CA Form 497 Contribution Report No. 5 - Ken Dyda 497 Contribution Report Amounts may be rounded to whole dollars
NAME OF FILER Date of Date Stamp CALIFORNIA 497
D £ Fit RP/ L t 1 f Cow',L)L 5 This Filing RECEIVED FORM
AREA CODE/PHONE NUMBER I D NUMBER(if applicable)
31 ° 9.311 3°27 / 5 Report No CITY OF RANCHO PAIRS RD;- Official Use Only
STREET ADDRESS OCT 28 2019
❑Amendment
?, -_ to Report No
CITY STATE ZIP CODE (explain below)
t)
CTV CLERKS OFFICE
giA. c/Ay P4 I, f ,t7 1406— C,4975 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
i'V PAW' V 121)e CiA Le P El IND /J
- 3-.2-o i j AA vlet •Tr6-6- �oAi O,�'�-.-v0 io/t) r ® COM
p(rya 1,2t5 vi c;'f••►"3- (.L - ,9 15 3 2-S ❑ OTH ❑Check if Loan
C/e Rere- OptvoAS
❑ SCC ono
s ;C.- Sr CA % -7/ Provide interest rate
❑ IND
❑ COM
❑ OTH ❑Check if Loan
❑ PTY
❑ SCC ok
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