California Form 3509 - Political Or Legislative Activities By Section 23701d Organizations - 2016

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Political or Legislative Activities by

TAXABLE YEAR

CALIFORNIA FORM

3509

2016

Section 23701d Organizations

For calendar year 2016 or fiscal year beginning (mm/dd/yyyy)

, and ending (mm/dd/yyyy)

Attach to Form 199. FTB 199N filers see instructions.

Corporation/Organization name

California corporation number

Street address (suite, room, or PMB no.)

FEIN

City

State

ZIP code

Part I – Political Activities

Complete if the organization supported or opposed a candidate for public office. See instructions.



. . . . . .

Yes

Has the organization participated or intervened in any political campaign on behalf of any elective public office candidate?

If “Yes,” describe the activities. Provide a summary of any published material relating to the activities.

Has the organization contributed funds to support or oppose any individual public office candidate, or any organizations formed



to support or oppose a public office candidate? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Yes

If “Yes,” describe the activities. Include the name of the individual or organization the organization contributed to,

the amount paid, and date of contribution.

Part II – Legislative Activities

Complete if the organization attempted to influence legislation.

Has the organization attempted to influence any national, state or local legislation, or ballot measure and not filed a

federal Form 5768, Election/Revocation of Election by an Eligible Section 501(c)(3) Organization to Make Expenditures to



Yes

Influence Legislation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

If “Yes,” See instructions.



Yes

4a Has the organization, during the 2016 taxable year, filed a federal Form 5768? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4a

If “Yes,” attach a copy of federal Form 5768 filed with the Internal Revenue Service and skip question 4b. This fulfills the

organization’s need to file an election for state purposes.

If “No”, go to question 4b and see instructions.



Yes

4b Has the organization filed a federal Form 5768 in a prior year that has not been revoked? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4b

Note:

The organization cannot make this election if it is a church, an integrated auxiliary of a church, a private foundation, or

an affiliated organization.

Furnish the following financial information for the taxable year:

Exempt Purpose Expenditures

The total amount paid or incurred to accomplish the charitable, educational, religious, etc. purpose. . . . . . . . . . . . . . . . . . . . . . . . 5

Lobbying Expenditures

The total amount expended for the purpose of influencing legislation through communication with any member or employee

of a legislative body or any government official or employee who may participate in the formation of legislation. . . . . . . . . . . . . . . 6

Grass Roots Expenditures

The amount expended to influence any legislation through attempts to affect the opinions of the general public or any

segment of it.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

FTB 3509 2016 Side 1

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