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497 Contribution Report Amounts may he rounded towhole dollars.
497 CONTRelitlON REPORT
NAME OF FILER
D.100(
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IFAN INDIVIDUAL,
ENTER OCCUPATIONANDEMPLOYER
a
doff Tkac to- City cy Council 2oE5
This Filing oa/
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is VFEMPLONEC, ENTIm WANE OF SUFoFSS,
RECEIVED
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For Official USe Only
AREACODEiPHONENUNIBER
1.O. NUMBER rrf.nrl* ,
S,vCO.]B
1,
Report No. Caonle�
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water N.Y.me
;
T3e,68,
Amendment
❑ ( -OM
STREET ADDRESS
to Report No.
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❑ OTH
CITY STATE 2PCODE
No. of Pages 1
❑ PTY
..
❑ SCC
1. Contribution(s) Received
DATE
FULL NAME SIREET ES5 AND 21P CODE OF CONTRIBUTOR
CONTRIBUTOR
IFAN INDIVIDUAL,
ENTER OCCUPATIONANDEMPLOYER
AMULINT
RECEIVED
IirCCU.nmms�.asoB.i[n l.c.num5[RI
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is VFEMPLONEC, ENTIm WANE OF SUFoFSS,
RECEIVED
C5 /06/2015
LTeffery Tkac
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J'+ner
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❑ ( -OM
❑ OTH
❑ Check J Lode
❑ PTY
❑ SCC
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IND
CAM
❑ OTH
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❑ PrY
❑ SCC
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Pnllo. 11.1.31.1.
❑ IND
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❑ Check if Loan
❑ PTY
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Reason for Amendment.
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•Contributor Codes
IND - Individual
COM - Renpient CommOee (other thin MY or SCC)
Ol H - Olher (eg_ business entity)
PTY - POINCaIParry
SCC -Small ContubmOr Comrrifie ,
FPPC Form 497 (Jan R)16)
FPPC Adolce: adHce®fppera.gov (866/Y7S3772)
www.fppc.ca gov