HomeMy WebLinkAboutVEREEN 497 03/19/13497 Contribution Report
AREA CODE/PHONE NUMBER
(
No. of Pages
497 CONTRIBUTION REPORT
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
CONTRIBUTOR
CODE *
IF AN INDIVIDUAL'
ENTER OCCUPATION AND EMPLOYER
(IF SELF-EMPLOYED, ENTER NAME OF BUSINESS)
AMOUNT
RECEIVED
� /
DOV1clt� V erect irl
D<'ND
J
1o60,00
:2—)1- Zo)
El Com
❑ OTH
Check if Loan
(/^
/
❑ PTY
O SCC
Provide interest rate
Re) q odd G- 'NOS
%pg IND
-$100.0 d
El COM
��
❑ OTH
❑ Check if Loan
❑ PTY
❑ SCC
Provide interest rate
F_ c t_ n e_ `ie r e,e-o
l IND
`
❑ OTH
❑ 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 Forth 497 (March/2011)
FPPC Toll -Free Helpline: 866/ASK -FPPC (8661275 -3772)
497 Contribution Report Type or print in ink.
P Amounts may be rounded to whole dollars.
497 CONTRIBUTION REPORT
NAME OF FILER 2013 Date of Date Stamp
This Filing
AREA ClODEIPHONE NUMBER / I.D. NUMBER (i ppNcable) "or Pa Wse
( Report No.
STREETADDRESS
/�/� ❑ Amendment
to Report No.
CITY
No. of Pages
1. Contribution(s) Received
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR
(IF COMMITTEE. ALSO ENTER I.D. NUMBER)
CONTRIBUTOR
CODE *
IF AN INDIVIDUAL,
ENTER OCCUPATION AND EMPLOYER
(IF SELF - EMPLOYED, ENTER NAME OF BUSINESS)
AMOUNT
RECEIVED
S h i rl e.y R.
.
IND
❑
El O OTH TH
El PTY
❑ scc
1,0(), o 0
❑ Check if Loan
Provide interest rate
f4e.Ar-a J L....ekr
0❑ IND
od
(
COM
❑ OTH
❑ PTY
❑ SCC
❑ Check if Loan
Provide interest rate
�1 c.k� .*rtcare sand
"IND
O coM
$26-'00
�
❑ OTH
❑ PTY
❑ SAC
p Check if Loan
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 (March/2011)
FPPC Toll -Free Helpline: 866/ASK -FPPC (8661275 -3772)