497 Pena 2018 Report 1 - 10/15497 Contribution Report
Amounts may be rounded to whole dollars.
NAME OF FILER
COMMITTEE TO ELECT JOHN PENA CITY COUNCIL 2018
AREA CODE/PHONE NUMBER
STREET ADDRESS
I.D. NUMBER (if applicable)
1370057
CITY
LA QUINTA
STATE ZIP CODE
CA 92253
Date of 10/16/18
This Filing
Report No
❑ Amendment
to Report No.
(explain below)
No. of Pages
Date Stamp
LC
1
RECEIVED
OCT 16 2018
CITY OF LA CiUINTA
ITY CLERK DEPARTMENT
CALIFORNIA 497
FORM
or
cia
se
n
y
1. Contribution(s) Received
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
CONTRIBUTOR
CODE *
IF AN INDIVIDUAL,
ENTER OCCUPATION AND EMPLOYER
(IF SELF-EMPLOYED, ENTER NAME OF BUSINESS)
AMOUNT
RECEIVED
10/15/2018
ACME HOUSE CO.
Palm Springs, CA 92262
❑IND
❑ coM
4,900
❑Check if Loan
ok
X
• pm'
❑ SCC
Provide interest rate
❑ IND
❑ COM
❑ OTH
❑ PTY
❑SCC
❑ Check if Loan
%
Provide interest rate
❑ IND
❑ COM
❑ OTH
❑ PTY
❑ Check if Loan
%
■ SCC
Provide interest rate
Reason for Amendment
`*Contributor Codes
IND — Individual
COM — Recipient Committee (other than PTY or SCC)
OTH — Other (e.g., business entity)
PTY — Political Party
SCC — Small Contributor Committee
FPPC Form 497 (Jul/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov