FPPC Form 470/470 Supplement (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Ofceholder and Candidate Campaign Statement —
Short Form - AND - Form 470 Supplement
CALIFORNIA
FORM
470
Who Uses Form 470:
Form 470 is for use by ofceholders and
candidates who:
do not have a controlled committee;
do not anticipate receiving contributions totaling
$2,000 or more during the calendar year; and
do not anticipate spending $2,000 or more
during the calendar year.
Ofceholders and candidates who have a
controlled committee or who have raised or spent
$2,000, le the Recipient Committee Statement –
Form 460.
Exceptions:
The following individuals seeking or holding
ofce are not required to le campaign disclosure
statements (Form 470 or Form 460):
candidates for county central committee ofces
that do not raise or spend $2,000 or more in a
calendar year;
ofceholders whose salaries are less than $200
per month and judicial candidates who have
not made or received contributions or made
expenditures during non-election years; and
judges who do not receive contributions and who
make personal expenditures of less than $1,000
or more in non-election years.
Period Covered:
The period covered is always the calendar year
(January 1 through December 31).
$2,000 Threshold:
To determine if $2,000 has been raised or spent,
or will be raised or spent, the candidate’s personal
funds for the ling fee or statement of qualications
are excluded.
A campaign bank account must be established if
the candidate receives contributions from other
persons.
When to File:
Ensure campaign deadlines are met. Go to
www.fppc.ca.gov for campaign disclosure ling
schedules.
If the Form 470 is led in connection with an
election, or on or before the ling deadline for the
rst campaign statement required for the calendar
year, no additional campaign statements need
to be led for that calendar year as long as total
contributions received remain less than $2,000 and
total expenditures made remain less than $2,000.
In most cases, July 31 is the ling deadline for the
rst campaign statement required to be led by
ofceholders and candidates not being voted upon.
The Form 470 is led in connection with an election
if it is led with the declaration of candidacy, or
as a rst preelection statement in connection with
an election, covering the year of the election. If,
after ling Form 470, receipts or expenditures
reach $2,000 or more, see the attached Form 470
Supplement for important reporting requirements.
Where to File:
State Elections:
State ofceholders, state candidates, candidates
and members of CalPERS and CalSTRS, judges
and judicial candidates must le the original and
one copy with:
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 the Form 470 must also be led with
the candidate’s county of domicile’s ling ofcer.
CalPERS and CalSTRS board candidates must le
a copy of the Form 470 with the relevant CalPERS
or CalSTRS ofce and not the candidate’s county
of domicile.
Local Elections:
Elected ofcers and candidates for local multi-
county agencies le an original and one copy
with the elections ofcial for the county with the
largest number of registered voters in the district
and one copy with the candidate’s county of
domicile.
Elected county ofceholders and candidates for
county ofces le an original and one copy with
the elections ofcial for that county.
Elected city ofceholders and candidates for city
ofces le an original and one copy with the city
clerk.
Note: A local agency may impose additional
requirements.
Amendments: If you are ling an amendment to a
previously led statement, give a brief explanation
of the amendment. Be sure to enter the calendar
year covered by the statement you are amending
and the date of election, if applicable.
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.
Officeholder and Candidate
Campaign Statement -
Short Form
CALIFORNIA
FORM
470
For Of cial Use Only
Date Stamp
1. Statement Covers Calendar Year 20 .
NAME OF OFFICEHOLDER OR CANDIDATE
STREET ADDRESS
AREA CODE/DAYTIME PHONE NUMBER OPTIONAL: FAX / E-MAIL ADDRESS
OFFICE SOUGHT OR HELD
DISTRICT NUMBER
(IF APPLICABLE)
4. Commi ee Informa on
List all commi ees of which you have knowledge that are primarily formed to receive contribu ons or to make expenditures on behalf of your candidacy.
COMMITTEE NAME AND I.D. NUMBER
5.
Verica on
I declare under penalty of perjury that to the best of my knowledge I anticipate that I will receive less than $2 ,000 and that I will spend less than $2,000 during the calendar year and that I have
used all reasonable diligence in preparing this statement. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
2. O ceholder or Candidate Informa on
3. O ce Sought or Held
CITY STATE ZIP CODE
JURISDICTION (LOCATION)
COMMITTEE ADDRESS NAME OF TREASURER
Executed on
DATE
By
SIGNATURE OF OFFICEHOLDER OR CANDIDATE
Amendment (Explain Below)
Date of elec on if applicable:
(Month, Day, Year)
FPPC Form 470/470 Supplement (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Clear Form
Print Form
Officeholder and Candidate
Campaign Statement -
Form 470 Supplement
CALIFORNIA
FORM
470
For Of cial Use Only
Date Stamp
SEE INSTRUCTIONS ON REVERSE
1. O ceholder or Candidate Informa on
NAME OF OFFICEHOLDER OR CANDIDATE
STREET ADDRESS
CITY STATE ZIP CODE
AREA CODE/DAYTIME PHONE NUMBER OPTIONAL: FAX / E-MAIL ADDRESS
2. O ce Sought
OFFICE SOUGHT
3. Date Contributions Totaling $2,000 or More Were Received or Date Expenditures of $2,000 or More Were Made
This form is written notification that the officeholder/candidate listed below has received contributions totaling $2,000 or more
or has made expenditures of $2,000 or more during the calendar year.
DATE OF ELECTION (MONTH, DAY, YEAR)
(MONTH, DAY, YEAR)
DISTRICT NUMBER
(IF APPLICABLE)
Amendment (Explain Below)
FPPC Form 470/470 Supplement (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Clear Form
Print Form
FPPC Form 470/470 Supplement (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Instructions for Completing
Form 470 Supplement
CALIFORNIA
FORM
470
Form 470 Supplement:
If an ofceholder or candidate les the Form
470 for an election year and later receives
contributions (including monetary and non-
monetary contributions, loans, and the candidate’s
personal funds) totaling $2,000 or more or makes
expenditures totaling $2,000 or more during the
same calendar year, the ofceholder or candidate
must send a written notice within 48 hours. Use
the attached Form 470 Supplement or follow the
instructions below for preparing the notice.
When to File:
The notice must be sent within 48 hours of
receiving contributions totaling $2,000 or more or
making expenditures of $2,000 or more.
Method of Delivery:
The notice must be sent by guaranteed overnight
delivery service, personal delivery, fax, or email.
Regular mail may not be used.
Where to File:
Secretary of State’s Ofce;
local ling ofcer with whom the ofceholder/
candidate is required to le the originals of his/
her campaign statements; and
each candidate seeking the same ofce.
Contact your ling ofcer for candidate addresses.
Officeholder/Candidate Information
Enter the ofceholder/candidate’s full name,
residential or business address and daytime
telephone number.
Office Sought
Enter the title of the ofce sought;
the district number, if any; and
the date of the election.
Date Contributions/Expenditures Were Made or
Received:
Enter the date monetary or non-monetary
contributions totaling $2,000 or more (including the
candidate’s personal funds) were received or the
date expenditures of $2,000 or more were made.
Amendments: If you are ling an amendment to a
previously led statement, give a brief explanation
of the amendment.
Note: Once an ofceholder or candidate reaches
the $2,000 threshold in receipts or expenditures,
in addition to ling the Form 470 Supplement,
other forms are required. See FPPC Campaign
Disclosure Manual 1 for state candidates or
Manual 2 for local candidates.
SUPPLEMENT