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I <br />MINTIROTIT"oT"My".77-T.T.r2l <br />Amounts may be rounded to whole dollars. <br />497 CONTRIBUTION REPORT <br />NAME OF FILER <br />Date of <br />Date Stamp <br />IF AN INDIVIDUAL, <br />ENTER OCCUPATION AND EMPLOYER <br />Erin Edwards for City Council Ward 1 2019 <br />This Filing 09/20/2019 <br />(IF COMMITTEE.ALSO ENTER I.D. NUMBER) <br />1 <br />For Official Use Only <br />AREA CODE/PHONE NUMBER <br />I.D. NUMBER (ifapplicable) <br />09/19/2019 <br />� <br />Report No.683362-KA <br />V <br />1,000.00 <br />NNENNN00- <br />1406052 <br />[:] Amendment <br />SEP 2 0 2019 <br />STREET ADDRESS <br />to Report No. <br />(explain below) <br />City of Riverside <br />E] Check if Loan <br />CITY STATE ZIP CODE <br />No. of Pages 2 <br />Cid Clerk's Office <br />Riverside CA <br />SCC <br />1. Contribution(s) Received <br />DATE <br />FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR <br />CONTRIBUTOR <br />IF AN INDIVIDUAL, <br />ENTER OCCUPATION AND EMPLOYER <br />AMOUNT <br />RECEIVED <br />(IF COMMITTEE.ALSO ENTER I.D. NUMBER) <br />CODE <br />(IFSELF-EMPLOYED, ENTER NAME OF BUSINESS) <br />RECEIVED <br />09/19/2019 <br />4ission Impossible Antiques, Inc. dba The Hideaway Cafe <br />❑ IND <br />1,000.00 <br />Riverside, CA <br />F-1 com <br />FX_1 OTH <br />E] Check if Loan <br />PW <br />SCC <br />Provide interest rate <br />F -I IND <br />El COM <br />[I OTH <br />❑ Check if Loan <br />El PTY <br />❑ SCC <br />Provide interest rate <br />El IND <br />El COM <br />R OTH <br />E] Check if Loan <br />El PTY <br />El SCC <br />% <br />Provide interest rate <br />Reason for Amendment: <br />*Contributor Codes <br />IND - Individual <br />COM - Recipient Committee (other than PTY or SCC) <br />OTH - Other (e.g., business entity) <br />PTY - Political Party <br />SCC - Small Contributor Committee <br />FPPC Form 497 (Feb/2019) <br />FPPC Advice: advice@fppc.ca.gov (866/275-3772) <br />www.fppc.ca.gov <br />I <br />