CA Form 497 Contribution Report No. 4 - Dave Emenhiser 0 -
497 Contribution Report Amounts may be rounded to whole dollars.
NA I OF FILER Date of Date StampCALIFORNIA 497
,a1A49 -,� 4 This Filing j4-5:-/ RECEIVE FORM
EA CODE/PHONE NUMBER I D NUMBER appbcable) QITY OF RANCHO t°ALO. . ,_
Report No. or•fficlal Use Only
,30— ,' /g— s `-71.0z /' /2 0 / 171/
Nov 0 5 STREET
to Report N o. .I r Rf/•Y.--,,,„,7@f.plR, - ..•...•a••o
CITY STATE ZIP CODE (explain below) Cfl"Y C LERK1S OFFICE
jeia,jt, Aid Tagi
d 51No.of Pages
Z7,
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'VeLef ./;11) 1- EI-4ND iteri
lfit DD
H....:5...77 ElCOM
. El 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