HomeMy WebLinkAbout497 Late Contribution Report (1)497 Contribution Report
Type or print in ink.
Amounts may be rounded to whole dollars.
NAME OF FILER
IF AN INDIVIDUAL,
ENTER OCCUPATION AND EMPLOYER
AMOUNT
I;VN I illtiU I ON REPORT
DLJIZ5
on Sun for Cupertino City Council 2014
Date of
Phis Filing G �`
t
LS
e =Uenly
AREACODElPHONE NUMBER
I D. NUMBER (ltappicabie)
4082021080
1365260
fieport No.
S�� _ 4 20i
&J,
STREETADDRESS
.
El Amendment
❑ Scc
1131 S. Stelling Rd.
to Report No.
(explain below)
/� C tn�
CUPER f T INO CITY
LERK
CITY STATE ZIP CODE
CA 95014
No. of Pages
❑ COM
❑ OTH
0 Check if Loan
DATE I FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR
RECEIVED (IF COMMITTEE, ALSO ENTER I.O. NUMBER)
17 ° l /� G1� >✓ I w� ( t d Cy
Reason forAmendment:
CONTRIBUTOR
CODE *
IF AN INDIVIDUAL,
ENTER OCCUPATION AND EMPLOYER
AMOUNT
COM —
(IF SELF-EMPLOYED, ENTER NAME OF BUSINESS)
RECEIVED
ICJ IND
' 6v S
$ ( oy v OD
❑ com
°"_�_
❑ OTH
l
l 1/+X v\l� Qr`!{ I t1 C'
D Check if Loan
El PTY
.
❑ Scc
Provide interest rate
❑ IND
❑ COM
❑ OTH
0 Check if Loan
❑ PTY
❑ SCC
1.
Provide interest rate
❑ IND
Cj COM
❑ OTH ❑ Check if Loan
❑ PTY
❑ SCC Ai
Provide interest rate
"Contributor Codes
IND —
Individual
COM —
Recipient Committee (other than PTY or SCC)
OTH —
Other (e.g., business entity)
PTY —
Poiitical Party
SCC —
Small Contributor Committee
FPPC Form 497 (March12011)
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