FPPC Form 497 (Feb/2019)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
497 24-hour/10-day Contribution Report
Instructions
CALIFORNIA
FORM
497
Who Uses Form 497
• Candidatesandcertaincommieesthat
makeorreceivecontribuonsthattotalin
theaggregate$1,000ormoreinthe90days
beforeoronthedateofanelecon.
• Statecandidatesandstateprimarily
formedballotmeasurecommieesthatle
electronicallyandreceiveacontribuonof
$5,000ormoreatanymeotherthana90-
dayeleconcycle.
• Staterecipientcommieesthatle
electronicallyandmakecontribuonstotaling
$5,000ormoretoastateballotmeasure
commiee.
• Certainrecipientcommieesthatmake
contribuonstotaling$5,000ormoreto
supportoropposethequalicaonofalocal
ballotmeasure.
1

State Commiees - When a Form 497 is Required
StatecommieesmustleaForm497when:
• Contribuonsthattotalintheaggregate
$1,000ormoreareeither:
– madetoacandidateoraprimarily
formedcommieetosupportoroppose
acandidateorballotmeasureinthe90
daysbeforeoronthedateofanelecon;
or
– receivedbyacandidateoraprimarily
formedcommieetosupportoroppose
acandidateorballotmeasureinthe90
daysbeforeoronthedateofanelecon.
• Contribuonsthattotalintheaggregate
$1,000ormorearemadetoorreceivedbya
stateorcountypolicalpartycommieein
the90daysbeforeoronthedateofanystate
elecon.
• Contribuonsthattotalintheaggregate
$1,000ormorearemadetoorreceivedby
acandidateinaCalPERSorCalSTRSelecon
inthe90daysbeforeoronthedateofthe
elecon.ThedateofaCalPERSorCalSTRS
eleconisthedeadlinetoreturnballots.
• Asinglecontribuonof$5,000ormoreis
receivedbyastatecandidate’scommiee
orastateprimarilyformedballotmeasure
commieeatanymeoutsidethe90-day
eleconcycle.
– Requiredofstatee-lersonly
• Contribuonsaremadebyarecipient
commieetotaling$5,000ormoretoastate
ballotmeasurecommiee.
– Requiredofstatee-lersonly
– CompleteParts1and2ofthisform
– Notrequiredwhenaprimarilyformed
ballotmeasurecommieemakesa
contribuontoanotherprimarilyformed
commieeformedforthesamemeasure
oranothermeasureonthesameballot.
Thisexcepondoesnotapplytothe
$1,00090-dayreportnotedintherst
bulletabove.(RefertoFPPCRegulaon
18466foraddionalinformaon.)
• Contribuonstotaling$5,000ormoreare
madebyarecipientcommieetosupportor
opposethequalicaonofasinglelocalballot
measure.
– CompleteParts1and2ofthisform
– Notespeciallinglocaonbelow*
State Commiees - Where to File
Exceptasnotedbelow,statecommieesleForm497
electronicallywiththeSecretaryofState.Thisapplies
eventocommieesthathavenotreachedthe$25,000
thresholdforlingotherreportselectronically.No
papercopiesofthisreportarerequired,andnocopies
arerequiredtobeledwithotherlingocers.
*Forcontribuonsrelatedtothequalicaonof
localmeasures,theForm497mustbeledinthe
place(s)aprimarilyformedcommieeforthelocal
measureisrequiredtole.ThisForm497mustbe
ledbyfax,guaranteedovernightdelivery,personal
deliveryoremail.Somejurisdiconsrequireelectronic
submissions.Checkwiththelocaleleconsoce.
1
AmeasureincludescertainLAFCOproceedings.
FPPC Form 497 (Feb/2019)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Local Commiees – When a Form 497 is Required
LocalcommieesmustleaForm497when:
• Contribuonsthattotalintheaggregate
$1,000ormoreareeither:
– madetoacandidateoraprimarily
formedcommieetosupportoroppose
acandidateorballotmeasureinthe90
daysbeforeoronthedateofanelecon;
or
– receivedbyacandidateoraprimarily
formedcommieetosupportoroppose
acandidateorballotmeasureinthe90
daysbeforeoronthedateofanelecon.
• Contribuonsthattotalintheaggregate
$1,000ormorearemadetoastateorcounty
policalpartycommieeinthe90daysbefore
oronthedateofany stateelecon.
• Contribuonsthattotalintheaggregate
$1,000ormorearemadetoacandidatein
aCalPERSorCalSTRSeleconinthe90days
beforeoronthedateoftheelecon.
• Contribuonstotaling$5,000ormoreare
madebyarecipientcommieetosupportor
opposethequalicaonofasinglelocalballot
measure.
– CompleteParts1and2ofthisform
– Notrequiredtobeledbyacommiee
primarilyformedtosupportoropposethe
measure
– Notespeciallinglocaonbelow*
497 24-hour/10-day Contribution Report
Instructions
Local Commiees – Where to File
LocalcommieesleForm497atthesamelocaon(s)
itregularlylescampaignstatements.
*Forcontribuonsrelatedtothequalicaonoflocal
measures,theForm497mustbeledintheplace(s)
aprimarilyformedcommieeforthelocalmeasureis
requiredtole.
Regularmailmaynotbeused.TheForm497mustbe
ledbyfax,guaranteedovernightdelivery,personal
deliveryoremail.Somejurisdiconsrequireelectronic
submissions.Checkwiththelocaleleconsoce.
FPPC Form 497 (Feb/2019)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
497 Contribution Report
NAME OF FILER
AREA CODE/PHONE NUMBER I.D. NUMBER
(if applicable)
Amounts may be rounded to whole dollars.
STREET ADDRESS
CITY
DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR
RECEIVED
Reason for Amendment:
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
1. Contribution(s) Received
STATE ZIP CODE
CONTRIBUTOR
IF AN INDIVIDUAL,
AMOUNT
Check if Loan
Check if Loan
Check if Loan
%
%
%
Provide interest rate
Provide interest rate
Provide interest rate
RECEIVED
ENTER OCCUPATION AND EMPLOYER
(IF SELF-EMPLOYED, ENTER NAME OF BUSINESS)
CODE*
IND
IND
IND
COM
COM
COM
OTH
OTH
OTH
PTY
PTY
PTY
SCC
SCC
SCC
Date of
Date Stamp
For Ofcial Use Only
This Filing
Report No.
Amendment
to Report No.
No. of Pages
(explain below)
CALIFORNIA
FORM
497
* 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
Clear Page
Print
FPPC Form 497 (Feb/2019)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
497 24-hour/10-day Contribution Report
Instructions
CALIFORNIA
FORM
497
Filing Deadlines:
24-Hour Deadline
Exceptforthe10-daydeadlinenotedbelow,theForm
497isduewithin24hoursofmakingorreceiving
contribuonsthattotalintheaggregate$1,000or
more.
Excepons:
• Thosewhoreceivealatenon-monetaryorin-
kindcontribuonmustleForm497within48
hoursofthedatethecontribuonwasreceived.
• Reportsdueonaweekendorstateholiday,
otherthantheweekendbeforetheelecon,are
extendedtothenextbusinessday.
10-Business Day Deadline
• Anyofastatecandidate’scommieesorastate
primarilyformedballotmeasurecommiee
thatreceivesacontribuonof$5,000ormore
fromasinglecontributoratanymeotherthan
duringa90-dayeleconcycle,mustleaForm
497within10businessdays.Thisappliesto
electronic lers only.
• Astaterecipientcommieethatles
electronicallyandmakescontribuonstotaling
$5,000ormoretoastateballotmeasure
commieemustleForm497within10
businessdays.Ifallrequiredinformaonis
reportedona90-dayeleconcyclereport,this
10-businessdayreportisnotrequired.
• Arecipientcommieethatmakescontribuons
totaling$5,000ormoretosupportoroppose
thequalicaonofasinglelocalballotmeasure
mustleForm497within10businessdays.
Other Important Informaon:
• RefertotheFPPClingscheduleslocatedat
www.fppc.ca.gov,orthelocaljurisdicon’s
lingschedulewhenapplicable,forspecic
lingdates.
• Reportablecontribuonsincludemonetary
andnon-monetarycontribuons,loans,
oranycombinaonofmonetaryandnon-
monetarycontribuonsandloans,including
contribuonsorloansfromacandidate’s
personalfundstohisorhercampaignand
contribuonstoalegaldefensecommiee.
• Thedonorofanon-monetarycontribuon
mustnofytherecipientofthecontribuon’s
valuewithin24hoursofthedatethe
contribuonwasmade.Nocaonsdueon
aweekendorstateholiday,otherthanthe
weekendbeforetheelecon,areextendedto
thenextbusinessday.
• Contribuonsof$5,000ormorereceived
fromanonrecipientcommieerequirea
majordonornocaontobesenttothe
donor.
• The$1,000reportsarerequiredfor
contribuonsthattotalintheaggregate
$1,000duringthe90-dayeleconcycle.For
example,duringthe90-dayperiodbeforean
elecon,aForm497isrequiredifasingle
sourcemadetwo$500contribuonstothe
samecandidate.
• Form497isnotrequiredwhenatransferis
madebetweentwocampaigncommiees
forelecveocecontrolledbythesame
candidate.
• ContribuonslistedonForm497mustalso
bereportedonthenextregularcampaign
statement(Form450or460).
How to Complete Form 497
Report Number:Provideauniqueidenfyingnumber
oneachForm497led.Amendmentstoareportmust
showtheoriginalreportidencaonnumberand
statethereasonfortheamendment.
Date of Elecon:Ifthecontribuonwasmadetoacity
orcountycommiee,youmustenterthedateofthe
elecon.
Contribuons Received:CompletePart1.
Contribuons Made: CompletePart2.
Commiees required to disclose making contribuons
of $5,000 or more (see “When a Form 497 is
Required” on previous pages):ReportonPart1all
contribuonsof$100ormorereceivedsincethe
closingdateofthelastcampaignstatement(Form
450or460)led.Suchcontribuonsarenotrequired
tobereportedonmorethanoneballotmeasure
contribuonreport(Form497).
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82036,
84203,84203.3,84204.5,84250and85309andFPPC
Regulaons18116and18466
FPPC Form 497 (Feb/2019)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Reason for Amendment:
497 Contribution Report
NAME OF FILER
AREA CODE/PHONE NUMBER I.D. NUMBER (if applicable)
STREET ADDRESS
STATE ZIP CODECITY
Amounts may be rounded to whole dollars.
Date of
This Filing
Report No.
Amendment
to Report No.
No. of Pages
(explain below)
Date Stamp
For Ofcial Use Only
CALIFORNIA
FORM
497
DATE OF ELECTION
(IF APPLICABLE)
CONTRIBUTION
AMOUNT OF
CANDIDATE AND OFFICE
FULL NAME, STREET ADDRESS AND ZIP CODE OR RECIPIENTDATE
2. Contribution(s) Made
MADE
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
MEASURE AND JURISDICTION
OR
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