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Form 700 Statement Of Economic Interest (Amendment Schedules) Form. This is a California form and can be use in Fair Political Practices Commission Statewide.
Tags: Form 700 Statement Of Economic Interest (Amendment Schedules), 700, California Statewide, Fair Political Practices Commission
Please type or print in ink. 700FAIR POLITICAL PRACTICES �CC OMMISSION �CALICALI F �ORNIAORNIA F �ORMORM �AA MENDMENT � � Date Left / / � (Check one circle.) � � The period covered is January 1, 2018, through the date of � � The period covered is / / , through � � The period covered is January 1, 2018, through � December 31, 2018 � The period covered is / / , through December 31, 2018STATEMENT OF �EE CONOMIC �II NTERE �sS T �sS�CC OVER PAGEFPPC Form 700 (2018/2019)FPPC Advice Email: advice@fppc.ca.govFPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov � (month, day, year) � (Check at least one box) State � Multi-County � County of City of � Other � (Check at least one box) � � Date of Election � � � Date assumed / / Date Initial Filing Received Agency Name (Do not use acronyms) Division, B � �NN AME OF �FF ILER � ( �LL A �sS T) � ( �FF IR �sS T) � ( �MM IDDLE) �i �i �Add �sss �ci �y � �ip �d ( ) �y �im �p �m E- �maMA I �lL �addADD R �essESS (Business or Agency Address Recommended - Public Document) � (File the originally signed paper � (Do not use acronyms) �A � Schedules attached Investments 226 schedule attached Investments 226 schedule attached Real Property 226 schedule attached Income, Loans, & Business Positions 226 schedule attached 226 schedule attached 226 schedule attached None - No reportable interests on any schedule � Total number of pages including this cover page: American LegalNet, Inc. www.FormsWorkFlow.com � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �EE xample: � � � � � � � � � � � � � � � � � � Part 3. �TT ype of �SS tatement � � � � � � � � � � � � � � � � � � � � � � � � � � 2018 � � do not � � � � � � � 2019 � � � � � � � � � previous year222s � � � � � � � � � � � � 2019 � � � � 2019 � � � � � � � � � 2020 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � Part 4. �SS chedule �SS ummary � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � use to disclose interests; or � � � � � � � � � � � � � � � � Please do not � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � When you sign your statement, you are stating, under penalty of perjury, that it is true and correct. � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � Because the Form 700 is a public document, address instead of your home address. � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �DD o not use acronyms. � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �DD o not use acronyms. � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �EE xample: � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �II nstructions �CC over PageFPPC Form 700 (2018/2019)FPPC Advice Email: advice@fppc.ca.govFPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov State � Multi-County � County of City of � Other � (Check at least one box) Agency Name (Do not use acronyms) Division, B � (Do not use acronyms) �A � xYuba & Sutter CountiesBoard MemberN/AN/AFeather River Irrigation District American LegalNet, Inc. www.FormsWorkFlow.com Print �NN ame or �CC ourt �SS tatement �TT ype � 2018/2019 Annual � Assuming � � Annual � � (yr) � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �II certify under penalty of perjury under the laws of the �SS tate of �CC alifornia that the foregoing is true and correct. �DD ate �SS igned � (month, day, year)Filer222s �SS ignature �if applicable � list date / / � / / �ac �ired �isposed�if applicable � list date / / � / / �ac �ired �isposed�if applicable � list date / / � / / �ac �ired �isposed�if applicable � list date / / � / / �ac �ired �isposed�if applicable � list date / / � / / �ac �ired �isposed 1818181818181818 � �ame of b �siness entity� �eneral description of �his b �siness � �ame of b �siness entity� �eneral description of �his b �siness � �ame of b �siness entity� �eneral description of �his b �siness � �ame of b �siness entity� �eneral description of �his b �siness � �ame of b �siness entity� �eneral description of �his b �siness �CC omments: �SS CHEDULE �AA -1 �II nvestments � � � � � � � � � Investments must be itemized.FPPC Form 700 (2018/2019) Sch. A-1FPPC Advice Email: advice@fppc.ca.govFPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov �fair mar �et �al �e � � � � � � � � � � Over � �fair mar �et �al �e � � � � � � � � � � Over � �fair mar �et �al �e � � � � � � � � � � Over � �fair mar �et �al �e � � � � � � � � � � Over � �fair mar �et �al �e � � � � � � � � � � Over � �at �re of in �estment � � � � � Income Received � � � � � � � � � � � (Report on Schedule C) �at �re of in �estment � � � � � � � � � � � � � � � � � (Report on Schedule C) �at �re of in �estment � � � � � � � � � � � � � � � � � (Report on Schedule C) �at �re of in �estment � � � � � Income Received of $0 - � � � � � � � (Report on Schedule C) �at �re of in �estment � � � � � � � � � � � � � � � � � (Report on Schedule C) 1818 700FAIR POLITICAL PRACTICES �CC OMMISSION �CALICALI F �ORNIAORNIA F �ORMORM �AA MENDMENT American LegalNet, Inc. www.FormsWorkFlow.com �II nstructions 226 �SS chedules �AA -1 and �AA -2 �II nvestments � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �RR eportable investments include: � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � You are not required to disclose: � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � Annuities � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �UU se �SS chedule �AA -1 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �UU se �SS chedule �AA -2 � � � � � � � � � � � �TT o �CC omplete �SS chedule �AA -1: � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �EE xamples: � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � Alice � � � � � � � � � � � � � � � � � � � �RR eminders � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � FPPC Form 700 (2018/2019)FPPC Advice Email: advice@fppc.ca.govFPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov American LegalNet, Inc. www.FormsWorkFlow.com 700FAIR POLITICAL PRACTICES �CC OMMISSION �CALICALI F �ORNIAORNIA F �ORMORM �AA MENDMENT 3. � �LL IST THE NAME O �fF EACH RE �pP ORTA �bB LE SINGLE SOURCE O �fF INCOME O �fF $10,000 OR MORE ( �AA ttach a separate sheet if necessary.) �if applicable � list date / / � / / �ac �ired �isposed�if applicable � list date / / � / / �ac �ired �isposed 181818 �SS CHEDULE �AA -2 �II nvestments, �II ncome, and �AA ssetsof Business �EE ntities/ �TT rusts � � � � � Address (Business Address Acceptable) �fair mar �et �al �e � � � � � � � � � � � � � Over � �eneral description of �his b �siness � � �n �estment � �eal �roperty � � � � � � or � � � � � � � � � � � � or � � � � � � � 4. � INVESTMENTS AND INTERESTS IN REAL �pP RO �pP ERT �yY HELD OR LEASED �byBY THE �bB USINESS ENTIT �yY OR TRUSTCheck one � � � go to 2 � � � � complete the b