HomeMy WebLinkAboutTATUM 497 10/06/20497 Contribution Report Amounts may be rounded to whole dollars.
NAME OF FILER
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Date of0
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This Filing ,a �6
Date Stamp
[FAN INDIVIDUAL,
ENTER OCCUPATION AND EMPLOYER
AMOUNT
Report No.
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
0
AREA CODE/PHONE NUMBER
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OCT -6 'IM (Z: 15
STREETAADDRESS
El COM
a,16TH
E] Amendment
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to Report No.
(explain below)
No. of Pages —�
CITY STATE ZIP CODE
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1. Contribution(s) Received
DATE
FULL NAME, STREETADDRESS AND ZIP CODE OF CONTRIBUTOR
CONTRIBUTOR
[FAN INDIVIDUAL,
ENTER OCCUPATION AND EMPLOYER
AMOUNT
RECEIVED
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
CODE'
(IF SELF-EMPLOYED, ENTER NAME OF BUSINESS)
RECEIVED
If
❑ IND
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El COM
a,16TH
❑ Check if Loan
❑ PTY
�
❑SCC
Provide interest rate
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COM
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El SCC
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E]COM
❑ OTH
_
❑ PTY
E] Check if Loan
❑ SCC
/
Provide interest rate
Reason for Amendment:
` Contributor Codes
IND - Individual
COM - Recipient Committee (other than PTY or SCC)
OTH - Other (e.g., business entity)
PTY - Political Party
SCC - Small Contributor Committee
FPPC Form 497 (Feb/2019)
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www.fppc.ca.gov