Major Donor and Independent Expenditure Committee Campaign Statement

Form 461 Instructions

Part 1 of 6: Statement Period Covered







Part 2 of 6: Name and Address of Filer









Part 3 of 6: Nature and Interest of Filer

Complete each applicable section












Part 4 of 6: Summary

Amounts may be rounded to whole dollars.







Part 5 of 6: Verification

I have used all reasonable diligence in preparing this statement. I have reviewed the 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 individual donor or responsible officer sign


Part 6 of 6: 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.

First Contribution and Expenditre Made



Type of Payment









Second Contribution and Expenditre Made



Type of Payment









Third Contribution and Expenditre Made



Type of Payment









Fourth Contribution and Expenditre Made



Type of Payment









Part 6 Subtotal


Please press 'Create PDF Document' button below. Filled out Form 461 PDF document will be opened. Please print the document and sign at the bottom of the page.