMPLOYER
(IF SELF-EMPLOYED, ENTER NAME OF BUSINESS)
AMOUNT
RECEIVED
WvtL'flIVI (/fI,LV� /J'IC
q`vl
❑ COM
�H
❑ Check if Loan
(
❑ PTY
❑ SCC
Provide interest rate
(�f/l�l L� (if (Gt✓ �Y J Get (�� S �G�'fS�� L" "" J
❑ IND
L�
%SDS
❑ COM
�TH
❑ Check if Loan
q141t
ElPTY
El SCC
Provide interest rate
❑ IND
❑ COM
❑ OTH
❑ Check if Loan
❑ PTY
❑ SCC
Provide interest rate
Reason for Amendment:
"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 (Jul/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov