California Form 3509 - Political Or Legislative Activities By Section 23701d Organizations - 2012

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Political or Legislative Activities by
CALIFORNIA FORM
TAXABLE YEAR
3509
2012
Section 23701d Organizations
For calendar year 2012 or fiscal year beginning month______day_____year_______, and ending month ______ day_________year______.
Attach to Form 199. FTB 199N filers see instructions.
Corporation/Organization name
California corporation number
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
No
1
Has the organization participated or intervened in any political campaign on behalf of any elective public office candidate?
1
If “Yes,” describe the activities. Provide a summary of any published material relating to the activities.
2
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
No
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. See instructions.
Complete if the organization attempted to influence legislation.
Yes
No
3
Has the organization attempted to influence any national, state or local legislation, or ballot measure? . . . . . . . . . . . . . . . . . . . . . 3
If “Yes,” describe the activities in detail. Provide a summary of any published materials relating to the activities.
4
Has the organization, during the taxable year listed above, filed a federal election Form 5768, Election/Revocation
Yes
No
of Election by an Eligible Section 501(c)(3) Organization to Make Expenditure to Influence Legislation? . . . . . . . . . . . . . . . . . . . . . 4
The organization cannot make this election if it is a church, an integrated auxiliary of a church, a private foundation, or
an affiliated organization.
If “Yes,” attach a copy of federal Form 5768 filed with the Internal Revenue Service (IRS).
If the organization elected to make expenditures to influence legislation, furnish the following financial information for the taxable year:
5
Exempt Purpose Expenditures
The total amount paid or incurred to accomplish the charitable, educational, religious, etc. purpose. . . . . . . . . . . . . . . . . . . . . . . . 5
$
00
6
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
$
00
7
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
00
FTB 3509 2012 Side 1
8311123

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