Recipient Committee
Campaign Statement – Short Form
CALIFORNIA
FORM
Who Uses Form 450:
Form 450 May Be Filed As:
Form 450 is for use by a recipient committee if the
committee:
• A Semi-annual Statement
• Is not controlled by a candidate. (Exception:
Candidate controlled ballot measure committees
may use this form.)
• A Supplemental Pre-election Statement
• Has not received a contribution which must be
itemized (a cumulative amount of $100 or more
from a single source);
• A Quarterly Statement in connection with a ballot
measure
• Has not received any other payment of $100 or
more (miscellaneous increases to cash);
This form was prepared by the Fair Political
Practices Commission (FPPC). For detailed
information on campaign reporting requirements
and the Information Practices Act of 1977, see the
FPPC Campaign Disclosure Manual for your type
of committee (available from your filing officer or
the FPPC). Campaign filing deadlines, forms, and
other informational materials are available on the
FPPC website (www.fppc.ca.gov).
• An Amendment
• Has no outstanding loans made or received; and
450
Note: Mark the preelection statements box if a
committee files a monthly report in connection with
a LAFCO proposal.
• Has no accrued expenses (unpaid bills).
The committee may use this form only if all of the
above criteria are met. If all criteria are not met,
the committee must use Form 460, Recipient
Committee Campaign Statement.
• A Pre-election Statement
• A Special Odd-Year Campaign Report
• A Termination Statement
See reverse for general guidance on where to file
this form.
Contribution Limits:
Candidates for elective state office are subject to
state contribution limits. Contributions received by
committees for the purpose of making contributions
to candidates for elective state office are also
subject to limits. A chart identifying the limits is
located at www.fppc.ca.gov. In addition, local
candidates may be subject to contribution limits
imposed by local ordinance. Questions concerning
local limits should be addressed to election officials
in the local jurisdiction.
FPPC Form 450 (Jan/05)
FPPC Form 450 Instructions - Rev. 1 (Aug/2012)
FPPC Advice: advice@fppc.ca.gov 866/275-3772
Instructions for
Recipient Committee
Campaign Statement – Short Form
Where to File:
In general, state committees file with the Secretary
of State and local committees file with the filing
officer of the local jurisdiction.
State Committees:
State committees file this form with the Secretary
of State. State committees include committees
primarily formed to support or oppose candidates
seeking office in a CalPERS or CalSTRS election.
Secretary of State
Political Reform Division
1500 11th Street, Room 495
Sacramento, CA 95814
Phone (916) 653-6224
Fax (916) 653-5045
www.sos.ca.gov
Additional Copies:
A copy of this form must also be filed with the
relevant CalPERS or CalSTRS office if the
committee is a primarily formed committee for a
CalPERS or CalSTRS election.
Local Committees:
If a committee makes 70% or more of its
contributions and independent expenditures
on county candidates and measures and other
county committees, file this form with the county
elections official. An original and one paper copy
are required. A local agency may also require
electronic submissions.
CALIFORNIA
FORM
450
If a committee makes 70% or more of its
contributions and independent expenditures on
city candidates and measures and other city
committees, file this form with the city clerk. An
original and one paper copy are required. A local
agency may also require electronic submissions.
LAFCO Proposals: Committees primarily formed
to support or oppose a LAFCO proposal file this
form with the county elections office in the county
where the proposal may be voted upon. Once a
proposal is listed on a ballot, a committee will file
as a multi-county, county or city committee.
Fast Facts:
Statement of Organization: Committees must
make certain that information on its Statement of
Organization, Form 410, is current and correct.
This form includes information such as whether the
committee is primarily formed or general purpose,
its status as a state, county or city committee,
and a current list of principal officers, as well as
other important information about the committee’s
formation. Information listed on a Form 450 must
be the same as that disclosed on the Form 410.
Paper Copies: All committees must file the original
and one copy in paper format with the designated
filing officer. Most state committees must also file
an electronic version. Some local jurisdictions also
require electronic submissions.
Electronic Filing: State committees must file
electronic reports with the Secretary of State if
the committee receives contributions or makes
expenditures totaling $25,000 or more.
General Purpose Committees: FPPC Regulation
18227.5 sets out the procedures for determining
whether a committee should file with the state,
county, or city elections office. In general, most
committees file with the Secretary of State unless
the committee is making more than 70% of its
contributions and expenditures in connection with
a city or county election. The regulation sets out
review time lines and exceptions. A committee
shall not knowingly file in an incorrect jurisdiction
with the intention of avoiding the appropriate legal
disclosure to the public. Committees that change
jurisdictions file in both jurisdictions until the end of
the calendar year.
FPPC Form 450 (Jan/05)
FPPC Form 450 Instructions - Rev. 1 (Aug/2012)
FPPC Advice: advice@fppc.ca.gov 866/275-3772
SHORT FORM
Recipient Committee
Campaign Statement – Short Form
Date Stamp
Type or print in ink.
CALIFORNIA
FORM
450
SEE INSTRUCTIONS ON REVERSE
Statement covers period
For use by recipient committees that have not received a
contribution or other receipt that must be itemized, have not
received or made loans, and have no outstanding accrued
expenses.
Page
of
For Official Use Only
from
through
1. Type of Recipient Committee:
Ballot Measure Committee
Primarily Formed
Controlled
Sponsored
Date of election if applicable:
(Month, Day, Year)
2. Type of Statement:
General Purpose Committee
Sponsored
Small Contributor Committee
Pre-election Statement
Semi-annual Statement
Termination Statement
Quarterly Statement
Special Odd-year Report
Supplemental Pre-election
Statement - Attach Form 495
Amendment (Explain)
Primarily Formed Candidate/
Officeholder Committee
(Also check type of statement you are amending)
I.D. NUMBER
3. Committee Information
Treasurer(s)
COMMITTEE NAME
NAME OF TREASURER
MAILING ADDRESS
STREET ADDRESS (NO P.O. BOX)
CITY
CITY
STATE
ZIP CODE
AREA CODE/PHONE
MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX
CITY
STATE
STATE
ZIP CODE
AREA CODE/PHONE
STATE
ZIP CODE
AREA CODE/PHONE
NAME OF ASSISTANT TREASURER, IF ANY
MAILING ADDRESS
ZIP CODE
AREA CODE/PHONE
CITY
OPTIONAL: FAX / E-MAIL ADDRESS
OPTIONAL: FAX / E-MAIL ADDRESS
4. Verification
I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein is true and complete. I certify
under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Executed on
By
DATE
SIGNATURE OF TREASURER OR ASSISTANT TREASURER
Executed on
By
DATE
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT, OR RESPONSIBLE OFFICER OF SPONSOR
Executed on
By
DATE
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT
Executed on
By
DATE
Clear Cover Pg
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT
Print Form
Specify pages to print
FPPC Form 450 (January/05)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
Instructions for Recipient Committee
Campaign Statement – Short Form
Period Covered by a Statement:
The “period covered” by a campaign statement
begins the day after the closing date of the last
campaign statement you filed. For example, if the
closing date of the last statement was September
30, the beginning date of the next statement will be
October 1.
If this is the committee’s first campaign statement,
begin with January 1 of the current calendar year.
The closing date of the statement depends on the
type of statement you are filing.
Date of Election:
If this statement is filed in connection with an
election, enter the date of the election.
Type of Recipient Committee:
Check one box to indicate the type of committee
filing the statement.
Ballot Measure Committees
A person, entity, or organization that receives
contributions totaling $1,000 or more during a
calendar year for the primary purpose of supporting
or opposing the qualification, passage, or defeat
of one or more ballot measures. A controlled
committee is one that is controlled directly or
indirectly by an officeholder, candidate, or proponent
of a state ballot measure or that acts jointly with an
officeholder, candidate, or proponent of a state ballot
measure in connection with making expenditures.
CALIFORNIA
FORM
450
Primarily Formed Candidate/Officeholder
Committees
A person, entity, or organization that receives
contributions totaling $1,000 or more during
a calendar year to support or oppose a single
candidate or officeholder, or two or more candidates
or officeholders who are being voted upon in the
same city, county, or multi-county election. This type
of committee is not controlled by the candidate(s) or
officeholder(s).
Amendments: If you are filing an amendment to a
previously filed statement, give a brief explanation
of the amendment and attach the pages being
amended. Be sure to enter the period covered of
the statement you are amending.
General Purpose Committees
A person, entity, or organization that receives
contributions totaling $1,000 or more during
a calendar year to support or oppose various
candidates and measures (e.g., political parties,
political action committees).
Enter the committee’s full name, identification
number, address, and telephone number as stated
on the Statement of Organization, Form 410, filed
with the Secretary of State. Note on the form if the
identification number has not yet been received
from the Secretary of State’s office. Then enter the
treasurer’s name, the assistant treasurer’s name
(if any), their permanent addresses and telephone
numbers during business hours.
Sponsored Committee
A sponsored committee is one that has a sponsor—
a business entity, organization, union, or other
entity—that meets certain criteria. Sponsored
committees must include the name of the sponsor in
the name of the committee.
Small Contributor Committee:
A small contributor committee is one that has been
in existence for more than six months; receives
contributions from 100 or more persons; makes
contributions to five or more candidates; and has
not received more than $200 from one person in a
calendar year. A small contributor committee has
a higher limit on the amount of contributions it can
make to a state candidate.
Type of Statement:
Check the appropriate box(es) to indicate the type of
statement you are filing (or amending).
Termination: A committee must continue filing
campaign statements each year until it is eligible to
terminate and files a Form 410 Termination.
Committee Information:
Verification:
The statement must be signed by the committee
treasurer or the assistant treasurer named on the
committee’s Statement of Organization (Form
410). An officeholder, candidate, or state measure
proponent who controls the committee must also
sign the statement. If two or three officeholders,
candidates, or proponents control the committee,
each must sign the statement. If more than three
control the committee, one may sign on behalf of the
others.
Under certain circumstances, the responsible
officer of a sponsoring organization must sign the
statement.
FPPC Form 450 (Jan/05)
FPPC Form 450 Instructions - Rev. 1 (Aug/2012)
FPPC Advice: advice@fppc.ca.gov 866/275-3772
Type or print in ink.
Amounts may be rounded
to whole dollars.
Recipient Committee
Campaign Statement
Summary Page
SHORT FORM
Statement covers period
from
through
Page
NAME OF COMMITTEE
450
CALIFORNIA
FORM
of
I.D. NUMBER
Expenditures Made
1. Expenditures of $100 or more made this period .....................................................................................................................................
$
2. Expenditures under $100 made this period (Not itemized.) ....................................................................................................................
3. SUBTOTAL EXPENDITURES MADE THIS PERIOD ......................................................................................................................... Add Lines 1 + 2
$
4. Nonmonetary Adjustment .......................................................................................................................................... From Line 8 Below
5. Total expenditures made from previous statement ............................................................................... Previous Summary Page, Line 6
(If this is the first statement for the calendar year, enter zero.)
$
6. TOTAL EXPENDITURES MADE TO DATE .................................................................................................................................. Add Lines 3 + 4 + 5
$
Contributions Received
7. Monetary contributions received this period ...........................................................................................................................................
$
8. Non-monetary contributions received this period ....................................................................................................................................
9. Total contributions received from previous statement ......................................................................... Previous Summary Page, Line 10
(If this is the first statement for the calendar year, enter zero.)
$
10. TOTAL CONTRIBUTIONS RECEIVED TO DATE ......................................................................................................................... Add Lines 7 + 8 + 9
$
Current Cash Statement
11. Beginning cash balance ..................................................................................................................... Previous Summary Page, Line 15
$
12. Cash receipts this period .................................................................................................................................................... Line 7 above
13. Miscellaneous increases to cash ............................................................................................................................................................
$
14. Cash expenditures this period ............................................................................................................................................ Line 3 above
15. ENDING CASH BALANCE THIS PERIOD ..................................................................................... Add Lines 11 + 12 + 13, then subtract Line 14
Clear Summ Pg
Print Form
Specify pages to print
$
FPPC Form 450 (January/05)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
SHORT FORM
Recipient Committee
Campaign Statement – Short Form
Type or print in ink.
Amounts may be rounded
to whole dollars.
Statement covers period
from
Page
through
SEE INSTRUCTIONS ON REVERSE
of
I.D. NUMBER
NAME OF COMMITTEE
5. Payments Made
DATE *
450
CALIFORNIA
FORM
(If more space is needed, use additional copies of this page for continuation sheets.)
NAME AND ADDRESS OF PAYEE
DESCRIPTION OF PAYMENT
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
NAME OF CANDIDATE AND OFFICE OR
NAME OF BALLOT MEASURE AND
BALLOT NUMBER OR LETTER
AND JURISDICTION
AMOUNT
THIS PERIOD
CUMULATIVE
AMOUNTS TO DATE*
Calendar Year
$
Other
Support
Oppose
Contribution
Ind. Exp.
$
Calendar Year
$
Other
Support
Oppose
Contribution
Ind. Exp.
$
Calendar Year
$
Other
Support
Oppose
Contribution
Ind. Exp.
$
SUBTOTAL $
* Required only for payments which are contributions or independent expenditures.
Clear Page
Print Form
Specify pages to print
FPPC Form 450 (January/05)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
Instructions for Recipient Committee
Campaign Statement – Short Form
Payments Made:
For each payment of $100 or more provide:
Date
Provide the date if the expenditure is a contribution
or an independent expenditure.
Name and Address of Payee
For each payee or creditor of $100 or more, enter
the full name, street address, city, state, and zip
code. If the payee is different than the vendor
providing the goods and services (subvendor), also
enter the subvendor’s full name, street address,
city, state and zip code if the payment to the
subvendor was $500 or more.
Credit Card Payments
Disclose the name, address, and amount paid to
the credit card company during the period. Also
disclose the name, address, amount paid, and
description of payment for each vendor paid $100 or
more.
Payments by Agents and Independent
Contractors
When an agent or independent contractor (e.g.,
campaign worker, advertising agency, campaign
management firm) makes payments on your
behalf (“subvendor payments”), disclose the name,
address, amount paid, and description of payment
for each vendor paid $500 or more.
Description of Payment
If the payment is a direct payment to a candidate
or committee, enter “monetary contribution.” If the
expenditure is a non-monetary contribution, enter
“non-monetary contribution,” describe the goods or
services provided, and enter the fair market value if
different from the amount paid.
CALIFORNIA
FORM
If the payment is for overhead or operating
expenses of the committee, enter a brief
description of the goods or services received.
Ownership Interests or Business Employment
A ballot measure committee that makes a payment
to any business entity (1) which is owned 50
percent or more by any of the individuals listed
below, or (2) in which any of the individuals listed
below is an officer, partner, consultant, or employee
must report that individual’s name, relationship to
the committee, and a description of the ownership
interest or position with the business entity.
Individuals covered by (1) or (2) above, include:
-- A candidate or person controlling the
committee;
-- An officer or employee of the committee; or
-- The spouse of any of the above.
Name of Candidate and Office or Ballot Measure
For a candidate, provide the individual’s full name,
office sought or held, and jurisdiction. For a ballot
measure, provide the name of the measure and the
measure’s number or letter and the jurisdiction of
the measure.
Support/Oppose
Check the appropriate box to indicate if the
expenditure or contribution made was for or against
the candidate or measure.
450
Cumulative Amount to Date - Calendar Year
For payments that are contributions or independent
expenditures, enter the total amount of contributions
made to or independent expenditures for or against
each candidate or measure since January 1 of the
current calendar year. Cumulate contributions and
independent expenditures separately.
Cumulative Amount to Date - Other
Complete the “Other” column if a contribution
is made to a candidate that is subject to state
contribution limits. In this section, disclose the total
amount contributed to the committee in connection
with each limitation cycle and identify the election
year. The primary and general elections are
separate elections. For example, a $3,900
contribution to a candidate for a primary election in
2012 would be disclosed as “$3,900 P-12.”
“Other” Column
Limitation Cycle
Primary P
General G
Special S
Runoff
R
Year of Election
2012 12
2013 13
2014 14
2015 15
Contribution/Independent Expenditure
Check the box if the payment is a contribution or an
independent expenditure.
Amount Paid
Enter the amount paid this period.
FPPC Form 450 (Jan/05)
FPPC Form 450 Instructions - Rev. 1 (Aug/2012)
FPPC Advice: advice@fppc.ca.gov 866/275-3772
