CA Form 497 Contribution Report No. 5 - Krista Johnson 497 Contribution Report Amounts may be rounded to whole dollars.
NAME OF FILER Date of Date Stamp CALIFORNIA A0 /
7
Kirista Johnson for RPV City Council 2017 This Filing 12/29/17 FORM
AREA CODE/PHONE NUMBER I.D,NUMBER(if apPlicabre)
RECEIVE E , �,�a Se any
310508-3201 1398133 Report No. GIN OF RANCHO PALOS VER s
STREET ADDRESS
0 Amto No.nt JAN o 201$
CITY STATE ZIP CODE (explain below) _
Rancho Palos Verdes CA 90275 No.of Pages 1 CITY CLERK'S OFFICE
1. Contribution(s) Received +
IF AN INDIVIDUAL,
DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR AMOUNT
RECEIVED (IF COMMITTEE.ALSO ENTER LO.NUMBER) * ENTER OCCUPATION AND EMPLOYER
CODE OF SELF-EMPLOYED,ENTER NAME OF BUSINESS) RECEIVED
Krista Johnson El IND Self Employed
❑ cam Starrock Business $7,000.00
12/28/17 Rancho Palos Verdes, CA 90275 ❑ OTH
Financial Services Ox Check if Loan
❑ PTY 0.00
❑ scc %
Provide Interest rate
El IND
❑ COM
El OTH ❑Check if Loan
❑ PTY
❑ SCC %
Provide interest rate
❑ IND
El COM
El OTH 0 Check If Loan
❑ PTY
❑ SCC %
Provide interest rale.
**Contributor Codes
IND — Individual
COM— Recipient Committee(other than PTY or SCC)
OTH — Other(e.g.,business entity)
PTY — Political Party
Reason for Amendment: SCC — Small Contributor Committee
FPPC Form 497(1uI/2016)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov