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497 Contribution Report
Type or print in ink.
Amounts may be rounded ft whale dellam,
497 CONRtIEIUTK)N REPORT
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Date of
This Filing 15 o+�p
R.po:Np. L
{]Amendment
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I AUG 15 AN 11
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1. Contributign(s) Received
DATE
FULL NAME STREET ADDRESS 4WD ZIP COOL OF CONTRBU FOR
NUUB3§
COMM allTOR
CODES
IF AFMONANDE
ENTER OCLUMTIONAND EMPLOYER
AMOUNT
RECENED
RECEVEO
nF fr U ...rSOFxrEPrC
(rPSEIf�dCICTFn. ENTFP xYIEL BULwEi)
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I IND
❑
��d*+..
�, Jo0-
il
coM
Lj
❑Cb.,dr if Loan
F1 PTY
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ums t. J 13 j o 9
❑ SCC
Prwrae mleren r.re
[ IND
C COM
[ OTH
❑ Check if Loan
PTV
[! SCC
Pro.as inwaN rax
[i IND
[ COM
❑ OTH
O Check d Loan
❑ PTY
❑ SCC
PraMEe rtereA rice
Reason for Amendment
— CMnlributor Codes
IND - Indirldual
COM- Raciplent CCmmMe(other Man PTY or SCC)
OTH - Otter (e.9., bush.. erniy)
PTY - Poetical Parry
SCC - Small Contnbutor CommiMee
FPPC Form 497(MamWill I)
FPPC Toll -Fm Helpllne: 66 &ASK -FPPC (666R7&3T2I