497 Late Contribution Report (2)497 Contribution Report Type
p
or print in ink.
Amounts may
be rounded to whole
dollars.
Date of
Date Stamp
497 CONTRIBUTION REPORT
NAME of FILER
This Filing
Report No.
Amendment
u
OCT Z I 2014
�•- •
or Official Use Only
AREA CODEIPH NE NUMBER
71L 0
6 -
I.D. NUMBER (irappucable)
0'`. i-D
STREETADDRESS
STATE ZIP CODE
1 / 74
No. of Pages
PERTINO CITY CLE
1. Contributions) Received
DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR
RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER)
CONTRIBUTOR
CODE
.......... .......
IF AN INDIVIDUAL,
ENTER OCCUPATION AND EMPLOYER AMOUNT
(IF SELF- EMPLOYED, ENTLR NAME OF BUSINESS) RECEIVED
c/,/A /J
IND
fC6-AC &Y.S7Ara
�- -rN � 9
SCC
v
Provide interest rate
�
o p
El OTH
El Check if Loan
' 7r� fl C' A 9
❑ PTY
❑ SCC
Provide interest rate
❑ IND
❑ com
❑ OTH
I] 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 (March12011)
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