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Major Donor andIndependent ExpenditureCommittee Campaign StatementWho Uses Form 461:Major Donors An individual or entity that makes monetary ornonmonetary contributions (including loans)to state or local officeholders, candidates,and committees totaling 10,000 or more in acalendar year.“Contribution” includes direct monetarycontributions (e.g., purchasing tickets tocampaign fundraisers), loan guarantees andloan forgiveness, nonmonetary contributions ofgoods or services, and discounts not provided tothe public generally.Independent Expenditure Committees An individual or entity that makes independentexpenditures totaling 1,000 or more in acalendar year to support or oppose state or localcandidates or ballot measures.An “independent expenditure” is an expenditurefor a communication that expressly advocatesthe nomination, election or defeat of a clearlyidentified candidate or ballot measure that is notmade to—or at the behest of—an officeholder,candidate, or committee.Note: There are different forms and reportingrequirements for committees that receivecontributions totaling 2,000 or more during acalendar year (“recipient committees”).CALIFORNIAFORMPersonal Contributions by Candidatesand Officeholders:Form 461 is also required if, during a calendaryear, a candidate or officeholder uses personalfunds to make: Contributions totaling 10,000 or more to otherstate or local candidates, officeholders orcommittees; or Independent expenditures totaling 1,000 ormore to support or oppose other state or localcandidates, officeholders, or ballot measures.Contribution Limits:Candidates for elective state office are subjectto contribution limits. Contributions receivedby committees for the purpose of makingcontributions to candidates for elective state officeare also subject to limits. A chart identifying thelimits is located at www.fppc.ca.gov. In addition,local candidates may be subject to contributionlimits imposed by local ordinance. Questionsabout local limits should be directed to electionofficials in the local jurisdiction.461 Exceptions to the definition of “contribution” and“expenditure” for certain types of activities (e.g.,volunteer personal services and communicationsto members of an organization) Reporting contributions and independentexpenditures made during the 90 days prior toan election or on the date of the election The Information Practices Act of 1977This form was prepared by the Fair PoliticalPractices Commission (FPPC). Campaignfiling deadlines, forms, and other informationalmaterials are available on the FPPC website(www.fppc.ca.gov). See reverse for generalinformation on where to file this form.Additional Important Information:Refer to the FPPC Campaign Disclosure Manuals5 and 6 for important information about: When and where to file Form 461 Aggregation of contributions and expendituresby certain combinations of individuals andentities (e.g., parent and subsidiaries)FPPC Form 461 (Jan/2016)FPPC Advice: advice@fppc.ca.gov (866/275-3772)www.fppc.ca.gov

Instructions forMajor Donor andIndependent ExpenditureCommittee Campaign StatementWhere to File:State CommitteesA state committee is one that makes at leastone contribution or independent expenditureto a state candidate, measure or other statecommittee (e.g. political party). A state majordonor and independent expenditure committeefiles an original and a copy in paper format with theSecretary of State. A committee must also file anonline report if the committee makes contributionsor independent expenditures totaling 25,000 ormore in a calendar year.Secretary of StatePolitical Reform Division1500 11th Street, Room 495Sacramento, CA 95814Phone (916) 653-6224Fax (916) 653-5045www.sos.ca.govLocal CommitteesIf a committee makes more than 70% of itscontributions and independent expenditures oncounty candidates and measures and other countycommittees, file this form with the county electionsofficial. An original and one paper copy is required.CALIFORNIAFORM461If a committee makes more than 70% of itscontributions and independent expenditures oncity candidates and measures and other citycommittees, file this form with the city clerk. Anoriginal and one paper copy is required.Note: FPPC Regulation 18227.5 sets out thecriteria for determining if a committee is state,county, or city. The regulation provides that acommittee may qualify as a state committee if itdoes not qualify as a city or county committee andallows, under certain circumstances, that a localcommittee may retain city or county status even if acontribution is made to a state committee.Electronic Filing:State CommitteesMajor donor and independent expenditurecommittees that are required to file reports with theSecretary of State must file Form 461 electronicallyif they make contributions or independentexpenditures totaling 25,000 or more in acalendar year. Paper reports are also required.Local CommitteesSome local jurisdictions also require reports to beelectronically filed.FPPC Form 461 (Jan/2016)FPPC Advice: advice@fppc.ca.gov (866/275-3772)www.fppc.ca.gov

Major Donor andIndependent Expenditure CommitteeCampaign StatementCLEAR FORMStatement covers periodDate StampPRINT FORMDate of election if applicable:(Month, Day, Year)For Official Use Onlythrough3. Summary1. Name and Address of FilerNAME OF FILER(Amounts may be rounded to whole dollars.)RESIDENTIAL OR MAILING ADDRESS(NO. AND STREET)1. Expenditures and contributions(including loans) of 100 or moremade this period. (Part 5.). CITYSTATERESPONSIBLE OFFICERAREA CODE/DAYTIME PHONE(If filer is other than an individual)2. Nature and Interests of FilerZIP CODE(Complete each applicable section.)A FILER WHO IS AN INDIVIDUAL MUST LIST THE NAME, ADDRESS, AND BUSINESS INTERESTSOF EMPLOYER OR, IF SELF-EMPLOYED, THE NAME, ADDRESS, AND NATURE OF THE BUSINESSNAME OF EMPLOYER/BUSINESSBUSINESS INTERESTSADDRESS OF EMPLOYER/BUSINESSA FILER THAT IS A BUSINESS ENTITY MUST DESCRIBE THE BUSINESS ACTIVITY IN WHICH IT ISENGAGEDA FILER THAT IS AN ASSOCIATION MUST PROVIDE A SPECIFIC DESCRIPTION OF ITS INTERESTSA FILER THAT IS NOT AN INDIVIDUAL, BUSINESS ENTITY, OR ASSOCIATION MUST DESCRIBE THECOMMON ECONOMIC INTEREST OF THE GROUP OR ENTITYAmendment (Explain):461ofPagefromSEE INSTRUCTIONS ON REVERSECALIFORNIAFORM2. Unitemized expenditures andcontributions (including loans) under 100 made this period. 3. Total expenditures and contributionsmade this period. (Add Lines 1 2.).SUBTOTAL 4. Total expenditures and contributionsmade from prior statement. (Enteramount from Line 5 of last statementfiled. If this is the first statement forthe calendar year, enter zero.). 5. Total expenditures and contributions(including loans) made sinceJanuary 1 of the current calendar year.(Add Lines 3 4.). TOTAL 4. VerificationI have used all reasonable diligence in preparing this statement. I havereviewed the statement and to the best of my knowledge the informationcontained herein is true and complete. I certify under penalty of perjury underthe laws of the State of California that the foregoing is true and correct.Executed onByDATESIGNATURE OF INDIVIDUAL DONOR ORRESPONSIBLE OFFICER, IF OTHER THAN AN INDIVIDUALFPPC Form 461 (Jan/2016)FPPC Advice: advice@fppc.ca.gov (866/275-3772)www.fppc.ca.gov

Instructions forMajor Donor andIndependent ExpenditureCommittee Campaign StatementFor definitions and detailed informationabout completing Form 461, refer to the FPPCCampaign Disclosure Manuals 5 and 6.Period Covered by a Statement:The “period covered” by a campaign statementbegins the day after the closing date of the lastcampaign statement filed. For example, if theclosing date of the last statement was June 30,the beginning date of the next statement will beJuly 1.If this is the first campaign statement for thecalendar year, begin with January 1.The closing date of the statement depends on thetype of statement you are filing.Date of Election:Enter the date of the election if you are filingForm 461 as a city or a county major donor orindependent expenditure committee and the cityor county’s election will be held this year.1. Name and Address of Filer:Enter the legal name of the individual or entityfiling the statement. If the filer is commonly knownto the public by another name, that name maybe used. When a person directs and controlsthe making of contributions and independentexpenditures by a related entity (e.g., a parentand subsidiaries or a majority shareholder of aCALIFORNIAFORMcorporation) that must be aggregated and reportedon Form 461, list as the “Name of Filer” the nameof the individual or entity that directs and controlsthe making of the contributions and independentexpenditures. In addition, you must: Indicate that the campaign statement includesthe contributions and independent expendituresof other entities. For example, “ABCCorporation, including aggregated contributions/independent expenditures.” Identify any entities added to this report thatwere not included in a prior report filed for thecurrent calendar year, as well as any entitiesincluded in a prior report for the current calendaryear that are no longer required to aggregateunder the name of filer. Identify both names if the “Name of Filer” listedon a previous report filed for the current calendaryear is different than the name identified onthis report. For example, “John Lewis, formerlyidentified as Lewis Construction.”4613. Summary:Summary totals are calculated from theinformation itemized in Part 5 of the Form 461 andunitemized payments of less than 100. If this isthe first report being filed for a calendar year, entera zero on line 4 of the summary.4. Verification:A responsible officer of an entity or an entity filingjointly with any number of affiliates must signthe Form 461. An attorney or a certified publicaccountant may sign on behalf of the entity orentities. A statement filed by an individual must besigned by the individual.Amendments:To amend previously filed Form 461, check the“Amendment” box, enter the period covered by thestatement you are amending, and complete Part1. Disclose the amended information, includingPart 3, if applicable, and complete the Verification.Enter the name of the responsible officer of anentity or organization filing the statement.2. Nature and Interests of Filer:When more than one person or entity is listedunder “Name of Filer,” identify the nature andinterests of each. (Use appropriately labeledcontinuation sheets if necessary.)FPPC Form 461 (Jan/2016)FPPC Advice: advice@fppc.ca.gov (866/275-3772)www.fppc.ca.gov

Major Donor andIndependent Expenditure CommitteeCampaign StatementAmounts may be roundedto whole dollars.Statement covers periodfromCLEAR FORMCALIFORNIAFORM461PRINT FORMthroughSEE INSTRUCTIONS ON REVERSENAME OF FILERPageof5. Contributions (Including Loans, Forgiveness of Loans, and Loan Guarantees) and Expenditures Made(If more space is needed, use additional copies of this page for continuation sheets.)DATENAME, STREET ADDRESS, CITY, STATE AND ZIP CODEOF PAYEETYPE OF PAYMENT(IF COMMITTEE, ALSO ENTER I.D. NUMBER)DESCRIPTION OFPAYMENT(IF OTHER THAN MONETARYCONTRIBUTION OR LOAN)CANDIDATE AND OFFICE,MEASURE AND JURISDICTION,OR COMMITTEEAMOUNT THISPERIODCUMULATIVE AMOUNTRELATED TO THISCANDIDATE, MEASURE,OR onetaryContributionIndependentExpenditureSUBTOTAL FPPC Form 461 (Jan/2016)FPPC Advice: advice@fppc.ca.gov (866/275-3772)www.fppc.ca.gov