Form 462 Verification of Independent Expenditures
462
CALIFORNIA FORM
This verification form identifies the individual responsible for ensuring that a campaign committee’s independent 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.
Amendment (Explain)
1
1. Name of Committee:
COMMITTEE ID #
NAME OF RECIPIENT COMMITTEE, ENTITY OR INDIVIDUAL
12399XX
Friends Supporting Alvarez for Mayor 20XX
CITY
STREET ADDRESS
10 Main Street
Oakmont
ZIP CODE 95443
TELEPHONE NUMBER
STATE
CA
707 111-2222
kluuci@hotmail.com
(
)
2
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.)
SUPPORT
OFFICE SOUGHT OR HELD/ BALLOT NO./LETTER
OPPOSE
JURISDICTION AND DISTRICT, IF ANY
ELECTION DATE
NAME OF CANDIDATE (First/Last) OR BALLOT MEASURE
✔
Manuel Alvarez
Mayor
Oakmont
11/4/20XX
OFFICE SOUGHT OR HELD/ BALLOT NO./LETTER
JURISDICTION AND DISTRICT, IF ANY
ELECTION DATE
SUPPORT
OPPOSE
NAME OF CANDIDATE (First/Last) OR BALLOT MEASURE
SUPPORT
OPPOSE
OFFICE SOUGHT OR HELD/ BALLOT NO./LETTER
JURISDICTION AND DISTRICT, IF ANY
ELECTION DATE
NAME OF CANDIDATE (First/Last) OR BALLOT MEASURE
NAME OF CANDIDATE (First/Last) OR BALLOT MEASURE
OFFICE SOUGHT OR HELD/ BALLOT NO./LETTER
JURISDICTION AND DISTRICT, IF ANY
ELECTION DATE
SUPPORT
OPPOSE
3
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.
[Date Required]
[Signature Required]
Karen Lucci
Signature
Printed Name
Signed on
(month, day, year)
Candidate/Officeholder
(Check One):
Principal Officer
State Ballot Measure Proponent
FPPC Form 462 (Aug/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov
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Clear Page
Completing the Form 462 1 Name of Committee
Enter the name and street address of the committee that is making the independent expenditure(s). The address should be the same as the address listed on the committee’s Statement of Organization (Form 410). Provide the committee’s assigned committee ID number. 2 Candidates or Measures List the name of the candidate(s) or ballot measure(s) and mark the applicable support or oppose box. For candidates, list the office sought or held. The candidate’s or measure’s jurisdiction (and district if applicable) and the date of the election must also be listed.
Fair Political Practices Commission advice@fppc.ca.gov
Chapter 11.20
Campaign Manual 2 August 2023 Page 389
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