HomeMy WebLinkAboutForm 497 - Maribeth Bushey-Lang for City Council 2013 (2013-09-12)4AME OF FILER
Man"beth Bushey Lang for San Rafael City Cound.
AREA CODE PHONE NUMBER W. RLWBER rw
1358,370
STUET ADDRESS
CITY STATE
San Rafael CA
ype or print in ink.
Amounts may be rounded to whole dollars.
Date of 09112/13
Thi's Fffln!g
Report No. _WqU I -IJV-4&
Amendment
to Report Na.
ZIP CODE (explain bekmd
94901 No. of Pages
20103
CA(v Clev.,-Ws Ofirflicie
of San Raf�e-1
DATE
RECEIVED
FULL NA&F, MEETADDRESSANO ZIP COOS OF GONTRI BUTOR
(IF COM -MITT EE.ALSO ENT ER 1.D. MWMR)
COM".. ,[BUTCH
CODE
IF AN IbNE)IVI DUAL,
ENTER OCCUPATION AND EMPLOYER
AMOUNT
'RECEIVED
IjIF -SE U-MKOW-D, EWER N"E OF SW NES}
San Rafael Firefighters PA. G.Xandfldate Account
F] IND
ID # 891308
nX CON!
$13500.00
PO Box 2519
n OTH
J--1 Check if Loan
San Rafael, CA 94912
F] PTY
El8GC
Pmvidelinterest rale
IND
coo
OTH
E] Ghmeck if Loan
El PTY
Prime intereM rate
IND
F1 COM
El {STM
® Check if Lean
® PTY
El SCC
Previte interest rate
M -T W I I I 1 15
Post -le Fax Note 76715
- - - - - - - - - - - - - - - - - - -
"Contributor Codes
IND — Individual
COM — Recipient Committee (other than FTY or SCCA
ntjty)
PTY PoRical Party
SCG — Small Contributor CornnniUea
Form 4,97 (March12011 1)
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