HomeMy WebLinkAboutMARTINEZ 497 06/06/13Report Type or print in ink.
Late Contribution Re
P Amounts may be rounded to whole dollars.
LATE CONTRIBUTION REPORT
NAME OF FILER Date of Date Stamp e 4
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AREA CODE/PHONE NUMBER I.D. NUMBER (dapplicable) r For Official Use Only
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❑ Amendment
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Late Contribution(s) Received
DATE
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR
CONTRIBUTOR
CODE *
IF AN INDIVIDUAL,
ENTER OCCUPATION AND EMPLOYER
AMOUNT
RECEIVED
RECEIVED
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
ENTER
(IF SELF-EMPLOYED. ENTER NAME OF BUSINESS)
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❑ IND
4 2 stag 60
o (C G �, �;
? �.
❑ OTH
❑ PTY
❑ SCC
Check if Loan
❑ IND
❑ COM
❑ OTH
❑ PTY
❑ SCC
Check if Loan
❑ IND
❑ COM
❑ OTH
❑ PTY
❑ SCC
Check if Loan
*Contributor Codes
IND — Individual PTY — Political Party
COM — Recipient Committee (other than PTY or SCC) SCC — Small Contributor Committee
OTH — Other
Reason for Amendment:
FPPC Form 497 (Jan /03)
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