Roloff 497-3497 Contribution Report
Amounts may be rounded to whole dollars.
NAME OF FILER
Jennifer Roloff City Council 2016
AREA CODE/PHONE NUMBER
415-999-4395
STREET ADDRESS
I.D. NUMBER (if applicable)
1385651
Alameda
STATE ZIP CODE
CA 94501
Date of
This Filing
Report No
11/01/2016
497-03
o Amendment
to Report No.
(explain below)
No. of Pages
Date Stamp
LE
NOV 0 1 2016
CITY OF ALAMED
CITY CLERK'S OFF
CALIFORNIA 497
FORM
1. Contribution(s) Received
DATE
RECEIVED
FULL NAME, STREET ADDRESSAND ZIP CODE OF CONTRIBUTOR
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
CONTRIBUTOR
CODE *
IF AN INDIVIDUAL,
ENTER OCCUPATION AND EMPLOYER
(IF SELF-EMPLOYED, ENTER NAME OF BUSINESS)
AMOUNT
RECEIVED
11/01/2016
DeLong Liu
Walnut Creek, CA 94597
IND
O COM
LI OTH
111 PTY
LI SCC
Business Owner
Circle K Alameda
1,000.00
1:1 Check if Loan
Provide interest rate
O IND
0 COM
LI OTH
• PTY
LI SCC
I=1 Check if Loan
Provide interest rate
0 IND
• COM
LI OTH
• PTY
111 scc
0 Check if Loan
Provide interest rate
Reason for Amendment
**Contributor Codes
IND — Individual
COM — Recipient Committee (other than PTY or SCC)
OTH — Other (e.g., business entity)
PTY — Political Party
SCC — Small Contributor Committee
FPPC Form 497 (Jul/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov