HomeMy Public PortalAboutForm 497 Ted Mertens 2022 (2)497 Contribution Report
_cNIP 7,6' Ariiounts may be rounded to whole dollars.
NAME OF FILER
Elect Ted Mertens I.W. City Council 2022
Date of 9/6/2022
This Filing
Date Stamp
CALIFORNIA 497
FORM
For Official Use Only
Report No. 2
AREACODE/PHONE NUMBER
760-776-8186
I.D. NUMBER (if applicable)
Pending
IN Amendment
to Report No
STREET ADDRESS
(explain below)
1
No. of Pages
CITY STATE ZIP CODE
1. Contribution(s) Received
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR
OF COMMITTEE, ALSO ENTER ID. NUMBER)
CONTRIBUTOR
CODE`
IF AN INDIVIDUAL,
ENTER OCCUPATION AND EMPLOYER
(IF SELF-EMPLOYED, ENTER NAME OF BUSINESS)
AMOUNT
RECEIVED
Gino Poma
Retired
1000.00
i'4 IND
• COM
• OTH
❑ Check if Loan
• PTY
• SCC
Provide interest rate
IN IND
• COM
IN OTH
• Check if Loan
El PTY
■ SCC
Provide interest rate
■ IND
• COM
■ OTH
• Check if Loan
• PTY
■ 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)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov