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HomeMy WebLinkAboutForm 497- Greg Brockbank for Mayor 2011 (2011-11-07)C Rec Type or print In ink, ti r 4 497 Contribution Report Amounts mnyberounded tow4holedolisre, 4g7CONTRIBUTION REPORT NAME OF FILER Dateof Gato• Cx �3QO��C+�f1N�4{i �.�JtJa, FM M���Q_ ThisFHit� (1 � (I v •' " ` AREA CpDEfpt1O1JE NUMBERi.D. NUMBERtaepo+tra6�s) t)r a 58. 9] y c �j iZ 3 Report No. a #� to Report No. r CITY STATE ZIP CODE (exptaln fxek>+Jj + Rn 3 No. of Pages t 1. Contribution(s) Received IFAM IMI MILIAL, AMOUtJT DATE FULL NAME, STREET ADDRMANDZIPCOM OFCONTRIBUTOR CONTRIBUTOR ENTER.00CUPATIONAND F-WLOYER RECEIVED RECEIVED •(tFC#NWrfM.ALSO ENTMMUMBER) OODE lip SEu�M.<rreu.ENTIMNAWOrSUSI&S) . Uic�r f t �nn+l}e2. �ei5"7 (b ❑ KV END ❑ COM © Check !(Loan incrc��ona , SCC . Pro title werw rMe F ❑ IND ❑ COty! OTH 0 Check If Loan n ❑ PT`s - ❑'SGC Prrn�Ide FAarest rate a F _ ❑ IND � ❑ COM ❑ OTH ©.CtT If'Loan ❑ PTY ❑ SGC,._e prrr.4de 4�teresi rate "Contributor Codes 114D -- Individual COM - Redpeent Committee (other Ihan PTY or SCC) 0TH - Otiier (a -g., business entity) PTY - Polkical Party c Reason for Amendment: SCC - Smell ContribuW Committee FPPC Form 4.97 (March/Zl i) FPPC Toll -Free Heipilne: OWASK-FPPC (&661275-at72) - c