CA Form 497 Contribution Report No. 3 - Stephen Perestam 497 Contribution Report Amounts may be rounded to whole dollars.
NAME OF FILER Date of 10/4/2019 Date Stamp CALIFORNIA 497
Stephen Perestam This Filing RECEIVE
FORM
AREA CODE/PHONE NUMBER I.D.NUMBER(if applicable) CITY OF RANCHO PALOS 1420123
Report No. 3 VER fficial Use Only
STREET ADDRESS OCT 04 2019
❑Amendment
to Report No.
CITY STATE ZIP CODE (explain below) CrrY CLERK'S of Pages
F� I C
.--,
Rancho Palos Verdes CA 90275 No.
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
Brad Culbertson ® IND Businessman 1000
. 90275
❑ OTH ❑Check if Loan
❑ PTY
❑ SCC
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.gov(866/275-3772)
www.fppc.ca.gov