CA Form 497 Contribution Report No. 3 - Dave Emenhiser 497 Contribution Report Amounts may be rounded to whole dollars.
NAME OF FILER , Date of "1L2 Date Stamp CALIFORNIA27
P --
p< Z , This Filing FORM
49 7
_ /1
AREA CODE/PHONE NUMBER I D NUMBS applicable) RECEIVE r
Report No. For Official Use Only
3'/ - ?'JY- 0,i- /92 D / CriY OF RANCHO PALOS VERDES
STREET ADDRESS ❑Amendment
OCT 28 2019
9 p V ... de„..0 c„, ,,e4 --/...? to Report No.
CITY STATE ZIP CODE (explain below)AlialtIL
No.of Pages _ CITY CLERK'S OFICE
1. Contribut onci0 D 27 /(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
k„,/,,,, pic.j.,„, y'..2441 ,4i.„,/ El IND lel DD
/,'2 7-77 ' Zo-,;4;j01,4._ciAl;jefa ---7"(1.. . [ OM
- /- —5.* P- -Alt-12. 1"'' '//f° 0 OTH ❑Check if Loan
a ❑ PTY
1_41. 40 /./i1, .._ct"_„,._,P_Jac) :iif 7 no 7 / ❑ SCC 0/0
Provide interest rate
❑ IND
❑ COM
❑ OTH LJ 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