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LateIndependent Expenditure Report Type or print in ink. <br /> Amounts may be rounded to whole dollars. <br /> LATE INDEPENDENT EXPENDITURE REPORT <br />NAME OF FILER ~'~ ~/f~i,/~,.~7~ ThisDate ofFiling //~'~ . ~;~'~ Da e Stamp <br /> <br />AREA CODE/PHONE NUMBER I I.D. NUMBER (#app~bab/e) ~= For Official Use Only <br /> <br />STREET ADDRESS <br />~ ~~// ~, ~to RepoHAmendmentNo. <br /> <br /> / <br />List Only One Candidate or Ballot Measure <br /> <br /> NAME OF CANDIDATE SUPPORTED OR OPPOSED NAME OF BALLOT MEASURE SUP 'ORTEI ~ OR OPPOSED <br /> <br />Independent Expenditures Made ~:~ add/#onal /flfo~af/ofl off app~p~ate~ la~/g cofll/fluaf/ofl ~l~. <br /> <br /> DA~ DESCRIPTION OF EXPENDI~RE AMOU~ <br /> <br /> FPPC Form 496 (8/99) <br /> For Technical Assistance: 916/322-5660 <br /> State of California <br /> <br /> <br />