497 Contribution Report 4-1 - Contributions Received on 11-1-22 Amended497 Contribution Report
NAME OF FILER
AREA CODE/PHONE NUMBER I.D. NUMBER (if applicable)
Amounts may be rounded to whole dollars.
STREET ADDRESS
CITY
DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR
RECEIVED
Reason for Amendment:
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
1. Contribution(s) Received
STATE ZIP CODE
CONTRIBUTOR
IF AN INDIVIDUAL,
AMOUNT
Check if Loan
Check if Loan
Check if Loan
%
%
%
Provide interest rate
Provide interest rate
Provide interest rate
RECEIVED
ENTER OCCUPATION AND EMPLOYER
(IF SELF-EMPLOYED, ENTER NAME OF BUSINESS)CODE*
IND
COM
OTH
PTY
SCC
Date of Date Stamp
For Official Use Only
This Filing
Report No.
Amendment
to Report No.
No. of Pages
(explain below)
CALIFORNIA
FORM 497
* 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 (Feb/2019)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
IND
COM
OTH
PTY
SCC
IND
COM
OTH
PTY
SCC