HomeMy WebLinkAboutForm 462 Preserve SaratogaForm 462 1 GALIFORF'Ua-2-��
Verification of Independent Expenditures FORM
This verification form identifies the individual responsible for ensuring that a campaign committee's independent ❑ Amendment (Explain)
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.
STATE ZIP CODE E-MAIL TELEPHONE NUMBER
C �l So i® <
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.)
NAME OF CANDIDATE (First/Last) OR BALLOT MEASURE
//7
SUPPORT
OPPOSE
F
OFFICE SOUGHT OR HELD/ BALLOT NO./LETTER
JURISDICTION AND DISTRICT, IF ANY
ELECTION DATE
h"
NAME OF CANDIDATE (First/Last) OR BALLOT MEASURE
SUPPOR
OPPOSE
OFFICE IOUGHTOR HELD/ BALLOT NO./LETTER
JURISDICTION AND STRICT, IF ANY
ELECTION DATE
NAME OF CANDIDATE (First/Last) OR BALLOT MEASURE
SUPPORT
OPPOSE
OFFICE OUGHT OR HELD/ BALLOT NO./LETTER
JURISDICTION ANkVISTRICT, IF ANY
ELECTION DATE
F-1,
1711
NAME OF CANDIDATE (First/Last) OR BALLOT MEASURE
SUPPORT
❑
OPPOSE
OFFICE SOUGHT OR HELD/ BALLOT NO./LETTER
JURISDICTION AND DISTRICT, IF ANY
ELECTION DATE
❑
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.
Signature Printed NameC^�F�/ - ��//UL� Signed on rv�
(month, day, year)
(Check One): Principal Officer ❑ Candidate/Officeholder ❑ State Ballot Measure Proponent FPPC Form 462 (Aug/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov