CA Form 497 Contribution Report No. 1 - Dave Emenhiser 497 Contribution Rep
ort t Type or print in ink.
P Amounts may be rounded to whole dollars. 497 CONTRIBUTION REPORT
NAME OF FILER Date Stamp
r Date of /� CALIFORNIA 497
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7Ufl1SE-4 i R avcoce,ciz.. 2G/7 This Filing `r1�240i/ RECEIVED FORM
AREA CODE/PHONE NUMBER / I.D.NUMBER(if applicable)
L'M—i or•'cla 1seeny
310-./V-g/y _ /3q ?2s- Report No. CL Y OF RANCHO PALOS VERDES
ty
STREET ADDRESS /�
9 4 SLVt)2 P1. nt CEP 15 2097
to Repportort No.
ClClrh STATE ZIP CODE (explain below)
/4Z.Z.M.K #/111 S L3ix /�- 910 CA2 91 No.of Pages i
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1. Contribution(s) Received
DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, AMOUNT
RECEIVED (IF COMMITTEE,ALSO ENTER I.D.NUMBER) CODE * ENTER OCCUPATION AND EMPLOYER RECEIVED
(IF SELF-EMPLOYED,ENTER NAME OF BUSINESS)
4/rcar A. AE25o.L ® IND
R�`c- 2°`7 dolz cbotmut-2.veew
El OTH kErigeb ['Check if Loan
AgiieND I�-o C ilc12.6c CA 9,07s, ❑ PTY
❑ SCC
Provide interest rate
❑ IND
O COM
O OTH ❑Check if Loan
❑ PTY
❑ SCC
Provide interest rate
O IND
❑ COM
❑ OTH ❑Check if Loan
❑ PTY
❑ SCC
Provide interest rate
**Contributor Codes
IND — Individual
COM— Recipient Committee(other than PTY or SCC)
� r OTH — Other(e.g.,business entity)
ReasonforAmendment: —VA) J Ki �o[.)rlQcil itilo,J Tc PA,,u711t)4 f14404'GS 2 PTY — Political Party
SCC — Small Contributor Committee
r ieS.r G/t.1P4/ca/ F&beg ex-Pe-305er
FPPC Form 497(March/2011)
FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772)