CA Form 497 Contribution Report No. 1 - Ken Dyda 497 Contribution Report Type or print in ink.
p Amounts may be rounded to whole dollars.
497 CONTRIBUTION REPORT
NAME OF FILERDate of Date Stamp CALIFORNIA 497
Committee to Support Ken Dyda for Council, 2015 This Filing 10/7/2015RE
CEIVED FORM
AREA CODE/PHONE NUMBER I.D.NUMBER(if applicable) PL 1 CITY OF RANCHO PALO 4:'z'•cial Use Only
1379423 Report No.
STREET ADDRESS OCT 0 7 2015
❑Amendment
to Report No.
CITY STATE ZIP CODE (explain below)
1
No.of Pages
CITY CLERK'S OFFICE
Rancho Palos Verdes CA • 90275 9
1. Contribution(s) Received
DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, AMOUNT
ENTER OCCUPATION AND EMPLOYER
RECEIVED (IF COMMITTEE.ALSO ENTER I.D.NUMBER) CODE * (IF SELF-EMPLOYED ENTER NAME OF BUSINESS) RECEIVED
Lorraine R. Dyda 0 IND $3,000
10/7/2015 ❑ COM Retired
Rancho Palos Verdes,CA 90275 ❑ OTH EI Check if Loan
❑ PTY
❑ SCC 0
Provide interest rate
❑ IND
❑ COM
❑ OTH ❑ Check if Loan
❑ PTY
❑ SCC
Provide interest rate
❑ IND
❑ COM
❑ OTH 0 Check if Loan
D PTY
❑ SCC
Provide interest rate
Contributor Codes
IND-Individual
• COM-Recipient Committee(other than PTY or SCC)
OTH-Other(e.g.,business entity)
PTY-Political Party
Reason for Amendment:
SCC-Small Contributor Committee
FPPC Form 497 (November/07)
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