CA Form 497 Contribution Report No. 20240930-01 - Jeff Chen 497 Contribution Report Amounts may be rounded to whole dollars.
NAME OF FILER Date of 09/30/2024 Date Stamp CALIFORNIA 497
JEFF CHEN FOR RPV CITY COUNCIL 2024 This Filing FORM
AREA CODE/PHONE NUMBER I.D.NUMBER(if applicable) 20240930-01 J01 =10 SN1:131 !''rifficial Use Only
424-888-0178 1473420 Report No.
STREET ADDRESS
❑Amendment iZO? g 130
46E Peninsula Center#191 to Report No.
CITY STATE ZIP CODE (explain below) 1 SB(1 3/1 S01Vd fi JNVH JO k1IO
Rolling Hills Estates CA 90274 No. of Pages 03,N1307311:1
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
9/28/2024 Daisy Fan ® IND Home Maker
$2,000.00
coM
1 Sagebrush Ln ❑ Retired
Rolling Hills, CA 90274 ❑ OTH ❑Check if Loan
❑ PTY
❑ SCC
Provide interest rate
❑ IND
❑ COM
❑ OTH ❑Check if Loan
❑ PTY
❑ SCC
Provide interest rate
❑ IND
❑ COM
❑ OTH ❑Check if Loan
❑ PTY
❑ SCC cyo
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
A