Fillable Form 496: 496 24-hour/10-day Independent Expenditure Report Instructions (CITY OF LA HABRA)

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Form 496: 496 24-hour/10-day Independent Expenditure Report Instructions (CITY OF LA HABRA)

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FPPC Form 496 (Feb/2019)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
496 24-hour/10-day Independent Expenditure Report
Instructions
CALIFORNIA
FORM
496
What is an “independent expenditure”?
An “independent expenditure” is an expenditure made
in connecon with a communicaon (e.g., a billboard,
adversement, or mailing) that expressly advocates
the elecon or defeat of a clearly idened candidate
or the qualicaon, passage, or defeat of a clearly
idened measure.
1
An independent expenditure is a
payment that is not made to—or at the behest of—the
aected candidate or commiee.
Independent Expenditures in Connecon with State
Elecons – When and Where to File a Form 496
When: A Form 496 is due within 24 hours when:
• Independent expenditures that total in the
aggregate $1,000 or more are made to support or
oppose a single state candidate or a single state
ballot measure in the 90 days before or on the
date of the candidate’s or measure’s elecon.
A Form 496 is due within 10 business days when:
• A recipient commiee that is required to le
electronically with the Secretary of State makes
independent expenditures totaling $5,000 or
more to support or oppose the qualicaon or
passage of a single state ballot measure outside
the 90-day elecon cycle.
Where: File Form 496 electronically with the Secretary
of State. No paper copies are required and no copies
are required to be led with other ling ocers.
A commiee that makes independent expenditures in
connecon with a CalPERS or CalSTRS elecon must
also le a copy with the relevant board’s oce.
Independent Expenditures in Connecon with Local
Elecons – When and Where to File a Form 496
When: A Form 496 is due within 24 hours when:
• Independent expenditures that total in the
aggregate $1,000 or more are made to support or
oppose a single local candidate or a single local
ballot measure in the 90 days before or on the
date of the candidate’s or measure’s elecon.
A Form 496 is due within 10 business days when:
• A recipient commiee makes independent
expenditures totaling $5,000 or more to support
or oppose the qualicaon of a single local ballot
measure.
Where: File Form 496 by fax, guaranteed overnight
delivery, personal delivery or email with the ling
ocer(s) who would receive your campaign statements
if you were a commiee primarily formed to support
or oppose the candidate or ballot measure supported
or opposed by the independent expenditure. In most
cases this is the ling ocer with whom the candidate
or ballot measure commiee les. Regular mail may
not be used. A local ordinance may also require this
form to be led electronically.
Other Important Informaon
• Candidates: Form 496 is not required for
expenditures supporng your elecon that
are made from your commiee, including
expenditures opposing an opponent.
• Ballot Measure Commiees: A primarily formed
ballot measure commiee does not le Form 496
for expenditures made in support of its campaign.
• All independent expenditures reported on
Form 496 must also be reported on subsequent
campaign reports (i.e., Forms 460, 450 or 461).
• Form 462 - Vericaon of Independent
Expenditures is also required to be led when
an independent expenditure that totals in the
aggregate $1,000 or more is made. The principal
ocer, or in the case of a controlled commiee,
the candidate or state measure proponent who
controls the commiee, must verify that he/
she has not received any unreported money
or reimbursement to make the independent
expenditures and has not coordinated with the
candidate or the opponent of the candidate
or the proponent or the opponent of the state
measure that is the subject of the expenditure.
Form 462 must be led with the Fair Polical
Pracces Commission.
• CalPERS and CalSTRS Candidates: The date of the
elecon is the deadline to return ballots.
Reporng Examples
• A state general purpose commiee makes
an independent expenditure by paying for
an adversement opposing two city council
candidates. The ad costs $4,000 and features
the candidates equally. The commiee must le
a separate Form 496 with the city clerk’s oce
for each candidate within 24 hours and disclose
$2,000 for each candidate.
• A commiee makes a $500 independent
expenditure to support a candidate 60 days
before the candidate’s elecon and a second
independent expenditure for the same candidate
of $600, 20 days before the elecon. A Form
496 is required 24 hours aer the second
independent expenditure.
1
A measure includes certain LAFCO proceedings.
FPPC Form 496 (Feb/2019)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
496 24-hour/10-day Independent Expenditure Report
Instructions
CALIFORNIA
FORM
496
How to Complete Form 496
Report Number: Provide a unique idenfying number
on each Form 496 led. Amendments to a report must
show the original report idencaon number and
state the reason for the amendment.
Part 1. Candidate or Measure: Idenfy the candidate
or ballot measure supported or opposed. Include the
candidate’s district number (if any) or the leer or
number of the ballot measure and its jurisdicon. Use
a separate form for each candidate or measure. For
independent expenditures supporng or opposing the
qualicaon of a local measure, idenfy the measure’s
name or subject maer.
Part 2. Independent Expenditures Made: Provide
the date and in the descripon eld, a descripon
of the expenditure (e.g., radio adversement,
billboard, mailing) and the cumulave-to-date total
for that candidate or measure in connecon with the
elecon. When ling an amendment, ensure that
the cumulave-to-date total is accurate on the most
recently led Form 496. It is not necessary to amend
the cumulave-to-date total on previous reports.
In the amount eld, list the amount of the specic
expenditure disclosed in the descripon eld.
Note: The cumulave-to-date total is not required
when ling a 10-day $5,000 ballot measure report
outside of the 90-day elecon cycle.
Part 3. Contribuons Received: Disclose contribuons
of $100 or more received since the closing date of
the last campaign statement led (Form 450 or 460)
through the date of the independent expenditure.
Start with January 1 if no statement has been led.
Disclose the name and address of the contributor and,
if the contributor is an individual, his or her occupaon
and the name of his or her employer. If the contributor
is self-employed, disclose the name of the business.
Include the date and amount of the contribuon, the
contributor code, and type of contribuon. Enter the
interest rate if the contribuon is a loan.
Except for contribuons reported on a Form 496
related to the qualicaon of a local ballot measure,
once a contribuon has been reported on Form 496,
it is not necessary to report that contribuon on any
addional Form 496 lings.
This form was prepared by the Fair Polical Pracces
Commission (FPPC). For detailed informaon on
campaign reporng requirements and the Informaon
Pracces Act of 1977, see the FPPC Campaign
Disclosure Manual for your type of commiee.
Campaign ling deadlines, forms, and other
informaonal materials are available on the FPPC
website (www.fppc.ca.gov).
Authority cited: Government Code Secons 82031,
82036.5, 84204, 84204.5, 84213, 84215 and 85500 and
FPPC Regulaon 18550
FPPC Form 496 (Feb/2019)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
496 Independent Expenditure Report
Amounts may be rounded to whole dollars.
NAME OF FILER
AREA CODE/PHONE NUMBER
I.D. NUMBER
(if applicable)
STATE
ZIP CODE
STREET ADDRESS
1. List Only One Candidate or Ballot Measure
2. Independent Expenditures Made
Attach additional information on appropriately labeled continuation sheets.
NAME OF CANDIDATE SUPPORTED OR OPPOSED
OFFICE SOUGHT OR HELD
DATE
Reason for Amendment
DESCRIPTION OF EXPENDITURE
AMOUNT
DISTRICT NO. SUPPORT OPPOSE
BALLOT NO./LETTER JURISDICTION SUPPORT
For Ofcial Use Only
CALIFORNIA
FORM
496
Date Stamp
Date of
This Filing
Report No.
Amendment
to Report No.
No. of Pages
(explain below)
OPPOSE
NAME OF BALLOT MEASURE SUPPORTED OR OPPOSED
CITY
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FPPC Form 496 (Feb/2019)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
496 Independent Expenditure Report
NAME OF FILER
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
IF AN INDIVIDUAL, ENTER OCCUPATION
AND EMPLOYER
(IF SELF-EMPLOYED, ENTER NAME OF BUSINESS)
CONTRIBUTOR
CODE
**
AMOUNT
RECEIVED
IND
IND
IND
IND
IND
IND
COM
COM
COM
COM
COM
COM
OTH
OTH
OTH
OTH
OTH
OTH
PTY
PTY
PTY
PTY
PTY
PTY
SCC
SCC
SCC
SCC
SCC
SCC
%
%
%
%
%
%
INTEREST RATES
I.D. NUMBER
(if applicable)
If loan,
enter interest rate, if any
If loan,
enter interest rate, if any
If loan,
enter interest rate, if any
If loan,
enter interest rate, if any
If loan,
enter interest rate, if any
If loan,
enter interest rate, if any
3. Contributions of $100 or More Received*
*Major donor and independent expenditure
committees that do not receive contributions are
not required to complete Part 3.
CALIFORNIA
FORM
496
** Contributor Codes
IND - Individual
COM - Recipient Committee (other than PTY or SCC)
OTH - Other (e.g., business entity)
PTY - Political Party
SCC - Small Contributor Committee
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Form 496: 496 24-hour10-day Independent Expenditure Report Instructions (CITY OF LA HABRA)

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Completed 6 August 2020

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