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1600-0
Late Contribution Report
NAME OF FILER
Type or print in ink.Amounts may be rounded to whole dollars.
LATE CONTRIBUTION REPORTDate Stamp
AREA CODE/PHONE NUMBERI.D. NUMBER
(if applicable)
STREET ADDRESSCITYSTATEZIP CODE
CALIFORNIAFORM
497
For Official Use Only*Contributor CodesIND - IndividualPTY - Political PartyCOM - Recipient Committee (other than PTY or SCC)SCC - Small Contributor CommitteeOTH - OtherReason for Amendment:
FPPC Form 497(June/01)FPPC Toll-Free Helpline: 866/ASK-FPPC
Late Contribution(s) Received
DATERECEIVEDFULL NAME, MAILING ADDRESS AND ZIP CODE OF CONTRIBUTOR
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
CONTRIBUTORCODE
*
IF AN INDIVIDUALENTER OCCUPATION AND EMPLOYER
(IF SELF-EMPLOYED, ENTER NAME OF BUSINESS)
AMOUNTRECEIVED
Date ofThis FilingReport No.Amendmentto Report No.
(explain below)
No. of Pages
INDCOMOTHPTYSCCINDCOMOTHPTYSCCINDCOMOTHPTYSCC
Small Business Action Committee PAC, No on 30/Yes on 32, citizens for reforming Sacramento(949)495-33141270683Laguna NiguelCA9267710/16/2012102Page1 of 210/15/2012Americans for Responsible LeadershipPhoenix, AZ 85916$11,000,000.00
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