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497 Contribution Report Amounts may be rounded to whole dolfars- <br />NAM E OF RLE R Date of 10124119 D.teStarn�- CALIFORNIA <br />Warren Avery For City Council Ward 3 2019 This Fifing FORM 497 <br />AREA COOEIPHONE NUMBER 1. D. V U 1,18 E R Of appymbi�) 20 FRECk.1EIVE1, Foi Official Use OMy <br />1416490 Report No. <br />STIREETADDRESS GICT 2 4 <br />Amendment <br />to Report No. <br />CITY STATE ZIP CODE (explain belaw) City & Riverside <br />11 <br />Riverside CA No. of Pages 1 Cit, aff It% Q, 0,171ce <br />I- ContribLrtion(s) Received <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 - PoliticalParty <br />SCC - Small Contributor Committee <br />FPPC Form 497 [Feb/2019) <br />FPPC Advice: advjce&ppc.ca-gov (8661275-3772) <br />www.fppcca.gcyv <br />2 <br />C) <br />0) <br />I c) <br />CD <br />Ln <br />—i <br />C5 <br />z <br />LU <br />U <br />LU <br />IFAN INDIVIDUAL, <br />DATE <br />FULL NAME, S7REETADDRESSAND ZIP CODE OF CONTRIBUTOR <br />CONTRIBUTOR <br />EN7ER OCCUPATION AND EMPLOYER <br />AMOUNT <br />RECEIVED <br />JIF COP.9.11177EE.ALSO ENTER I.D. *411FASER? <br />COOE, <br />(IF SELF-Elffl-LOYED. ENTER MWE OF BUSiNESS1 <br />REC;ErVED <br />Duane R. Roberts <br />Ej IND <br />Entrepreneurial Corporate Group <br />[] COM <br />Owner, CEO, Chairman of the <br />2500.00 <br />I OJ2411 9 <br />Newport Bea( -MM <br />h, CA <br />Ej OTH <br />Board <br />El Check if Loan <br />E] PTY <br />E:] SCC <br />Pra%ide inierest rate <br />IND <br />Com <br />r] OTH <br />0 Check if Loan <br />0 PTY <br />F-1 SCC <br />ProAde W -rest fale <br />IND <br />Com <br />OTH <br />[I Check if Loan <br />PTY <br />El ScC <br />PwowW- interesi 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 - PoliticalParty <br />SCC - Small Contributor Committee <br />FPPC Form 497 [Feb/2019) <br />FPPC Advice: advjce&ppc.ca-gov (8661275-3772) <br />www.fppcca.gcyv <br />2 <br />C) <br />0) <br />I c) <br />CD <br />Ln <br />—i <br />C5 <br />z <br />LU <br />U <br />LU <br />