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497 Contribution Report Amounts may be rounded to whole dollars. <br />d971:47INTRiRt Mr1N PP:Pr)PT <br />NAME OF FILER <br />Date of <br />Date Stamp <br />IF AN INDIVIDUAL, <br />ENTER OCCUPATION AND EMPLOYER <br />Monrow Mabon for Riverside City Council 2021 <br />ThisFiling05/25/202�Lng <br />ReportNo.8 <br />EEi V <br />�AREACODEIPHONE <br />50fficdial <br />NUMBER <br />LD. NUMBER tdapplicable) <br />11428458 <br />For Ilse Only <br />Service Employees International Union Local 121RN Health Care Fund <br />R <br />❑ IND <br />Amendment <br />MAY 2 6 2021 <br />STREET ADDRESS <br />c/o <br />to Report No. <br />(e*lainbelow) <br />City of Riverside <br />CITY STATE ZIP CODE <br />No. of Pages 1 <br />C*Ity 'Clerk's Office <br />Covina CA <br />❑ OTH <br />E] Check if Loan <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 />MOUNT <br />RECEIVED <br />(IFCOMMITTEE,ALSO ENTER I.D.D.NUMBER) <br />CODE * <br />(IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) <br />05/25/2021 <br />Service Employees International Union Local 121RN Health Care Fund <br />1,000.00 <br />❑ IND <br />Long Beach, CA <br />0 COM <br />Committee ID #a 1385421 <br />❑ OTH <br />E] Check if Loan <br />❑ PTY <br />❑ SCC <br />i <br />Provide interest rate <br />❑ IND <br />❑ COM <br />El OTH <br />p Check if Loan <br />❑ PTY <br />❑ SCC <br />i <br />Provide interest rate <br />❑ IND <br />❑ COM <br />OTH <br />❑ Check if Loan <br />❑ PTY <br />❑ SCC <br />ai <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 />