CA Form 497 Contribution Report No. 1 - Dave Emenhiser 497 Contribution Report Amounts may be rounded to whole dollars.
N F FILER / ` Date of ' i , ,� / G n t..I t t)��P�!!/� 497
4,u-e.. , c. Fr co.,44.4 t9p, This Filinga'r ir
,_,i •P RANCHO PALOS VE ,-O R M
REA CODE/PHONE NUMBER i .D.NUMBER(if applicable) f
(3/ ,V V �. °>/ ? el 41" Report No. OCT is 2019 For official use only
STREET ADDRESS
(explain below)
illa %1Z-- 2(1 9:442 No.of Pages
1. Contribut on(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.O.NUMBER) CODE* (IF SELF-EMPLOYED.ENTER NAME OF BUSINESS) RECEIVED
VP • • / t 1
D
5474 D ❑ PTY
❑ SCC %
Provide interest rate
gi, e/ Y4— ,, i
, OF 10--ite' p$4, 00
......
- 0 COM
/ /5 /,.
0 PTY
,,, ,,,_,/, 7 ,;.,,,, ❑ SCC
Provide Interest rate
❑ IND
❑ COM
❑ OTH
❑Check if Loan
❑ PTY
❑ SCC % _,
Provide Interest rate
4
*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