497 Peña 2022 Report 1 -10/14497 Contribution Report
NAME OF FILER
COMMITTEE TO ELECT JOHN PENA CITY COUNCIL 2022
Amounts may be rounded to whole dollars.
AREA CODE/PHONE NUMBER
I.D..NUMBEI-3 (if applicable)
1370057
STREET ADDRESS
CITY
LA QUINTA
STATE
CA
ZIP CODE
92253
Date of 10/14/2022
This Filing
Report No. 1
❑ Amendment
to Report No.
(explain below)
1
No. of Pages
Date Stamp
RECEIVED
OCT 14 2022
CITY OF LA QUINTA
CITY CLERK DEPARTME
For Official Use Only
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
ONE ELEVEN LA QUINTA, LLC
1,000.00
■ IND
• COM
10/14/2022
LA QUINTA, CA 92253
El Check if Loan
t•I OTH
■ PTY
IN SCC
Provide interest rate
■ IND
■ COM
■ OTH
❑ Check if Loan
• PTY
■ SCC
%
Provide interest rate
■ IND
• COM
■ OTH
❑ Check if Loan
• PTY
■ 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 (Feb/2019)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov