HomeMy Public PortalAboutForm 497 Ty Peabody 2022497 Contribution Report
Amounts may be rounded to whole dollars.
NAME OF FILER 11 ---_,..,,,,z.. Date
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CALIFORNIA 497
FORM
For Official Use Only
AREA CODE/PHONE NUMBER
7 I L _ 74 Z - 3 Qc()S
I.D. NUMBER Of applicable)
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Report No.
1
SEP
2022
II Amendment
to Report No.
STREET ADDRESS
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CITY
STATE ZIP CODE
(explain below)
No. of Pages
1
. c:on ution(s) ReceiveNt" d
/(sJ��� 04'NJ
e3) f ) 2 ? --
DATE
RECEIVED
L
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
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CONTRIBUTOR
CODE"
IF AN INDIVIDUAL,
ENTER OCCUPATION AND EMPLOYER
(IF SELF-EMPLOYED, ENTER NAME OF BUSINESS)
AMOUNT
RECEIVED
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% IND
1
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(-4,--2 i I),`b elves
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■ COM
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9 22.E
IIOTH
Check if Loan
■ PTY
■ SCC
O
Provide interest rate
■ IND
• COM
• OTH
■ Check if Loan
• PTY
■ SCC
%
Provide interest rate
• IND
• COM
U 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