CA Form 497 Contribution Report No. 1 - Dave Emenhiser 497 Contribution Report Amounts may be rounded to whole dollars.
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STREET ADDRESS
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CITY STATE ZIP CODE (explain below)
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1. Contribut on(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.O.NUMBER) CODE* (IF SELF-EMPLOYED.ENTER NAME OF BUSINESS) RECEIVED
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7'� O COM
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ElOTH Check if
❑ Loan
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%
El SCC SCC
Provide interest rate
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, OF , 0
0 COM
/115. /� ,_ L, 0 OTH L>Check if Loan
/ /,„ C 0 PTY
,,, ,,,_,/, 77,...,275 ❑ SCC
Provide Interest rate
❑ IND
❑ COM
❑ OTH
0 Check if Loan
❑ PTY
❑ SCC % ,
Provide Interest rate
4
*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