D sec 0 sec

497 Contribution Report
Amounts may be rounded to whole dollars.
Report No. _ _2_ ____
0Amendment
to Report No. ___ _ __..,,
=-:---------------------,S"'~"'
ATE=-----oZio-cPo-C=cO"'O:::------1
E
(explain below)
CA
EmeryVille
94608
1
1 __
No.ofPages ________
1. Contribution(s) Received
DATE
RECEN ED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR
OF COMMm£E, AlSO ENTER I 0 . NU I.IBER)
Louise Engel
10/21/16
Emeryville, CA 94608
CONTRIBUTOR
CODE*
12!J)4No
D COM
D OTH
D PlY
IF AN INDIVIDUAL,
ENTER OCCUPATION AND EMPLOYER
Self Employed.
MP Dreams, Inc.
0
0
0
0
0
$2,300.00
XJ)fheck if Loan
0
D sec
D
D
D
D
D
AMOUNT
RECEIVED
(lF SElF.tMPL.,'IED, ENlER NAME OF BUSINESS)
%
Provide interest rate
INO
COM
OTH
0
Checil if Loan
PlY
sec
'!.
Provide interest rate
IND
COM
OTH
0
Check if Loan
PlY
sec
·~
Provide intersst rate
"'*Contributor Codes
Reason for Amendment:--- - - - -- - - - - - - -- -- - -- - - - - - ---- - - - -
IND COMOTH PTY SCC -
Individual
Recipient Committee (other than PTY or SCC)
0\har (e.g. , biJsiness entity)
Po ll ~cal Party
Small Conlribulor Committee
FPPC Forni 497 (lul/2016)
FPPC Ad\lice: [email protected] (866/275-JnZl
www.fppc.ca.gov