CA Form 497 Contribution Report No. 1 - Ken Dyda 497 Contribution Report Amounts may be rounded to whole dollars.
NAME OF FILER Date of Date Stamp CALIFORNIA 497
D (( �O 2 cou&CI �- This Filing� fLPV D„ Enct � ORM
RECEI
AREA CODE/PHONE NUMBER I.D.NUMBER(if applicable) CITY OF RANCHO PALOSWartraSuse Only
3 i O qo ) 3t2-7 Report No.
STREET ADDRESS SEP 23 2019
❑Amendment
_ to Report No.
CITY STATE ZIP CODE (explain below)
RAPp
CITY CLERKS OFFICF-:
Cam( Lo S U v 126 t5 S CA, 9 (7 275 No. of Pages
1. Contribution(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
1(CW D"(1),A ® IND 1, 0OO :
9-X0 -19 ❑ COM Re-T-1(2-6-6
- ❑ OTH
CA) N L:6 Check if Loan
PA-A.1 PA-t,oS , C ' 0 2 15 ❑ PTY
❑ SCC 0 %
Provide interest rate
❑ IND
❑ COM
❑ OTH ❑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.gov4866/275-3772)
www.fppc.ca.gov