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Type or print in ink. <br /> 497 Contribution Report Amountsmayberoundedtowholedollars. 497CONTRIBUTIONREPORT <br /> NAME OF FILER Date of Date Stamp , � - . � <br /> I <br /> �},fY �rT�fV ,�r- �i �O(.lvt�i( '�1 ThisFiling .,... . - <br /> AREACODE/PHONE NUMBER I.D.NUMBER(ifapplicable) FOfOffIClB�!US2Oflly <br /> b� �6�-0 J 2 O r Z-�j 76 � Report Na <br /> STREET AD RESS ❑Amendment O C� � Z �� <br /> �7 `Z ��f- S� to Report No. <br /> CITY ' STATE ZIP CODE (explain below) <br /> �2��� C� G� � <br /> pl�D6 No.of Pages <br /> 1. Contribution(s) Received <br /> IF AN INDIVIDUAL, AMOUNT <br /> DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR ENTER OCCUPATIONAND EMPLOYER RECEIVED <br /> RECEIVED (IFCOMMITTEE,ALSOENTERI.D.NUMBER) CODE * (IFSELf-EMPLOYED,ENTERNAMEOfBUSINESS) <br /> Jo(�,ot-n h a �c�S'1�►� vSS�, �❑ conn ���i r`e.� �rI �� <br /> /� /Z/� t- �� ❑ OTH ❑ Check if Loan <br /> < i � ' ❑ Pn <br /> (?,eoCuro�d G� C�l G1'4fl� � ❑ S�� % <br /> Provide interest rate <br /> ❑ IND <br /> ❑ COM <br /> ❑ OTH ❑ Check if Loan <br /> ❑ � <br /> ❑ SCC °� <br /> Provide interest rate <br /> ❑ IND <br /> ❑ COM <br /> � OTH ❑ Check if Loan <br /> ❑ PTY <br /> ❑ SCC % <br /> Provide interest rate <br /> `Contributor Codes <br /> IND-Individual <br /> COM-Recipient Committee(other than PTY or SCC) <br /> OTH-Other(e.g., business entity) <br /> PTY-Political Party <br /> Reason for Amendment: SCC-Small ContributorCommittee <br /> FPPC Form 497 (November/07) <br /> FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) <br />