NOTE:or NAME ž (LAST) ž (FIRST) ž ( žMM IDD žlL E) žp žc ( ) žD žt žt žp FPPC Form 700-A (2018/2019)FPPC Advice žEE mail: advice@fppc.ca.govFPPC žTT oll-Free Helpline: 866/275-3772 www.fppc.ca.gov 3. ž Disclosure Statement1. Full Name of Agency2. žT T ype of Statement ž žD žR A Public document F žaA IR POLITI žcaCA L PR žacAC TI žcC E žsS COMMI žssSS IO žnN 700-ACA žLILI F žOROR N žII A F žORMORM STATEMENT OF žEE CONOMIC žII NTERE žsS T žsS FOR žAA UDITOR žsS , CLAIM žsS MANAGER žsS /ADJU žsS TER žsS , AND OTHER ELIGIBLE FILER žsS * ž Annual Statement (Year ): žY žA žD žI / / žD ž žY / / žY ž Note: žA žR Number of pages completed including this cover page: Part 1. No Disclosure žRR equired ž žI žI Part 2. Disclosure žRR equired žI žI žI žO žR ž žA ž žA ž žB ž ž ž žD ž žE -or- ž žI žI žII certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.Date Signed Signature Part 1a. No Disclosure žRR equired (Board of žEE qualization only) ž žI žI žI žI žA žI žR (Business or Agency Address Recommended - Public Document) žE žss žM žg žA žssst žtc žt žA žE American LegalNet, Inc. www.FormsWorkFlow.com