Roloff 497-2Oct 20 2016 02:39PM Roloff Fax 5105222416
497 Contribution Report
NAME OF FILER
Jennifer Roloff City Council 2016
Amounts may be rounded to whole dollars.
AREA CODE/PHONE NUMBER I.D. NUMBER OtaPPlicab(er)
415-999-4395 1385651
STREET ADDRESS
Alameda
1. Contribution (s) Received
STATE ZIP CODE
CA 94501
Date of
10/19/2016
This Filing
Report No.
497-02
El Amendment
to Report No.
(explain below)
No. of Pages
OCT 11 2016
CALIFORNIA 497
ORM
' or .3 c a Ilse on
CITY OF ALAMELA
CITY CLERK'S OFFICE
DATE
RECEIVED
FULL NAME, STREETADDRESS 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
10/18/2016
Jim Hager
Alameda, CA 94502
ll IND
LI COM
E] OTH
PTY
LI SCC
Retired
Retired
• IND
LI COM
LI OTH
• PTY
Eli SCC
1,000.00
Check if Loan
Provide Interest rate
1:1 Check if Loan
Provide interest rate
[71 IND
El COM
0 OTH
• Fry
LI scc
ID Check if Loan
Reason for Amendment:
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 (Jul/2016)
FPPC Advice: advice@fopc.ca.gou (866/275-3772)
www.fppc.ca.gov