CA Form 497 Contribution Report No. 3 - Ken Dyda 497 Contribution Report Amounts may be rounded to whole dollars.
NAM OF FILER Date of Date Ste. ::� CAL IFORNIA
N 1S / 1 * ��, i=O R M497
D�j �'�I�V Gt G�upu�„ This Filing �,
AREA CODE/PHONE NUMBER I.D.NUMBER(if applicable)
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STREET ADDRESS (JOCt
0 Amendment
30e40 cAsiL,./A on , to Report No.
CITY STATE ZIP CODE (explain below) C?:4-:':L 1Th c/Cai . tt 1�� '' �
(2.6t/ti4'‘41) Pitto-s Venal GA 90271— 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
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c. IND
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t pAWI vc crib s (--A 0701-71- ▪ OTH ❑Check if Loan
❑ PTY
3,0 z diS Seo,) 0 SCC %
Provide interest rate
❑ IND
❑ COM
❑ OTH ❑Check if Loan
❑ PTY
❑ SCC %
Provide interest rate
❑ IND
❑ COM
❑ OTH
❑Check if Loan
❑ PTY
❑ SCC , oh
,
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