Fppc Form 700 - Statement Of Economic Interests Page 9
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14700
schedule c
caliFornia Form
income, loans, & Business
Fair Political Practices commission
a m e n d m e n t
Positions
(Other than Gifts and Travel Payments)
►
1. income received
►
1. income received
NAME OF SOuRCE OF INCOME
NAME OF SOuRCE OF INCOME
ADDRESS (Business Address Acceptable)
ADDRESS (Business Address Acceptable)
BuSINESS ACTIvITY, IF ANY, OF SOuRCE
BuSINESS ACTIvITY, IF ANY, OF SOuRCE
YOuR BuSINESS POSITION
YOuR BuSINESS POSITION
GROSS INCOME RECEIvED
GROSS INCOME RECEIvED
No Income - Business Position Only
No Income - Business Position Only
$500 - $1,000
$500 - $1,000
$1,001 - $10,000
$1,001 - $10,000
$10,001 - $100,000
$10,001 - $100,000
OvER $100,000
OvER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIvED
CONSIDERATION FOR WHICH INCOME WAS RECEIvED
Salary
Spouse’s or registered domestic partner’s income
Salary
Spouse’s or registered domestic partner’s income
(For self-employed use Schedule A-2.)
(For self-employed use Schedule A-2.)
Partnership (Less than 10% ownership. For 10% or greater use
Partnership (Less than 10% ownership. For 10% or greater use
Schedule A-2.)
Schedule A-2.)
Sale of
Sale of
(Real property, car, boat, etc.)
(Real property, car, boat, etc.)
Loan repayment
Loan repayment
Commission or
Rental Income,
Commission or
Rental Income,
list each source of $10,000 or more
list each source of $10,000 or more
(Describe)
(Describe)
Other
Other
(Describe)
(Describe)
comments:
►
2. loans received or outstanding during the rePorting Period
*
You are not required to report loans from commercial lending institutions, or any indebtedness created as part of a retail installment or credit
card transaction, 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:
NAME OF LENDER*
INTEREST RATE
TERM (Months/Years)
%
None
ADDRESS (Business Address Acceptable)
SECuRITY FOR LOAN
None
Personal residence
BuSINESS ACTIvITY, IF ANY, OF LENDER
Real Property
Street address
HIGHEST BALANCE DuRING REPORTING PERIOD
$500 - $1,000
City
$1,001 - $10,000
Guarantor
$10,001 - $100,000
Other
OvER $100,000
(Describe)
Filer’s Verification
Print name
Office, Agency or Court
statement type
2017/2018 Annual
Annual
Assuming
Leaving
Candidate
(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
Filer’s Signature
(month, day, year)
FPPC Form 700 (2017/2018) Sch. C
FPPC Advice Email: advice@fppc.ca.gov
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FPPC Toll-Free Helpline: 866/275-3772
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