Cec Form 44 Statement Of City-Related Business
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1
2City Ethics Commission
200 N Spring Street
City Hall — 24th Floor
Los Angeles, CA 90012
Mail Stop 129
(213) 978-1960
Elected City officials, candidates for elected City office, members of City boards and commissions, general
managers and chief administrative officers of City agencies, and individuals who hold an appointive office named in
the Charter must file this form within ten calendar days after a City action affects their personal financial interests.
Original filing
Amended filing (original filed on ____/____/20____)
Total Pages: ____
Name:
(Last, First, Middle)
Agency or Office:
Position:
Phone:
Email:
A City action, other than a ministerial action, affected the following financial interests that were held by me, my
spouse or registered domestic partner, or a business entity in which one of us held an ownership interest of five
percent or more.
1. REAL OR PERSONAL PROPERTY
Personal property
Description:
Real Property
Address or assessor’s parcel number:
Property was:
Purchased (date: ____ / ____ / 20____ )
Sold (date: ____ / ____ / 20____ )
Council File, contract, or other City ID number: ___________________________________________________________
Property held by:
Me
My spouse/registered domestic partner
Name of spouse/partner:
Business in which I held an ownership interest of at least 5%
Name of business:
Business in which my spouse/partner held an ownership interest of at least 5%
Name of spouse/partner:
Name of business:
Do you have additional property to report?
No
Yes, and _____ additional pages are attached.
2. APPLICATION
Type:
License
Certificate
Permit
Franchise
Zone Change
Variance
Credential
Other
Application was:
Approved (date: ____ / ____ / 20____ )
Denied (date: ____ / ____ / 20____ )
Council File, contract, or other City ID number: ___________________________________________________________
Application sought by:
Me
My spouse/registered domestic partner
Name of spouse/partner:
Business in which I held an ownership interest of at least 5%
Name of business:
Business in which my spouse/partner held an ownership interest of at least 5%
Name of spouse/partner:
Name of business:
Do you have additional applications to report?
No
Yes, and _____ additional pages are attached.
February 2014
Los Angeles Municipal Code § 49.5.6(C); Election Code § 304
Page 1 of 2
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