HomeMy WebLinkAboutForm 497 - Rachel Kertz for Board of Education 2018 (2018-10-16)497 Contribution Report Amounts may be rounded to whole dollars.
497 CONTRIBUTION REPORT
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Rachel Kertz for Board of Education 2018 This Fili ng 10/16/2010
AREA CODE/PHONE NUMBER 1.D . NUMBER (ifapp/1cable)
( 1410420
Report No . 10162010 -1
STREET ADDRESS D Amendment
____________________ S_T_A_T_E ___ Z_I_P_C_O_D_E ____ --1 (expla in below )
Roseville CA 95661
No . of Pages __ ___::1'----
1. Contribution(s) Received
DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR
RECEIVED (IF COMMITTEE ALSO ENTER I D NUMBER ) CODE*
10 /15/2018 Rachel Kertz
D COM
D 0TH
Lo an D PTY
D sec
D IND
D COM
D 0TH
D PTY
D sec
D IND
D COM
D 0TH
D PTY
D sec
Reason for Amendment: ------------------------------------
www.netfile.com
OCT 1 6 ~Oi8
CITY CLERK'S OF ICE
IF AN INDIVIDUAL,
ENTER OCCUPATION AND EMPLOYER
(IF SELF -EMPLOYED , ENTER NAME OF BUSINESS )
Director of Strategic Programs
Belvedere Tiburon Library
Foundation
•contributor Codes
IND -Individual
AMOUNT
RECEIVED
3,500.00
D Check if Loan
%
Provide interest rate
D Check if Loan
%
Prov ide interest rate
D Check if Loan
.,
" Provide interest rate
COM -Recipient Committee (other than PTY or SCC)
0TH -Other (e.g., business entity)
PTY -Political Party
sec -Small Contributor Committee
FPPC Form 497 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov