HomeMy WebLinkAboutIndependent ExpendituresStatement of Independent Expenditures
Name of Individual, ,Organizati,o,n o'--r CollqITliite~ }'~epoi'~f~n~: . /~'Committee ID Number: '
R~stdcnce AddresJ(street/rou}e,~ty, state, county, zip code): . :~/ ,- d - ' Telephone Number (day):
Elect,on: : Primary 20 EE~Jeneral 20 'E: Other
Report: ~ 1 st Pre-election ~ 2nd Pre-election ~ 1 st Supplement to the 2nd pre ~ 2nd Supplement to the 2nd pre
~ Post-election ~ September Supplemental
Payee's Name Purpose Amount
Line g Date (as it appears on invoice, receipt or check) (see purpose codes
on back of form) Expenditure
1.
' .- ~
3. $
4. $
5. $
8- ,
~. $
~0. $
Name of Candidate and Office or Measure Tide PAGE TOTAL:
Name of the candidate and office or measnre ,
supported or opposed by independent expenditures. Support Oppose Expenditure: $ __~ C(
..... ~ ~ ' ~;::(:? L ,-. :~:' ~ ,~_. I hereby certif~ the above listed expenditures were
[ ~ ~ made Ibr thc candidates or measures provided.
~ ~ Signature of person or reprbscntative of organization
~ ~ D~ate sig,~
Statement of Independent Expenditures
Please type or print legibly in black ink. List only one entry per ~ine.
An independent expenditure is an expenditure for a communication that advocates the election or defeat of a clearly identified
candidate that is not made with the cooperation or with the prior consent of, or in consultation with, or at the request or suggestion of, a
candidate or any agent or authorized committee of the candidate. An independent expenditure made by a political committee is
reported on the Cash Expenditures and Loan Payments form (PC 3). However, if the independent expenditure is made during either of
the supplement to the second pre-election accounting periods, the committee must additionally file this form (PC 10) disclosing those
expenditures by the deadline for the applicable supplement to the second pre-election report, unless the expenditure is required to be
reported in the same accounting period on a form PC BB.
An independent expenditure also includes a person who makes an expenditure of more than $50 in support of or opposition to any
candidate or measure, and the expenditure is not reported by the candidate or political committee as a contribution.
AMOUNT OF EXPENDITURE - Amount of check, cash transaction or credit card charge.
DATE - List the date of the expenditure. Date must include month, day and year.
PAGE TOTAL - Total amount of independent expenditures reported on the Pa9e.
PAYEE'S NAME - The name of the vendor or individual to whom payment was made.
PURPOSE - Use the purpose codes from the list provided below (note exception) or write in the purpose of the expenditure. If one or
more of the followin9 purpose codes is used to describe an expenditure, no other description is generally needed.
A Agent: A payee who is an individual or firm, such as an advertising
agency or a public relations firm, authorized by a committee to
make expenditures for broadcast or newspaper advertising or for
payment of petition circulators and makes such expenditures. If an
expenditure is made for the committee by an agent, you must file a
Report of Expenditures Made by an Agent (PC 9) or submit a copy
of an invoice from the agent detailing the agent's expenditures.
The invoice must contain the same information required on form
PC 9.
B Broadcast Advertising: Expenditures for the purchase of radio
and television advertising. This is a sufficient purpose only if
payment is made directly to a specific radio or TV station. If
payment is made to an agent solely for preparation or production
of advertising, use code Z. If payment is made to an agent for
purchase of advertising, use code A.
L Literature, Brochures, Printing: Expenditures made for the
preparation and production of campaign literature and printed
solicitations, including expenditures for mailing lists, design,
photography, copy, layout, printing and reproduction. Use code P
for expenditures associated with literature malting costs.'
NI Newspaper and Othe'r Periodical Advertising: Expenditures for
the purchase of advertising in newspapers, periodicals and other
publications. This is a sufficient purpose only if payment is made
to a specific publication. If payment is made to an a, gent solely for
preparation or production of advertising, use code 2'_. if payment is
made to an agent for purchase of advertising, use code A.
O Other Advertising: Expenditures associated with the production
and purchase of advertising on billboards, yard signs and
campaign paraphernalia such as buttons, bumper stickers,
T-shirts, etc.
P Postage: Expenditures for stamps, postage, United Parcel
Service, Federal Express and direct mail services. Use code L for
design and other production costs associated with producing
campaign literature.
T Travel Expenses: Expenditures associated with travel. If a travel
expenditure is more than $50, describe the type of expenses (e.g.,
lodging, airfare, meals, gas, mileage, etc.)