497 Late Contribution Report (2)
Late Contribution Report
NA~ME.oF FILER . ~ 1 f)
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AREA. CODE/PHONE NUMBE I
(V/~)7:n- lJb
STREET ADDRESS
/ II 1 f 3. r 11-'1 ;' 1..1 /' l v-'\
CITY .
CU~/'"~V
Late Contribution(s) Received
Type or print in ink.
Amounts may be rounded to whole dollars.
o iI\ "l- ~./ ' I
Date of
This Filing
I.D. NUMBER (if applicable)
/Z1't.,/'i'/ "1
Report No.
,A-J.-
o Amendment
to Report No.
(explain below)
I
STATE
C;4-
ZIP'CODE
,frJb/0
No. of Pages
DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, AMOUNT
ENTER OCCUPATION AND EMPLOYER
RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE * (IF SELF.EMPLOYED, ENTER NAME OF BUSINESS) RECEIVED
A Ii:, t.. .....f, Tv...." it:- J.t-..r A SJ t "LJ. ''1 c.. <"* 6 D INO
~ ~~"eOM 1'"2 ~"Z(,~I ~ 1 \:)(? v
5 j 25/ () fJq j i;1 ;;4, d/'L fCll- Ie <--I ~ ' J Ie. Z 2 'J D OTH f(rc...~
~~.;$'~ L(> 1 ~ r 8 D PlY
rrl/l'\-<? ,,> D see D Check if Loan
D INO
D COM
D OTH
D PlY
D see D Check if Loan
D INO
D COM
D OTH
D PlY
D see D Check if Loan
'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
Reason for Amendment:
FPPC Form 497 (JanuaryI05)
FPPC Toll-Free Helpline: 866IASK-FPPC (8661275-3772)