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Late Contribution Re OI"t Type or print in ink. <br /> P Amounts may be rounded to whole dollars. LATE CONTRIBUTION REPORT <br /> NAME OF FILER � Date of Date Stamp � � � • <br /> � � / <br /> ��Us�h� � U�S � `-' � ���f1(1 This Filing 3/ � ' � - <br /> AREA CODE/PHONE NUMBER I.D.NUMBER(ifapplicable) FOf OfflClel USe Only <br /> �� " ` ��� �� � Report No. <br /> STREETADDRESS � - -� - <br /> <br /> to Repo�t Na <br /> CITY STATE ZIP CODE (explain below) <br /> ���W c�-^ � l.i � \ � �' �L1 U(I�� No. of Pages <br /> Late Contribution(s) Received <br /> IFAN INDIVIDUAL, <br /> DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR AMOUNT <br /> RECEIVED (IFCOMMITfEE,ALSOENTERI.D.NUMBER) CODE * ENTEROCCUPATIONANDEMPLOYER RECEIVED <br /> (IF SELF-EMPLOYED,ENTER NAME OF BUSINESS) <br /> / 1��v,2 V�'I 1 �-- i�� ��/e j�,�l�> ��,�� �No <br /> �b �U U� _ �'e' ❑ conn /�I l� L-r��e � — <br /> l ' g� I 3�� �-v�e � �i e ❑ OTH b w,�e�2 � � (� �j00� O U <br /> _ l _ /� ❑ Pnr H-�1�o2 v,'llrr-�e--1 <br /> S�„�"� ���{Z � C�- ��l(��. ❑ SCC �U� t� �i�/!e �JU K h— p Check if Loan <br /> �,UPS��2 N I"v����zc�r��e � {��t�'n ❑ IND <br /> lo (�u o1 Co,�vt.i���-,�'�,'2S t�soc��,� � �,A-C 0 o°H -1 • lJ . � �� dDU� (�� <br /> ` � �.� -- C l k�I �f� � �vo PT,r �- �� L <br /> �s5 �-p, � � 1 � �� �a� <br /> s���'��y��� � �. C g � � SCC ❑ Check if Loan <br /> ❑ IND <br /> ❑ COM <br /> ❑ OTH <br /> ❑ PTY <br /> ❑ SCC ❑ Check if Loan <br /> *Contributor Codes <br /> IND—Individual PTY—Political Party <br /> COM—Recipient Committee(other than PTY or SCC) SCC—Small Contributor Committee <br /> OTH—Other(e.g.,business entity) <br /> Reason for Amendment: <br /> FPPC Form 497(January/05) <br /> FPPC Toll-Free Helpline: 866/ASK-FPPC(8661275-3772) <br />