Form 497 Late Contribution Report
NAME OF FILER
Alice Jacobson for City Council
AREA CODE/PHONE NUMBER
STREET ADDRESS
164 Coop Court
CITY
Encinitas
Late Contribution(s) Received
Type or print in ink.
Amounts may be rounded to whole dollars.
Date of I-', '�ampT
This Filing 01/29/2005
I.D.NUMBER Otapplicabie) 1 �
1268244 Report No. 000-200 A Ft;t
❑ Amendment
to Report No.
STATE ZIP CODE (explain below)
CA 92024-1437 No.of Pages 2 1 /2
LATE CONTRIBUTION REPORT
For
DATE
RECEIVED
FULL NAME,MAILING ADDRESS AND ZIP CODE OF CONTRIBUTOR
CONTRIBUTOR
IF AN INDIVIDUAL
ENTER OCCUPATION AND EMPLOYER
AMOUNT
(IF COMMITTEE,ALSO ENTER I.D.NUMBER)
CODE
(IF SELF-EMPLOYED,ENTER NAME OF BUSINESS)
RECEIVED
10/22/2004
Alice Jacobson
Q IND
Manager
3000.00
164 Coop Court
❑ COM
❑ OTH
Western Financial Plannin-
Encinitas CA 92024-1437
❑ PTY
g
ID:
❑ SCC
❑ IND
❑ COM
'
❑ OTH
❑ PTY
ID:
❑ SCC
❑ IND
❑ COM
❑ OTH
❑ PTY
ID:
❑ SCC
*Contributor Codes
IND-Individual PTY-Political Party
COM-Recipient Committee(other than PTY or SCC) SCC-Small Contributor Committee
OTH-Other
Reason for Amendment:
FPPC Form 497(June/01)
Date Stamp FPPC Toll-Free Helpline:866/ASK-FPPC
Late Contribution Report
NAME OF FILER
Alice Jacobson for City Council
AREA CODE/PHONE NUMBER
STREET ADDRESS
CITY
Late Contribution(s) Made
I.D.NUMBER Wappiicable)
1268244
STATE
Type or print in ink.
Amounts may be rounded to whole dollars.
Date of
This Filing
Report No.
❑ Amendment
to Report No.
ZIP CODE (explain below)
No.of Pages
2/2
LATE CONTRIBUTION REPORT
Use Only
DATE
FULL NAME,MAILING ADDRESS AND ZIP CODE OF RECIPIENT
CANDIDATE AND OFFICE
OR
AMOUNT OF
DATE OF ELECTION
MADE
(IF COMMITTEE,ALSO ENTER I.D.NUMBER)
MEASURE AND JURISDICTION
CONTRIBUTION
(IF APPLICABLE)
Ballot:
ID:
Dist:
Ballot:
ID:
Dist:
Ballot:
ID:
Dist:
Ballot:
ID:
Dist:
Reason for Amendment:
FPPC Form 497(June/01)
FPPC Toll-Free Helpline:866/ASK-FPPC