2017-10-26 Form 497 - Palm Springs Forward1Ype or print In Ink.
_L_a_te_c_o_n_t_ri_b_u_t_io_n_R_e_p_o_rt ____________ A_mo-un_ts_ml_yr-be-rou_n_d_ecl_t_o_w_h_ole-dol~la.pirsfio • .iifi-1,1.1;, .... .w....l.~~~~;....--LATE CONTRIBUTION REPORT
NAME OF FILER Dale of Date Stamp
-=P_A ..... '-..... IJ\ .......... .::.S..;,..i'~IZ.'~N~~~'?.:;,__ro_~_~_A...,~.-Q--'i-' a_s_o_tJ __ M_e_A--~\t--~_E..;;,;;,..,..;;D~ This Filing 1 o · 'Z-\i {17 OC 2 6 PH ~: 30
AREA COOEJPHONE NUMBER 1.0 . NUMBER (it applicableJ
CALIFORNIA 49 7
FORM
$~---------------L------------------------~
'. . I i
0 Amendment -~~
CODE ' (ell plain below)
P A-1-11. S ,P 12.1"' GS .:::...4 a, ~a' 'l. No . of Pa ges ---'------
Late Contribution(s) Received
DATE
RECEIVED
I o ·2.b· r/
•contributor Codes
INO -Individual
FULL NAME, SmE~ AO~ESS AND ZIP CODE OF CONmiBliTOR
~ CO-ITTEE. ALSO ENTER I D . N\JioiiiERJ
t-1-A II.. tX. D M 14-IZ/Jl£12..
181 s. Ci\IIC. b12.•.Je, sre 1
PA-t.~ sp~~~.,"~ sl ~ 9-z,Z62.
PTY-Political Party
COM-Recipient Committee (other than PTY or SCC)
OTH-Other (e.g ., business eniiiY)
SCC-Small Contributor Commiltee
CONmiSUTOR
CODE*
()i!IND
0 COM
0 OTH
OPTY o sec
0 IND
0 COM
0 OTH
OPTY
0 sec
0 IND
0 COM
0 OTH
OPTY
0 sec
Reason for Amendment: --------------------------------------------------
IF AN INOMOUAl., AMOUNT ENTER OCCUPATION AND EMPLOYER
pF SEI.J'.EJ.U>LOYEO. ENTER NAME 0' BU&INE&Sj RECEIVED
cSt!t.,f! c&~ 3 96o.c o
.I
0 Check If Loan
0 Check If Loan
0 Check If Loan
FPPC Fonn 497 (JanuaryiO&)
FPPC Toll-Free Helpline: 866/ASK·FPPC (868127&-3n2)