CA Form 497 Contribution Report No. 3 - Ken Dyda 497 Contribution Report Amounts may be rounded to whole dollars.
NAM OF FILER Date of Date Ste. ::� CALIFORNIA
N 1S / ti J* ut FORM497
D�j �'�I�V Gt G�upu�„ This Filing �,
AREA CODE/PHONE NUMBER I.D.NUMBER(if applicable)
'It° 101 301/ jy2 /t./T Report No.
3 (-2fiffil5FRAAK6g. - • • "• ti 't e Only
STREET ADDRESS (JOCt
0 Amendment
, to Report No. _
CITY STATE ZIP CODE (explain below) ?:6111R1.:t1te' _
( 4 v/`'u41) Pitto-s Verzal c4A 90271— 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
r° ir ( I t/ .4 re-ofrapry cat» .9 i, 000 - ..
IND
&yip., CLv ❑
/
oi.71 ▪ OTH El Check if Loan
❑ PTY
3,0 z diS 5eo,) ❑ SCC %
Provide interest rate
❑ IND
❑ COM
❑ OTH ❑Check if Loan
❑ PTY
❑ SCC %
Provide interest rate
❑ IND
❑ COM
❑ OTH
❑Check if Loan
❑ PTY
❑ SCC oh
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