CA Form 497 Contribution Report No. 3 - Susan Brooks ` • I
497 Contribution Re ortType or print in ink.
Amounts may be rounded to whole dollars. 497 CONTRIBUTION REPORT
• Date Stamp
NAME OF FILER Date of ���_ R1� '� 491i
Susan Brooks for RPV CityCouncil 2015 Filing- �O N /rl' " ,RECEIVED This x "�.
Y
AREA CODE'PHONE NUMBER ID NUMBER of apolicahPF) CITY 1,F RANCHO PALOS V. - P -�.r•i icial Use Only
.
1378646 Report No.
3
STREET ADDRESS OCT 09 2015
0 Amendment
to Report No.
CITY STATE ZIP CODE {explain below)Rancho Palos Verdes / CI CLERK'S OFA"
4a
1. Contribution(s) Received
DATE FULL NAME.STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, AMOUNTENTER OCCUPATION AND EMPLOYER
RECEIVED OF COMMITTEE.ALSO ENTER I.D.NUMBER) CODE * OF SELF-EMPt.O ED.ENTER NAME OF BUSINESS) RECEIVED
1e/-4s 5-
/
1-14'3'�. .- IND .: o
❑ COM /� „
/rj A-e....4-Ajt_p_Ajt...),Ir,;� ❑ PTH ❑Check if loan
❑ PTY
,,,C.#e,r---)L4) 4r) Pc1-1-414-- ,2. cc 6-4 91);(7S D scc i r e
Provide interest.t ate r
❑ IND
D COM
O OTH 0 Check if Loan
❑ PTY
O SCC Q,,
Provide interest rate
O IND
❑ COM
O OTH 0 Check if Loan
D PTY
❑ SCC
Provide interest rate
t4*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 Contnbutor Committee
-- FPPC Form 497(March/2011)
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