Fppc Form 700 - Statement Of Economic Interests

Download a blank fillable Fppc Form 700 - Statement Of Economic Interests in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Fppc Form 700 - Statement Of Economic Interests with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

700
Date Initial Filing Received
Statement of economic intereStS
Official Use Only
caliFornia Form
Fair Political Practices commission
cover Page
a m e n d m e n t
Please type or print in ink.
name of filer
(laSt)
(firSt)
(middle)
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
Division, board, Department, District, if applicable
Your Position
If filing for multiple positions, list below or on an attachment. (Do not use acronyms)
agency:
Position:
2. Jurisdiction of Office
(Check at least one box)
State
Judge or Court Commissioner (Statewide Jurisdiction)
Multi-County
County of
City of
Other
3. Type of Statement
(Check at least one box)
Annual: The period covered is January 1, 2017, through
Leaving Office: Date Left
/
/
December 31, 2017.
(Check one)
-or-
The period covered is January 1, 2017, through the date of
The period covered is
/
/
, through
leaving office.
December 31, 2017.
-or-
Assuming Office: Date assumed
/
/
The period covered is
/
/
, through
the date of leaving office.
Candidate: Date of Election
and office sought, if different than Part 1:
4. Schedule Summary (must complete)
Total number of pages including this cover page:
Schedules attached
Schedule A-1 - Investments – schedule attached
Schedule C - Income, Loans, & Business Positions – schedule attached
Schedule A-2 - Investments – schedule attached
Schedule D - Income – Gifts – schedule attached
Schedule B - Real Property – schedule attached
Schedule E - Income – Gifts – Travel Payments – schedule attached
-or-
None
- No reportable interests on any schedule
5. Verification
MaIlIng aDDreSS
Street
CItY
State
ZIP CoDe
(Business or Agency Address Recommended - Public Document)
DaYtIMe telePhone nuMber
E-MAiL ADDrESS
(
)
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 acknowledge this is a public document.
I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date Signed
Signature
(month, day, year)
(File the originally signed statement with your filing official.)
FPPC Form 700 (2017/2018)
FPPC Advice Email: advice@fppc.ca.gov
Clear Page
Print
FPPC Toll-Free Helpline: 866/275-3772

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Financial