November 3, 2020 Candidate Packet - Flipping Book Version

496 Independent Expenditure Report

Amounts may be rounded to whole dollars.

496

Date Stamp

NAME OF FILER

CALIFORNIA FORM

Date of This Filing

AREA CODE/PHONE NUMBER

I.D. NUMBER (if applicable)

For Official Use Only

Report No.

STREET ADDRESS

Amendment

to Report No. No. of Pages (explain below)

STATE

ZIP CODE

CITY

1. List Only One Candidate or Ballot Measure NAME OF CANDIDATE SUPPORTED OR OPPOSED

NAME OF BALLOT MEASURE SUPPORTED OR OPPOSED

OFFICE SOUGHT OR HELD

DISTRICT NO.

SUPPORT OPPOSE

BALLOT NO./LETTER

JURISDICTION

SUPPORT OPPOSE

2. Independent Expenditures Made Attach additional information on appropriately labeled continuation sheets. DATE DESCRIPTION OF EXPENDITURE

AMOUNT

Reason for Amendment

FPPC Form 496 (Feb/2019) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov