CA Form 497 Contribution Report No. 1 - Ken Dyda 497 Contribution Report Amounts may be rounded to whole dollars.
NAME OF FILER Date of Date Stamp CALIFORNIA 497
D (( QO 2 coo&CI �- 01 1 This Filing� fLPV � FORM
RECEI
AREA CODE/PHONE NUMBER I.D.NUMBER(if applicable)
CITY OF RANCHO PALOSWartraSuse Only
3 i O qo ) 3 Report No.
STREET ADDRESS SEP 2 3 2019
0 Amendment
308 Co (A 5 IC_1i,)/1 Q(2_ to Report No.
CITY STATE ZIP CODE (explain below)
RAPCITY CLERKS OFFICF-:
120 45 3 C. , 9 '7275 No. of Pages
1. Contribution(s) Received
IF AN INDIVIDUAL,
DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR ENTER OCCUPATION AND EMPLOYER AMOUNT
RECEIVED (IF COMMITTEE,ALSO ENTER I D NUMBER) CODE* (IF SELF-EMPLOYED,ENTER NAME OF BUSINESS) RECEIVED
Ice-A) D.\(8,A ® IND 1) O O
9-xo -I9 o COM E7---1(2-E6
CAPk) OD 02 ;, ❑ OTH
N N( Check if Loan
CPAriv'- o PA- S if C:✓L�C�S C ' 0 2 15 ❑ PTY
❑ SCC 0 %
Provide interest rate
❑ IND
❑ COM
❑ OTH ❑Check if Loan
❑ PTY
❑ SCC °%
Provide interest rate
❑ IND
❑ COM
❑ OTH
❑Check if Loan
❑ PTY
❑ SCC
Provide interest rate
*Contributor Codes
. •
IND - Individual
COM - Recipient Committee(other than PTY or SCC)
OTH - Other(e.g., business entity)
Reason for Amendment: PTY - Political Party
SCC - Small Contributor Committee
FPPC Form 497(Feb/2019)
FPPC Advice:advice@fppc.ca.gov4866/275-3772)
www.fppc.ca.gov