Fppc Form 700 - Statement Of Economic Interests Page 3
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14700
schedule a-1
caliFornia Form
investments
Fair Political Practices commission
Stocks, Bonds, and Other Interests
a m e n d m e n t
(Ownership Interest is Less Than 10%)
Do not attach brokerage or financial statements.
► NAME OF BuSINESS ENTITY
► NAME OF BuSINESS ENTITY
GENERAL DESCRIPTION OF THIS BuSINESS
GENERAL DESCRIPTION OF THIS BuSINESS
FAIR MARkET vALuE
FAIR MARkET vALuE
$2,000 - $10,000
$10,001 - $100,000
$2,000 - $10,000
$10,001 - $100,000
$100,001 - $1,000,000
Over $1,000,000
$100,001 - $1,000,000
Over $1,000,000
NATuRE OF INvESTMENT
NATuRE OF INvESTMENT
Stock
Other
Stock
Other
(Describe)
(Describe)
Partnership
Income Received of $0 - $499
Partnership
Income Received of $0 - $499
Income Received of $500 or More
Income Received of $500 or More
(Report on Schedule C)
(Report on Schedule C)
IF APPLICABLE, LIST DATE:
IF APPLICABLE, LIST DATE:
17
17
17
17
/
/
/
/
/
/
/
/
ACQuIRED
DISPOSED
ACQuIRED
DISPOSED
► NAME OF BuSINESS ENTITY
► NAME OF BuSINESS ENTITY
GENERAL DESCRIPTION OF THIS BuSINESS
GENERAL DESCRIPTION OF THIS BuSINESS
FAIR MARkET vALuE
FAIR MARkET vALuE
$2,000 - $10,000
$10,001 - $100,000
$2,000 - $10,000
$10,001 - $100,000
$100,001 - $1,000,000
Over $1,000,000
$100,001 - $1,000,000
Over $1,000,000
NATuRE OF INvESTMENT
NATuRE OF INvESTMENT
Stock
Other
Stock
Other
(Describe)
(Describe)
Partnership
Income Received of $0 - $499
Partnership
Income Received of $0 - $499
Income Received of $500 or More
Income Received of $500 or More
(Report on Schedule C)
(Report on Schedule C)
IF APPLICABLE, LIST DATE:
IF APPLICABLE, LIST DATE:
17
17
17
17
/
/
/
/
/
/
/
/
ACQuIRED
DISPOSED
ACQuIRED
DISPOSED
Filer’s Verification
► NAME OF BuSINESS ENTITY
Print name
GENERAL DESCRIPTION OF THIS BuSINESS
Office, Agency
or court
FAIR MARkET vALuE
statement type
2017/2018 Annual
Assuming
Leaving
$2,000 - $10,000
$10,001 - $100,000
Annual
Candidate
$100,001 - $1,000,000
Over $1,000,000
(yr)
I have used all reasonable diligence in preparing this statement. I have
NATuRE OF INvESTMENT
reviewed this statement and to the best of my knowledge the information
Stock
Other
contained herein and in any attached schedules is true and complete.
(Describe)
Partnership
Income Received of $0 - $499
I certify under penalty of perjury under the laws of the State of
Income Received of $500 or More
(Report on Schedule C)
California that the foregoing is true and correct.
IF APPLICABLE, LIST DATE:
Date Signed
17
17
(month, day, year)
/
/
/
/
ACQuIRED
DISPOSED
Filer’s Signature
comments:
FPPC Form 700 (2017/2018) Sch. A-1
FPPC Advice Email: advice@fppc.ca.gov
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FPPC Toll-Free Helpline: 866/275-3772
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