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� <br /> Late Contribution Re O1� Type or print in ink. ' <br /> p Amounts may be rounded to whole dollars. <br /> LATE CONTRIBUTION REPORT <br /> NAME OF FILER Date Of Date Stamp � . <br /> {� ' /� � This Filin `� 3 C v � - I • <br /> „-�;--wy;vt�`.�-'r`�? f`L � c C f_ .�t✓►, ��i r� 9 <br /> AREA CODE/PHONE NUMBER I.D.NUMBER(ifapplicable) FOf OffICi21 USe Only <br /> t�S`U� •.iL f-�`�Z(�' � •Z S'h'.�� � Report Na <br /> STREET ADDRESS <br /> f-- ...., ❑ Amendment � •:�� <br /> �.�p / / � /� <br /> t J�'� �� t�l i ;l � �'l�i:�. � ` �t7 to Report No. �_ . r -�, <br /> CITY � , STATE ZIP CODE (explain below) <br /> �� 1 . „� � �j� �L�'(7� No.of Pages <br /> �'t, � 1 <br /> Late Contribution(s) Received <br /> DATE FULL NAME,STREETADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR �FAN INDIVIDUAL, AMOUNT <br /> RECEIVED (IFCOMMITfEE,ALSOENTERI.D.NUMBER) CODE * ENTEROCCUPATIONANDEMPLOYER RECEIVED <br /> . (IF SELF-EMPLOYED.ENTER NAME OF BUSINE55) <br /> ❑ IND <br /> l����wN� e t� i` � +—;,� �, ��,� r 1 ❑ conn L _ <br /> /l ,�j �SS d� ' � OTH ca �J �" .� /O_6 � <br /> I � / <br /> v <br /> � r /�y ¢ ❑ PTY n ���„� <br /> � �, ���X � t.� , �-�'c�W^�� `1 �`f-Ut3 1 ❑ SCC ❑ CheckifLoan <br /> �, {' IG1.h� lJCtir-�vcilL ❑ CoM Si' ( F— ftM�I��k%�� ~� � <br /> ( � � � �� � OTH iVt �'S�wt � � � <br /> �Vl t O �e�� �. � /') -I��� � ❑ S C �C7 C�-�. �C'.,r ❑ 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(866/275-3772) <br />