HomeMy WebLinkAboutForm 497_07/24/19 497 Contribution Report Amounts may be rounded to whole dollars.
NAME OF FILER Date of 7/24/2019 Date Stamp
CALIFORNIA 497
Shelley Kaplan This Filing FORM
AREA CODE/PHONE NUMBER I.D.NUMBER(if applicable) R EC E IT
Report No. For 0 cial Use Only
617-842-1243 1417408 p
STREET ADDRESS J U L 2 4 201E
67785 Foothill Rd ❑Amendment
toReport No
CI
. °� DEPT
CITY STATE ZIP CODE (explain below) TY -
Cathedral City CA 92234 No. of Pages
1. Contribution(s) Received
IF AN INDIVIDUAL,
DATE FULL NAME.STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR ENTER OCCUPATION AND EMPLOYER AMOUNT
RECEIVED (IF COMMITTEE,ALSO ENTER I.D.NUMBER) CODE* (IF SELF-EMPLOYED,ENTER NAME OF BUSINESS) RECEIVED
UFCW Local 1167 AFL-CIO P 0 Box 1167 Bloomington CA 92316-0030 ❑ IND
❑ COM 1500
7/24/2019 ® OTH
0 Check if Loan
❑ PTY
❑ SCC
Provide interest rate
❑ IND
❑ COM
❑ OTH ❑Check if Loan
❑ PTY
❑ SCC
Provide interest rate
❑ IND
❑ COM
❑ OTH
0 Check if Loan
❑ PTY
❑ SCC
Provide interest rate
*Contributor Codes
IND - Individual
COM - Recipient Committee(other than PTY or SCC)
OTH - Other(e.g., business entity)
Reason for Amendment: PTY - Political Party
SCC - Small Contributor Committee
FPPC Form 497(Feb/2019)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov