Recipient Committee Campaign Statement - Short Form

Instructions for Form 450

For use by recipient committees that have not received a contribution or other receipt that must be itemized, have not received or made loans, and have no outstanding accrued expenses.

Statement Covers Period





Part 1 of 5: Type of Recipient Committe








Part 2 of 5: Type of Statement








Part 3 of 5: Committee Information














Treasurer(s) Information
















Part 4 of 5: Verification

I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein 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.





Please print and have the treasurer or assistant treasurer sign the top line. The next 3 signatures must be from the controlling officeholder, candidate, or state measure proponent.

Expenditures Made

Amounts may be rounded to whole dollars.







Contributions Received

Amounts may be rounded to whole dollars.





Current Cash Statement

Amounts may be rounded to whole dollars.







Part 5 of 5: Payments Made

If more space is needed, use additional copies of this page for continuation sheets

First Payment Made





Please Select Reason for Payment







Second Payment Made





Please Select Reason for Payment







Third Payment Made





Please Select Reason for Payment







Subtotal


Please press 'Create PDF Document' button below. Filled out Form 450 PDF document will be opened. Please print the document and sign at the bottom of the page.


End of Page, From 450.