CA Form 497 Contribution Report No. 2 - Ken Dyda 497 Contribution Report Amounts may be rounded to whole dollars.
NAME OF FILERDate of Date Stamp CALIFORNIA 497
by i j'Lf' P'1 C t RJti1 L S This Filing s (c? FORM
AREA CODE/PHONE NUMBER I.D.NUMBER(if applicable) CITY OF RANCHO PALO V 7:1- 41.:7'
ial Use Only
3 D oiJ 1 Report No.
STREET ADDRESS SEP 2 7 209
0 Amendment
3 O 0 CA 5 )1., AJA p/L, to Report No.
CITY STATE ZIP CODE (explain below) CITY CLERK'S OFFICE
(1./
N- Nie-440, PV ifZb C 5, ON 9 a 2--).5- 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
RAN CAi1 Ort - �'�' 19
PAS IU(ci>c S C)."4 Le 4,1 e.1Ls. A ❑ IND g /� �No
A.."ft1 trc% E COM
S Po Ais J o �.� W,ki r- Po,,v,_ 0 k=141(-or,k.e-•vi U,C ❑ OTH
Ol 6� v s 1 Q t q31� Check if Loan
S Tr 1 D ❑ PTY
S LS S ` F t�-=' Az S' ❑ SCC
p�,�J C c, Ct Too `] 1 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.gov(866/275-3772)
www.fppc.ca.gov