HomeMy Public PortalAboutForm 497 Report No. 7(fiT x
497 Contribution Report
Partners for a Safe Claremont
Amounts may be rounded to whole dollars.
AREA CODE/PHONE NUMBER I.D. NUMBER (itgwcable)
909 575-1456 11403060
STREETADDRESS
2058 N Mills Ave Suite 430
CITY STATE ZIP CODE
Claremont CA 91711
1. Contribution(s) Received
Date of clamp
This Filing 06-01-2018 kE'C"'EIV
Report No.
❑ Amendment
7
to Report No.
(explain below)
No. of Pages 1
JUN 0 4 2018
CITY CLERK
CITY OF CLAREMO T
DATE
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR
CONTRIBUTOR
IF AN INDIVIDUAL,
ENTER OCCUPATION AND EMPLOYER
AMOUNT
RECEIVED
OF COMMITTEE. ALSO ENTER 1.D NUMBER!
CODE *
OF SELF-EMPLOYED. ENTER NAME CF BUSINt:-S51
RECEIVED
❑x IND
'5'
Daniel &Sally Metrie
❑ coM
Owner
,
06-01-2018
446 W Palm Drive
❑ OTH
Lizzies Gold Mine
Covina, CA 91723
❑ PTY
262 2nd Street
❑ Check if Loan
❑ scc
Claremont, CA 91711
provide interest rale
❑ IND
❑ COM
❑ OTH
❑ Check if Loan
❑ PTY
❑ SCC
Provide interest rale
❑ IND
❑ COM
❑ OTH
❑ Check if Loan
Cl 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 (Jul/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppr-ca.gov