CA Form 497 Contribution Report No. 4 - Ken Dyda 497 Contribution Report Amounts may be rounded to whole dollars.
NAME OF FILER Date of Date Stamp CALIFORNIA 497
DIDA 1-0(4_ APti coJA) /(_ i ci This Filing l ~/ -/ kECE
F DRM
AREA CODE/PHONE NUMBER I.D.NUMBER(if applicable) STY OF RANCHO " • Y Ise Only
01 101- 7 1 /Zii 95 Report No.
STREET ADDRESS OCT 15 2019
❑to Report No.
below)
CITY STATE ZIP CODE (explain , 71,,TY
C
LE
RK OFFIC
1l4N1 ukrywu r " �- No. of Pages
Vi -
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
IND t o
'(S-ft ay0/) EDCOM 1 ' TI 2c O
❑ OTH
6-416-- inCheck if Loan
gA_Aj p (.0.s u c./) 1.)')2 - E 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