November 3, 2020 Candidate Packet - Flipping Book Version

Reporting Multiple Nonmonetary Contributions If a committee anticipates that more than one nonmonetary contribution will be made to another committee or received from a single contributor during the 90 days before the election (including the date of the election), it may, on or before the deadline, file a single Form 497 covering the period in which the nonmonetary contributions will be made or received. The report must disclose the total value of nonmonetary contributions that will be made, or, if the actual value of nonmonetary contributions is not known at the time of filing, a good faith estimate of the value. If an estimated value differs from the reported amount by 20 percent or more, the committee must amend the Form 497 within 24 hours from the time the committee knows that the estimated value is incorrect.

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Type or print in ink. Amounts may be rounded to whole dollars. in Am s may be rounded to whole dollars. Type or print in ink. Amounts may be rounded to whole dollars.

497 Contribution Report R 497 Contribution Report

497 CONTRIBUTION REPORT CALIFORNIA FORM 497 497 CONTRIBUTION REPORT CALIFORNIA FORM 497 For Of fi cial Use Only For Of fi cial Use Only

B

A

Date Stamp D t Date Stamp

NAME OF FILER NAME OF FILER

Date of This Filing f Date of This Filing Report No. Report No.

11/01/20XX 1

Manuel Alvarez for Mayor 20XX

AREA CODE/PHONE NUMBER AREA CODE/PHONE NUMBER 707-555-6868

I.D. NUMBER (if applicable) I.D. NUMBER (if applicable)

12344XX

STREET ADDRESS STREET ADDRESS

Amendment Amendment

225 Presley Street

to Report No. (explain below) to Report No. (explain below) No. of Pages No. of Pages

CITY CITY

STATE STATE

ZIP CODE ZIP CODE

1

CA 95443

Oakmont

1

1. Contribution(s) Received 1. Contribution(s) Received

IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) IF AN INDIVIDUAL, IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOY R (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) Nurse - Oakmont Hospital

DATE RECEIVED DATE RECEIVED

FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR (IF COMMITTEE,ALSO ENTER I.D. NUMBER) , STRE FULL NAME, STREET ADDR SS AND ZIP CODE OF CONTRIBUTOR (IF COMMITTEE,ALSO ENTER I.D. NUMBER)

AMOUNT RECEIVED AMOUNT RECEIVED

CONTRIBUTOR CODE * CONTRIBUTOR CODE *

Loretta Stone 28 Hemlock Street Oakmont, CA 95434

IND COM OTH PTY SCC S IND COM OTH PTY SCC IND COM OTH PTY SCC C IND COM OTH PTY SCC IND COM OTH PTY SCC P IND COM OTH PTY SCC

$2,000

10/30/XX

Check if Loan c f Check if Loan

% Provide interest rate % % Provide interest rate

ABC Company 220 R Street Oakmont, CA 95434

$3,000

10/30/XX

Check if Loan h Check if Loan

% Provide interest rate % Provide interest rate

A Completing the Form 497 Filer Information Provide the committee’s full name, telephone number, street address, city, state, zip code, and committee ID number.

Check if Loan Check if Loan

% Provide interest rate % Provide interest rate

FPPC Form 497 (Jul/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov FPPC Form 497 (March/ 1 FPPC Toll-Free H lpline: 866/ASK-FPPC (866/275-3772) **Contributor Codes IND – Individual COM – Recipient Committee (other than PTY or SCC) OTH – Other (e.g., business entity) PTY – Political Party SCC – Small Contributor Committee o -Fre H l -F PC (866/ OTH – Other (e.g., business entity) l FPPC Form 497 (March/2011) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) **Contributor Codes IND – Individual COM – Recipient Committee (other than PTY or SCC) OTH – Other (e.g., business entity) PTY – Political Party SCC – Small Contributor Committee

Reason for Amendment: Reason for Amendment:

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Fair Political Practices Commission advice@fppc.ca.gov

Chapter 10. 5

Campaign Manual 2 June 2020