HomeMy WebLinkAboutForm 497 - Rachel Kertz for Board of Education 2018 (2018-10-02)497 Contribution Report Amounts maybe rounded to whole dollars.
497 OOAlTRIBUTION REPORT
NAME OF FILER Date of IE OT7 n/J • g
Rachel hertz for Board of Education 2016 This Filing 10/02/2016 lel/
AREA COOEPHONE NUMBER I.D. NUMBER rfaiDAW6ab)orOffidal Use Only
Report No. 10022G!8-1
( 1410420 I OCT 2 2018
STREET ADDRESS
E]Amendment
to Report
CITY STATE CLERK'S OFFI E
STATE ZJ P CODE
1
Roseville CA 95661 No. of Pages
1. Contribution(s) Received
DATE
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR
CONTRIBUTOR
*
IF AN INDIVIDUAL,
ENTER OCCUPATIONAND EMPLOYER
AMOUNT
RECEIVED
RECEIVED
0FCCW41rTEE.AbSDENTER I.D.NOLISS )
CODE
(IF 50.F -EMPLOYED, ENTER WAE OiF BUSENESS)
30/01/2018
Rachel Kertz
❑x IND
Director of Strategic Programs
Tiburon Library
3,00D.00
❑ COM
Foundation
SCC —Small Contributor Committee
❑ OTH
❑ Check if Loan
I
ElPTY
FPPC Form 497 (Janr2016)
cTI
FPPC Advice, advice@Fppc.ca gov (8661275-3772)
L�an
❑ SCC
Provide Interest rate
❑ IND
❑ cu4
❑ OTH
❑ Check if Loan
❑ MY
❑ SCC
Provide interest rate
❑ IND
❑ Cold
❑ OTH
❑ Check if Loan
❑ PTY
❑ SCC
Provide interest rete
Reason for Amendment:
www.nettile.com
I
O
00
'Contributor Codes
p
tND— Individual
CD
CD
COrki — Recipient Cornmiffee (other than PTY or SCC)
_o
OTH — Other (e.g., business entity)
O
PTY— Political Party
SCC —Small Contributor Committee
I
FPPC Form 497 (Janr2016)
cTI
FPPC Advice, advice@Fppc.ca gov (8661275-3772)
www.fppc.ca.gov