Fppc Form 700 - Statement Of Economic Interests Page 7
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14700
schedule B
caliFornia Form
Fair Political Practices commission
interests in real Property
a m e n d m e n t
(Including Rental Income)
► ASSESSOR’S PARCEL NuMBER OR STREET ADDRESS
► ASSESSOR’S PARCEL NuMBER OR STREET ADDRESS
CITY
CITY
FAIR MARkET vALuE
IF APPLICABLE, LIST DATE:
FAIR MARkET vALuE
IF APPLICABLE, LIST DATE:
$2,000 - $10,000
$2,000 - $10,000
17
17
17
17
/
/
/
/
/
/
/
/
$10,001 - $100,000
$10,001 - $100,000
ACQuIRED
DISPOSED
ACQuIRED
DISPOSED
$100,001 - $1,000,000
$100,001 - $1,000,000
Over $1,000,000
Over $1,000,000
NATuRE OF INTEREST
NATuRE OF INTEREST
Ownership/Deed of Trust
Easement
Ownership/Deed of Trust
Easement
Leasehold
Leasehold
Yrs. remaining
Other
Yrs. remaining
Other
IF RENTAL PROPERTY, GROSS INCOME RECEIvED
IF RENTAL PROPERTY, GROSS INCOME RECEIvED
$0 - $499
$500 - $1,000
$1,001 - $10,000
$0 - $499
$500 - $1,000
$1,001 - $10,000
$10,001 - $100,000
OvER $100,000
$10,001 - $100,000
OvER $100,000
If you own a 10% or greater
If you own a 10% or greater
SOuRCES OF RENTAL INCOME:
SOuRCES OF RENTAL INCOME:
interest, list the name of each tenant that is a single source of
interest, list the name of each tenant that is a single source of
income of $10,000 or more.
income of $10,000 or more.
None
None
*
You are not required to report loans from commercial lending institutions made in the lender’s regular course of
business on terms available to members of the public without regard to your official status. Personal loans and
loans received not in a lender’s regular course of business must be disclosed as follows:
Filer’s Verification
*
NAME OF LENDER
Print name
ADDRESS (Business Address Acceptable)
Office, Agency
or court
BuSINESS ACTIvITY, IF ANY, OF LENDER
statement type
2017/2018 Annual
Assuming
Leaving
Annual
Candidate
(yr)
INTEREST RATE
TERM (Months/Years)
I have used all reasonable diligence in preparing this statement. I have
reviewed this statement and to the best of my knowledge the information
%
None
contained herein and in any attached schedules is true and complete.
HIGHEST BALANCE DuRING REPORTING PERIOD
I certify under penalty of perjury under the laws of the State of
$500 - $1,000
$1,001 - $10,000
California that the foregoing is true and correct.
OvER $100,000
$10,001 - $100,000
Date Signed
(month, day, year)
Guarantor, if applicable
Filer’s Signature
comments:
FPPC Form 700 (2017/2018) Sch. B
FPPC Advice Email: advice@fppc.ca.gov
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FPPC Toll-Free Helpline: 866/275-3772
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