Democratic Club 497-1497 Contribution Report
Amounts may be rounded to whole dollars.
NAME OF FILER
(=---/Ty
AREA CODE/PHONE NUMBER
/6/ ) - zz43
STREET ADDRESS
///
CITY
C
.D. NUMBER (if applicable)
1. Contribution(s) Received
STATE
ZIP CODE
Date of
This Filing
Date Stamp
Report No.
D Amendment
to Report No
(explain below)
No. of Pages
OCT 03 2016
CALIFORNIA A elk
e FORM 6111,7
F
CITY OF ALAMEDA
CITY CLERK'S OFFICE
For Official Use Only
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND 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
/944 /?75
Pi c 65y
fi 1976‘)/1 C 4/
O IND
COM
• OTH
▪ PTY
• scc
ij
0 Check if Loan
ok
Provide interest rate
0 IND
O COM
O OTH
PTY
O SCC
D Check if Loan
Provide interest rate
O IND
• COM
• OTH
• p-ry
O 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