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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.
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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 þCC OMMISSION þCALICALI F þORNIAORNIA F þORMORM þAA MENDMENT þ þ Date Left / / þ (Check one circle.) þ þ The period covered is January 1, 2018, through the date of þ þ The period covered is / / , through þ þ The period covered is January 1, 2018, through þ December 31, 2018 þ The period covered is / / , through December 31, 2018STATEMENT OF þEE CONOMIC þII NTERE þsS T þsSþCC OVER PAGEFPPC Form 700 (2018/2019)FPPC Advice Email: advice@fppc.ca.govFPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov þ (month, day, year) þ (Check at least one box) State þ Multi-County þ County of City of þ Other þ (Check at least one box) þ þ Date of Election þ þ þ Date assumed / / Date Initial Filing Received Agency Name (Do not use acronyms) Division, B þ þNN AME OF þFF ILER þ ( þLL A þsS T) þ ( þFF IR þsS T) þ ( þMM IDDLE) þi þi þAdd þsss þci þy þ þip þd ( ) þy þim þp þm E- þmaMA I þlL þaddADD R þessESS (Business or Agency Address Recommended - Public Document) þ (File the originally signed paper þ (Do not use acronyms) þA þ 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 þ Total number of pages including this cover page: American LegalNet, Inc. www.FormsWorkFlow.com þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þEE xample: þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ Part 3. þTT ype of þSS tatement þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ 2018 þ þ do not þ þ þ þ þ þ þ 2019 þ þ þ þ þ þ þ þ þ previous year222s þ þ þ þ þ þ þ þ þ þ þ þ 2019 þ þ þ þ 2019 þ þ þ þ þ þ þ þ þ 2020 þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ Part 4. þSS chedule þSS ummary þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ use to disclose interests; or þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ Please do not þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ When you sign your statement, you are stating, under penalty of perjury, that it is true and correct. þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ Because the Form 700 is a public document, address instead of your home address. þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þDD o not use acronyms. þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þDD o not use acronyms. þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þEE xample: þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þII nstructions þCC over PageFPPC Form 700 (2018/2019)FPPC Advice Email: advice@fppc.ca.govFPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov State þ Multi-County þ County of City of þ Other þ (Check at least one box) Agency Name (Do not use acronyms) Division, B þ (Do not use acronyms) þA þ xYuba & Sutter CountiesBoard MemberN/AN/AFeather River Irrigation District American LegalNet, Inc. www.FormsWorkFlow.com Print þNN ame or þCC ourt þSS tatement þTT ype þ 2018/2019 Annual þ Assuming þ þ Annual þ þ (yr) þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þII certify under penalty of perjury under the laws of the þSS tate of þCC alifornia that the foregoing is true and correct. þDD ate þSS igned þ (month, day, year)Filer222s þSS ignature þif applicable þ list date / / þ / / þac þired þisposedþif applicable þ list date / / þ / / þac þired þisposedþif applicable þ list date / / þ / / þac þired þisposedþif applicable þ list date / / þ / / þac þired þisposedþif applicable þ list date / / þ / / þac þired þisposed 1818181818181818 þ þame of b þsiness entityþ þeneral description of þhis b þsiness þ þame of b þsiness entityþ þeneral description of þhis b þsiness þ þame of b þsiness entityþ þeneral description of þhis b þsiness þ þame of b þsiness entityþ þeneral description of þhis b þsiness þ þame of b þsiness entityþ þeneral description of þhis b þsiness þCC omments: þSS CHEDULE þAA -1 þII nvestments þ þ þ þ þ þ þ þ þ 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 þfair mar þet þal þe þ þ þ þ þ þ þ þ þ þ Over þ þfair mar þet þal þe þ þ þ þ þ þ þ þ þ þ Over þ þfair mar þet þal þe þ þ þ þ þ þ þ þ þ þ Over þ þfair mar þet þal þe þ þ þ þ þ þ þ þ þ þ Over þ þfair mar þet þal þe þ þ þ þ þ þ þ þ þ þ Over þ þat þre of in þestment þ þ þ þ þ Income Received þ þ þ þ þ þ þ þ þ þ þ (Report on Schedule C) þat þre of in þestment þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ (Report on Schedule C) þat þre of in þestment þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ (Report on Schedule C) þat þre of in þestment þ þ þ þ þ Income Received of $0 - þ þ þ þ þ þ þ (Report on Schedule C) þat þre of in þestment þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ (Report on Schedule C) 1818 700FAIR POLITICAL PRACTICES þCC OMMISSION þCALICALI F þORNIAORNIA F þORMORM þAA MENDMENT American LegalNet, Inc. www.FormsWorkFlow.com þII nstructions 226 þSS chedules þAA -1 and þAA -2 þII nvestments þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þRR eportable investments include: þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ You are not required to disclose: þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ Annuities þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þUU se þSS chedule þAA -1 þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þUU se þSS chedule þAA -2 þ þ þ þ þ þ þ þ þ þ þ þTT o þCC omplete þSS chedule þAA -1: þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þEE xamples: þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ Alice þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þRR eminders þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ 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 þCC OMMISSION þCALICALI F þORNIAORNIA F þORMORM þAA MENDMENT 3. þ þLL IST THE NAME O þfF EACH RE þpP ORTA þbB LE SINGLE SOURCE O þfF INCOME O þfF $10,000 OR MORE ( þAA ttach a separate sheet if necessary.) þif applicable þ list date / / þ / / þac þired þisposedþif applicable þ list date / / þ / / þac þired þisposed 181818 þSS CHEDULE þAA -2 þII nvestments, þII ncome, and þAA ssetsof Business þEE ntities/ þTT rusts þ þ þ þ þ Address (Business Address Acceptable) þfair mar þet þal þe þ þ þ þ þ þ þ þ þ þ þ þ þ Over þ þeneral description of þhis b þsiness þ þ þn þestment þ þeal þroperty þ þ þ þ þ þ or þ þ þ þ þ þ þ þ þ þ þ þ or þ þ þ þ þ þ þ 4. þ INVESTMENTS AND INTERESTS IN REAL þpP RO þpP ERT þyY HELD OR LEASED þbyBY THE þbB USINESS ENTIT þyY OR TRUSTCheck one þ þ þ go to 2 þ þ þ þ complete the b