CA Form 497 Contribution Report No. 3 - Dave Emenhiser 497 Contribution Report Amounts may be rounded to whole dollars.
NAME OF FILER Date of "1L2 Date Stamp CALIFORNIAE.27p4w-e_ 2t /5'ThIs Filing FORM
AREA CODE/PHONE NUMBER I D NUMBE applicable) RECEIVE r
Report No. For Official Use Only
Imo- ?i-P7/- D 9 2 D / CriY OF RANCHO PALOS VERDES
STREET ADDRESS ❑Amendment
OCT 28 2019
--/...? to Report No.
CITY STATE ZIP CODE (explain below)
AlialtIL
on 27 /
No.of Pages _ CITY CLERKS 0FICE
/1[4, filr7—
c� D(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
k„,/,,,, pic.j.,„,, y'..2441 ,4,0„,d' ❑ IND lel`‘ la
/iP'2 7-77 '
❑ SCC
Provide interest rate
❑ IND
❑ COM
❑ OTH LJ 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