HomeMy WebLinkAboutForm 497- Yes on Measure D (2016-05-13)497 Contribution Report Amounts may be rounded to whole dollars.
OF
Committee to Support San Rafael Libraries -Yes on Measure D
AREACOD8PHONENUMBER
415-446-4222
1000 Fourth Street, Suite 600
!.D. NUMBER (ifapplicab/e)
1383895
Date of
This Filing __ 5_/1_3_/2_0_1_6_
Report No. ___ 5 __ _
o Amendment
to Report No. ____ _
"::"C=ITY::-:------------------=;;:---=:-;;-;::;::';:"E------I (explain below)
San Rafael CA 94901 No.ofPages ___ 1~ __
1. Contribution(s) Received
FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR DATE
RECEIVED (IF COMMITTEE. AlSO ENTER 1.0. NUMBER) CODE *
Service Employees Intemational Union Local 1021 Issues PAC 0 (NO
555 Capitol Mall, Suite 1425 [g] COM
5/12/2016 Sacramento, CA 95814 0 OTH ID #1296947 0 PTY
0 sec
0 (NO
0 COM
0 OTH
0 PTY
0 sec
0 (NO
0 COM
0 OTH
0 PTY
0 sec
ReasonfurAmendment _________________________________ _
CITY CLERK'S 0
IF AN INDIVIDUAL.
ENTER OCCUPATION AND EMPLOYER
(IF SELF-EMPLOYEO. ENTER NAME OF BUSINESS)
"Contributor Codes
INO -Individual
AMOUNT
RECEIVED
5,000
o Check if Loan
%
Provide interest rate
o Check if Loan
%
Provide inlerest rate
o Check if Loan
%
Provide interest rete
COM -Recipient Committee (other than PTY or SCC)
OTH -Other (e.g., business entity)
PTY -Political Party
SCC -Small Contributor Committee
FPPC Form 497 (Jan/20i6)
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