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STATE OF CALIFORNIA

FRANCHISE TAX BOARD


P.O. BOX 942857
SACRAMENTO, CA 94257-4040 Political or Legislative Activities
TELEPHONE: (916) 845-4171
By Section 23701d Organizations

Name Corporate Number

Number and Street Federal Identification Number

City or Town State Zip Code

Please Check
(√)
YES NO

I (a) Have you participated or intervened in any political campaign on behalf of any candidate for elective
public office? If so, attach a detailed description of the activity and copies of any material published in
connection with such activity.

(b) Have you contributed funds to support or oppose any individual candidate for public office or to any
organization formed to support or oppose a candidate for public office? If yes, attach a detailed
description of the activity and a schedule of the amount paid, including dates and name(s) of the
individual(s) or organization(s).

II (a) Have you attempted to influence any national, state or local legislation or ballot measure? If yes,
attach a detailed description of such activities, copies of any materials published in connection with
the activities and a schedule of expenditures.

III Public Charities — Election to make expenditures to influence legislation


(a) Have you filed a federal election to make expenditures to influence legislation? If so, furnish a copy
of the Form 5768 filed with the Internal Revenue Service if not previously furnished. The furnishing of
the copy of the federal election constitutes the filing of an election for state purposes.

NOTE: An election is not permitted if you are a church, an integrated auxiliary of a church or a
private foundation. State and federal law is the same with regard to this election, except that state
law does not provide for an excise tax on excess lobbying expenditures.

(b) Organizations that have elected to make expenditures to influence legislation must furnish the
following financial information for the taxable year:

1. EXEMPT PURPOSE EXPENDITURES


(The total amount paid or incurred to accomplish the charitable, educational, religious, etc. purpose) $

2. LOBBYING EXPENDITURES
(The total amount expended for the purpose of influencing legislation through communication with any
member or employee of a legislative body or any government official or employee who may
participate in the formation of legislation) $

3. GRASS ROOTS EXPENDITURES


(The amount expended to influence any legislation through attempts to affect the opinions of the
general public or any segment thereof) $

FTB 3509 (REV 8-95)