CA Form 497 Contribution Report No. 2024092501 - Jeff Chen 497 Contribution Report Type or print in ink.
p Amounts may be rounded to whole dollars.
497 CONTRIBUTION REPORT
NAME OF FILER Date Stamp
Date of 9/25/2024 CALIFORNIA 497
JEFF CHEN FOR RPV CITY COUNCIL 2024 This Filing A FORM
AREA CODE/PHONE NUMBER Al.r(t'::I.D.NUMBER(if applicable) 202409250 + O RANC`� /�('� �'} . 'icia or • Ise •my
424-888-0178 1473420
Report No. g
STREET ADDRESS
El Amendment SEP 2 21��,4
5E PENINSULA CENTER #191 to Report No.
below)
CITY STATE ZIP CODE (explain1 CITY CLERK'S OFFICE
ROLLING HILLS ESTATES CA 90274 No. of Pages
1. Contribution(s) Received
DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, AMOUNT
ENTER OCCUPATION AND EMPLOYER
RECEIVED (IF COMMITTEE,ALSO ENTER I D.NUMBER) CODE * (IF SELF-EMPLOYED,ENTER NAME OF BUSINESS) RECEIVED
RANDALL FAN ❑X IND Physician
9/24/2024 26 Coffee Berry Lane G2 Anesthesia - BAAM $1,000.00
Orinda, CA 94563 COM
❑ OTH ❑ Check if Loan
❑ PTY
❑ SCC
Provide interest rate
❑ IND
❑ COM
❑ OTH ❑ Check if Loan
❑ PTY
❑ SCC
Provide interest rate
❑ IND
❑ COM
❑ OTH El 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)
PTY - Political Party
Reason for Amendment: SCC - Small Contributor Committee
FPPC Form 497(March/2011)
FPPC Toll-Free Helpline: 866/ASK-FPPC(866/275-3772)