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497 CONTRIBUTION REPORT <br />s may be rounded to whole dollars. <br />0 <br />E <br />497 Contribution Report <br />o. <br />For Official Use Only <br />01 0 <br />Ti IfE <br />G 6.0 <br />)7-...]CE'J 4 ,g) <br />CZ <br />4i1 <br />05/16/2019 <br />LU .06 <br />rr. <br />957696-Y.A <br />0 <br />z <br />t <br />0 <br />• o <br />Ez <br />c <br />• oE <br />Do <br />w <br />No. of Pages <br />NAME OF FILER <br />0 <br />ri <br />a <br />I.D. NUMBER (i. <br />N <br />0 <br />0 <br />0 <br />0 <br />rn <br />ri <br />w <br />m <br />Z <br />W <br />0 <br />a. <br />0 <br />0 <br />STREET ADDRESS <br />i <br />w <br />0 <br />0 <br />U <br />a <br />1. Contribution(s) Received <br />AMOUNT <br />RECEIVED <br />5,000.00 <br />❑ Check if Loan <br />Provide interest rate <br />❑ Check if Loan <br />Provide interest rate <br />Check if Loan <br />Provide interest rate <br />IF AN INDIVIDUAL, <br />ENTER OCCUPATION AND EMPLOYER <br />(IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) <br />CONTRIBUTOR <br />CODE <br />0O i > O0,OIIT- <br />8 <br />.9OH O <br />.000_(.0 <br />?0Oacn - <br />0Oaai <br />❑■■■a <br />■■■■■ <br />■■■■❑ <br />FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR <br />(IF COMMITTEE, ALSO ENTER I.D. NUMBER) <br />Service Employees International Union (SEIU) Local 721, CTW, CLC <br />State & Local Small Contributor Committee <br />Committee ID # 743794 <br />DATE <br />RECEIVED <br />o <br />N <br />01 <br />r1 <br />1.0 <br />0 <br />100 XU <br />`Contributor Codes <br />U <br />U <br />0 <br />m <br />L <br />o ai E <br />PW <br />. <br />.c <br />E o <br />o a <br />U • ro: <br />a. o <br />°?- <br />0 'a 0 0 m <br />> 0.) E <br />i; C) <br />Reason for Amendment <br />o m <br />N 10 <br />U <br />d u <br />LL <br />a <br />a <br />E• o <br />D 61 <br />LL N <br />a a <br />a a <br />LL <br />‘6) <br />u <br />ro <br />0 <br />.15U <br />d <br />Auedwoo au'aQ Nd 10 : ZO f1H,L/G 103/91/AVN <br />