Independent Expenditure Report

Amounts may be rounded to whole dollars.

Form 496 Instructions















Part 1 of 3: List Only One Candidate or Ballot Measure

Candidate Supported or Opposed




OR

Ballot Measure Supported or Opposed




OR


Part 2 of 3: Independent Expenditures Made

Attach additional information on appropriately labeled continuation sheets.

First Independent Expenditure Made




Second Independent Expenditure Made




Third Independent Expenditure Made




Fourth Independent Expenditure Made





Reason for Amendment






Part 3 of 3: Contributions of $100 or More Recieved

Major donor and independent expenditure committees that do not receive contributions are not required to complete Part 3.

First Contribution



Contributor Code:








Second Contribution



Contributor Code:








Third Contribution



Contributor Code:








Fourth Contribution



Contributor Code








Fifth Contribution



Contributor Code








Sixth Contribution



Contributor Code








Please press 'Create PDF Document' button below. Filled out Form 496 PDF document will be opened. Please print the document and sign at the bottom of the page.


End of Page, Form 496 - Independent Expenditure Report.