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497 Soubirous (11-01-13) 2R
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Late Contribution Report <br />Type or print in ink. <br />Amounts may be rounded to whole dollars. <br />LATE CONTRIBUTION REPORT <br />NAME OF FILER <br />Mike Soubirous for Riverside City Council - Ward 3 2013 <br />Date of <br />11/01/2013 <br />Date Stamp <br />RECEIVED.. <br />C74L1ORNIc;. ".;/�'' <br />AMOUNT <br />This Filing <br />LCR- 201311 <br />1 <br />,�. <br />AREA CODE/PHONE NUMBER <br />I.D. NUMBER (if zpplicable) <br />11355581 <br />For Official Use Only <br />Mrs. Be S ri s <br />it IND <br />Report No. <br />❑ Amendment <br />ND - 12013 <br />City of RiverSid <br />❑ COM <br />to Report No. <br />(explain below) <br />City Clerk's Office <br />CITY STATE ZIP CODE <br />D OTH <br />No. of Pages 2 <br />1/2 <br />Riverside CA <br />❑ pT,( <br />Late Contribution(s) Received <br />DATE <br />FULL NAME, MAILING ADDRESS AND ZIP CODE OF CONTRIBUTOR <br />CONTRIBUTOR <br />IF AN INDIVIDUAL <br />NTER OCCUPATION AND EMPLOYER <br />AMOUNT <br />RECEIVED <br />{IF COMMITTEE, ALSO ENTER I.D. LO. NUMBER) <br />CODE � <br />(IF SELF - EMPLOYED, ENTER NAME OF BUSINESS) <br />RECEIVED <br />11101/2013 <br />Mrs. Be S ri s <br />it IND <br />Retired <br />133.00 <br />❑ COM <br />D OTH <br />_ <br />Riverside CA <br />❑ pT,( <br />ID: <br />❑ sCC <br />❑ IND <br />❑ COM <br />❑ OTH <br />❑ PTY <br />ID: <br />❑ SCC <br />❑ IND <br />❑ COM <br />❑ OTH <br />❑ PTY <br />ID: <br />❑ SCC <br />`Contributor Codes <br />IND - Individual PTY - Political Party <br />COM - Recipient Committee (other than PTY or SCC) SCC - Small Contributor Committee <br />OTH - Other <br />Reason for Amendment: <br />FPPC Form 487 (June /01) <br />Date Stamp FPPC Toll -Free Helpline: 8661ASK -FPPC <br />T <br />0 <br />r— <br />m <br />PO <br />6 <br />z <br />p <br />n <br />C--) <br />00 <br />rn <br />w <br />v, <br />N <br />_d <br />W <br />N <br />0 <br />N <br />W <br />W <br />0 <br />a <br />0 <br />0 <br />N <br />
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