California Form 700 - Schedule D - Income - Gifts
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CALIFORNIA FORM
SCHEDULE D
FAIR POLITICAL PRACTICES COMMISSION
Income – Gifts
A M E N D M E N T
► NAME OF SOURCE (Not an Acronym)
► NAME OF SOURCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/dd/yy)
VALUE
DESCRIPTION OF GIFT(S)
DATE (mm/dd/yy)
VALUE
DESCRIPTION OF GIFT(S)
/
/
/
/
$
$
/
/
/
/
$
$
/
/
/
/
$
$
► NAME OF SOURCE (Not an Acronym)
► NAME OF SOURCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/dd/yy)
VALUE
DESCRIPTION OF GIFT(S)
DATE (mm/dd/yy)
VALUE
DESCRIPTION OF GIFT(S)
/
/
/
/
$
$
/
/
/
/
$
$
/
/
/
/
$
$
Filer’s Verification
► NAME OF SOURCE (Not an Acronym)
Print Name
ADDRESS (Business Address Acceptable)
Office, Agency
or Court
BUSINESS ACTIVITY, IF ANY, OF SOURCE
Statement Type
2015/2016 Annual
Assuming
Leaving
Annual
Candidate
DATE (mm/dd/yy)
VALUE
DESCRIPTION OF GIFT(S)
(yr)
I have used all reasonable diligence in preparing this statement. I have
/
/
reviewed this statement and to the best of my knowledge the information
$
contained herein and in any attached schedules is true and complete.
I certify under penalty of perjury under the laws of the State of
/
/
$
California that the foregoing is true and correct.
/
/
$
Date Signed
(month, day, year)
Filer’s Signature
Comments:
FPPC Form 700 (2015/2016) Sch. D
Clear Page
Print Form
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772
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