Sullwold 497497 Contribution Report
NAME OF FILER
Jane Sullwold for City Council 2012
AREA CODE /PHONE NUMBER
(510) 864 -7026
CITY STATE ZIP CODE
Alameda CA 94501
1. Contribution(s) Received
DATE
RECEIVED
Date of
This Filing
Report No.
❑ Amendment
to Report No.
(explain below)
No. of Pages
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR
(IF COMMITTEE, ALSO ENTER 1.D. NUMBER)
11/03/12
2120 Kensington Road
Toledo, Ohio 43608
Reason for Amendment:
11/05/12
1
1
CONTRIBUTOR
CODE *
IND
❑ COM
❑ OTH
❑ PTY
❑ SCC
❑ IND
❑ COM
❑ OTH
❑ PTY
❑ SCC
❑ IND
❑ COM
❑ OTH
❑ PTY
❑ SCC
497 CONTRIBUTION REPORT
CITY 0:: ALAM L LA.
CITY CLERK'S OFF! CF-
IF AN INDIVIDUAL,
ENTER OCCUPATION AND EMPLOYER
(IF SELF - EMPLOYED, ENTER NAME OF BUSINESS)
Retired /None
AMOUNT
RECEIVED
$5,000
❑ Check if Loan
Provide interest rate
❑ Check if Loan
Provide interest rate
❑ Check if Loan
Provide interest rate
*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 (November /07)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772)