neighbors who care 2016 yes on w

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  • 8/17/2019 Neighbors Who Care 2016 Yes on W

    1/1

    497 Contribution Report Amounts may be rounded to whole dollars.

     AMOUNT

    RECEIVED

    IF AN INDIVIDUAL,ENTER OCCUPATION AND EMPLOYER

    (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS)

    DATE

    RECEIVED

    497 CONTRIBUTION REPORT

    CALIFORNIA

    FORM

    Date Stamp

    FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR(IF COMMITTEE, ALSO ENTER I.D. NUMBER)

    CONTRIBUTORCODE *

    For Official Use Only

    497NAME OF FILER

     AREA CODE/PHONE NUMBER

    STREET ADDRESS

    CITY STATE ZIP CODE

    I.D. NUMBER (if applicable)

    1. Contribution(s) Received

    IND

    COM

    OTH

    PTY

    SCC

    Date of This Filing

    Report No.

    Amendment

    to Report No.

    No. of Pages

    IND

    COM

    OTH

    PTY

    SCC

    IND

    COM

    OTH

    PTY

    SCC

    *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

    (explain below)

    Reason for Amendment:

    Check if Loan

    %Provide interest rate

    Check if Loan

    %

    Provide interest rate

    Check if Loan

    %

    Provide interest rate

    www.netfile.com 

    FPPC Form 497 (Jan/2016)

    FPPC Advice: [email protected] (866/275-3772)www.fppc.ca.gov

    Neighbors Who Care 2016, Yes on W

    (530)268-1280 1384900

    Grass Valley CA 95945

    04/27/2016

    2016-1

    1

    04/27/2016 Americans for Good GovernmentGrass Valley, CA 95945

    X

    1,500.00

    E-Filed04/29/201600:11:14

    Filing ID:160295773