Fppc Form 462 - Verification Of Independent Expenditures

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Form 462

462

CALIFORNIA

Verification of Independent Expenditures

FORM

This verification form identifies the individual responsible for ensuring that a campaign committee’s independent

Amendment

(Explain)

expenditures were not coordinated with the listed candidate (or the opponent) or measure committee and that the

committee will report all contributions and reimbursements as required by law. An independent expenditure is not

subject to state or local contribution limits.

1. Name of Committee:

NAME OF RECIPIENT COMMITTEE, ENTITY OR INDIVIDUAL

COMMITTEE ID #

STREET ADDRESS

CITY

ZIP CODE

E-MAIL

TELEPHONE NUMBER

STATE

(

)

2. Candidate or Measures:

This committee has reported an independent expenditure(s) to support or oppose the candidate(s) or measure(s) listed on a ballot for the election date identified below. (Note:

The reporting of an independent expenditure may occur after this form is filed if an independent expenditure is made before the 90 day, 24-hour reporting period of Government

Code Sections 84204 and 85500.)

NAME OF CANDIDATE (First/Last) OR BALLOT MEASURE

SUPPORT

OPPOSE

OFFICE SOUGHT OR HELD/ BALLOT NO./LETTER

JURISDICTION AND DISTRICT, IF ANY

ELECTION DATE

OFFICE SOUGHT OR HELD/ BALLOT NO./LETTER

JURISDICTION AND DISTRICT, IF ANY

ELECTION DATE

NAME OF CANDIDATE (First/Last) OR BALLOT MEASURE

SUPPORT

OPPOSE

SUPPORT

OPPOSE

OFFICE SOUGHT OR HELD/ BALLOT NO./LETTER

JURISDICTION AND DISTRICT, IF ANY

ELECTION DATE

NAME OF CANDIDATE (First/Last) OR BALLOT MEASURE

SUPPORT

OPPOSE

OFFICE SOUGHT OR HELD/ BALLOT NO./LETTER

JURISDICTION AND DISTRICT, IF ANY

ELECTION DATE

3. Verification:

I have not received any unreported contributions or reimbursements to make these independent expenditures. I have not coordinated any expenditure made during this

reporting period with the candidate or the opponent of the candidate who is the subject of the expenditure, with the proponent or the opponent of the state measure that is the

subject of the expenditure, or with the agents of the candidate or the opponent of the candidate or the state measure proponent or opponent. I certify under penalty of perjury

under the laws of the State of California that the following is true and correct.

Signature

Printed Name

Signed on

(month, day, year)

(Check One):

Principal Officer

Candidate/Officeholder

State Ballot Measure Proponent

FPPC Form 462 (Aug/2016)

FPPC Advice: advice@fppc.ca.gov (866/275-3772)

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