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D Smullen 497
Amounts may be rounded to whole dollars. 497 Contribution Report A— I.D. NUMBER (if applicable) co co d > 0 C) d N C 0 9-' z 9-' C 0 U AMOUNT RECEIVED $102.00 ® Check if Loan 0 0� Provide interest rate $2763 ® Check if Loan 0 ro Provide interest rate $5000 ® Check if Loan 0 ro Provide interest rate IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) Planning Commission Chair, City of Saratoga Planning Commission Chair, City of Saratoga Planning Commission Chair, City of Saratoga CONTRIBUTOR CODE * O H OOQcn U CIO U ?OOacn 0O H U ?OOLcn x❑■❑❑ ©❑■■■ ©■■■■ FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR (IF COMMITTEE, ALSO ENTER I.D. NUMBER) Dorothea Smullen aka Dede Smullen 15363 Peach Hill Rd Saratoga CA 95070 Dorothea Smullen aka Dede Smullen 15363 Peach Hill Rd Saratoga CA 95070 Dorothea Smullen aka Dede Smullen 15363 Peach Hill Rd Saratoga CA 95070 DATE RECEIVED � r 35 co 8/8/16 **Contributor Codes U U 11111 OHFU ?0Oacn r information Reason for Amendment: Form m ▪ 0 M u • 14 Li ▪ N4.0 • O• 0 3 E c 3 o • 0•0 u fUJ a a fl u 0 u u a a LL