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Type or print in ink. <br /> 497 Contribution Report Amounts may be rounded to whole dollars. 497 CONTRIBUTION REPORT <br /> NAME OF FILER Date of Date Stamp CALIFORNIA 497 <br /> John Seybert for Redwood City Council 2009 This Filing 10/26/09 FORM <br /> AREA CODE/PHONE NUMBER I.D.NUMBER(if applicable) 1 For Official Use Only <br /> Report No. <br /> i l� <br /> 1313963 C.650-533-5053 ,�.� y <br /> �� <br /> � � <br /> STREET ADDRESS 0 Amendment <br /> 3782 Jefferson Avenue to Report No. <br /> CITY STATE ZIP CODE <br /> (explain below) - <br /> Redwood City CA 94062 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 OCCUPATION AND EMPLOYER RECEIVED <br /> RECEIVED (IF COMMITTEE,ALSO ENTER I.D.NUMBER) (IF SELF-EMPLOYED,ENTER NAME OF BUSINESS) <br /> ❑ IND $1000.00 <br /> 10/26/09 Service Employees International Union Local#521 Candidate PAC p COM <br /> ID# 1297708 ❑ OTH ❑ Check if Loan <br /> 555 Capitol Mall, Suite 1425 ❑ PTY <br /> Sacramento, CA 95814 ❑ SCC % <br /> Provide interest rate <br /> ❑ IND <br /> ❑ COM <br /> ❑ OTH ❑ Check if Loan <br /> ❑ PTY <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: Late contribution of$1000 or more. SCC—Small Contributor Committee <br /> FPPC Form 497 (November/07) <br /> FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) <br />