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
a1Ap -,� 4This Filing j4-5:-/ RECEIVE _ FORM
EA CODE/PHONE NUMBER I D NUMBER appbcable) QITY OF RANCHO PALO. - ,_
Report No. or•fficlal Use Only
,30- ,' /g- ( `-71.0 /' /2 0 / 171/
STREET ADDRES NOV 0 5 2O1S
g7 /3D 0 Amendment
0 . to Report No. +rRf/•Y.SJST�07fJ17`A�rAtT .•�•a••o
CITY STATE ZIP CODE (explain below) Cfl"Y CLERKS OFFICE
jeia,j:. mid Ta..,,z, d Z7,51No.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) RECEIVEDi'VeLef ./;11) lig-WiD lfit DD
H......:57.7/7
0 COM
7/5, fe,..... Aff„...e"424) d
l0OTH
❑ ❑Check if Loan
/(7/W C4 q'd2--75. ❑ PTY
❑ SCC %
Provide interest rate
❑ IND
❑ COM
❑ OTH 0 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