Slate Mailer Organization Campaign Statement

Form 401 Instructions


Statement Covers Period

Part 1 of 9: Slate Mailer Organization Information

Information About Slate Mailer Organization

Part 2 of 9: Is This a General Purpose Committe?

General Purpose Committee

If this Slate Mailer Organization is also a “general purpose committee” as defined in Government Code Section 82027.5, check box and attach the committee’s campaign disclosure report to this statement.

Part 3 of 9: Summary of Payments

Total This Period

Cumulative to Date (Since January 1 of calendar year covered)

Part 4 of 9: Verification


Part 5a of 9: Schedule A - Payments Received

First Payments Received

Second Payments Received

Third Payments Received


Fourth Payments Received

Fifth Payments Received

Sixth Payments Received

Seventh Payments Received


Part 5b of 9: Summary of Schedule A

Part 6a of 9: Schedule B - Payments Made

First Payment Made

Second Payment Made

Third Payment Made

Fourth Payment Made

Fifth Payment Made

Sixth Payment Made


Part 6b of 10: Summary of Schedule B

Part 7 of 9: Schedule B-1 - Payments Made By An Angent or Independent Contractor on Behalf of a Slate Mailer Organization

First Agent or Independent Contractor

Second Agent or Independent Contractor

Third Agent or Independent Contractor

Fourth Agent or Independent Contractor

Fifth Agent or Independent Contractor

Sixth Agent or Independent Contractor

Part 8 of 9: Schedule C - Persons Receiving $1,000 or More

You must identify each individual listed on your Statement of Organization (Form 400) who received, directly or indeirectly, $1,000 or more from the organization during the period. See instructions regarding "indirect" payments.

First Persons Receiving

Second Persons Receiving

Third Persons Receiving

Fourth Persons Receiving

Fifth Persons Receiving

Sixth Persons Receiving

Seventh Persons Receiving

Eight Persons Receiving

Ninth Persons Receiving

Tenth Persons Receiving

Eleventh Persons Receiving

Part 9 of 9: Schedule D - Candidates and Measures Not Listed on Schedule A

You must identify each candidate and measure supported or opposed in a slate mailer sent by you during the period for which you did not received a payment of $100 or more either from the candidate or ballot measure committee or from any other person.

First Candidate or Measure

Second Candidate or Measure

Third Candidate or Measure

Fourth Candidate or Measure

Fifth Candidate or Measure

Sixth Candidate or Measure

Seventh Candidate or Measure

Eigth Candidate or Measure

Ninth Candidate or Measure

Tenth Candidate or Measure

Eleventh Candidate or Measure

Twelfth Candidate or Measure

Please press 'Create PDF Document' button below. Filled out Form 401 PDF document will be opened. Please print the document and sign at the bottom of the page.

End of the Page, Form 401