Form 460 - Recipient Committee Campaign Statement Cover Page
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4COVER PAGE
Recipient Committee
Type or print in ink.
Date Stamp
460
CALIFORNIA
Campaign Statement
FORM
Cover Page
(Government Code Sections 84200-84216.5)
Page
of
Statement covers period
Date of election if applicable:
(Month, Day, Year)
For Official Use Only
from
SEE INSTRUCTIONS ON REVERSE
through
1. Type of Recipient Committee:
2. Type of Statement:
All Committees – Complete Parts 1, 2, 3, and 4.
Preelection Statement
Officeholder, Candidate Controlled Committee
Primarily Formed Ballot Measure
Quarterly Statement
State Candidate Election Committee
Committee
Semi-annual Statement
Special Odd-Year Report
Recall
Controlled
Termination Statement
Supplemental Preelection
(Also Complete Part 5)
Sponsored
(Also file a Form 410 Termination)
Statement - Attach Form 495
(Also Complete Part 6)
Amendment (Explain below)
General Purpose Committee
Primarily Formed Candidate/
Sponsored
Officeholder Committee
Small Contributor Committee
(Also Complete Part 7)
Political Party/Central Committee
I.D. NUMBER
3. Committee Information
Treasurer(s)
COMMITTEE NAME (OR CANDIDATE’S NAME IF NO COMMITTEE)
NAME OF TREASURER
MAILING ADDRESS
STREET ADDRESS (NO P.O. BOX)
CITY
STATE
ZIP CODE
AREA CODE/PHONE
NAME OF ASSISTANT TREASURER, IF ANY
CITY
STATE
ZIP CODE
AREA CODE/PHONE
MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX
MAILING ADDRESS
CITY
STATE
ZIP CODE
AREA CODE/PHONE
CITY
STATE
ZIP CODE
AREA CODE/PHONE
OPTIONAL: FAX / E-MAIL ADDRESS
OPTIONAL: FAX / E-MAIL ADDRESS
4. Verification
I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein and in the attached schedules is true and complete. I certify
under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Executed on
By
Date
Signature of Treasurer or Assistant Treasurer
Executed on
By
Date
Signature of Controlling Officeholder, Candidate, State Measure Proponent or Responsible Officer of Sponsor
Executed on
By
Date
Signature of Controlling Officeholder, Candidate, State Measure Proponent
Executed on
By
Date
Signature of Controlling Officeholder, Candidate, State Measure Proponent
FPPC Form 460 (January/05)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
Clear Cover Pg1
Print Form
State of California
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