HomeMy WebLinkAboutPerry Woodward - Annual 2014STATEMENT OF ECONOMIC I
Please type or print in ink.
NAME OF FILER (LAST)
VjoO DW kR.0
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
C)7i op caxo
Division, Board, Department, District, if applicable
COVER PAGE
(FIRST)
PE►e12y
Your Position
STS_
Initial Filing
Use Only
XAA S
60UN c t [ ,vjC.h 13EN
► If filing for multiple positions, list below or on an attachment. (Do not use acronyms) Say +~ c to fa �° r /./r T` r. } "fi •w /E J +A�r -
�c�u rs�l�► /core do 1, jeov 1 P•wcrs aetrd
Q
Agency: C•"`M�"'' -,,,10 1AcaJ� AratV�Y o� �a rl�oy Position: 44CA01 9EK
2. Jurisdiction of Office (Check at least one box)
❑ State .5, cttf,, Sc.J A44 f`co ? i.N )<•�.rusco El Judge or Court Commissioner (Statewide Jurisdiction)
Multi- County ( ,Rtounty of SAOTA C(AAA ( VTA)
❑ City of 61 "O Y ❑ Other
3. Type of Statement (Check at least one box)
X Annual: The period covered is January 1, 2014, through
December 31, 2014.
-or-
The period covered is I I through
December 31, 2014.
❑ Assuming Office: Date assumed
❑ Candidate: Election year
4. Schedule Summary
Check applicable schedules or "None."
Schedule A -1 - Investments — schedule attached
Schedule A -2 - Investments — schedule attached
Schedule B - Real Property — schedule attached
❑ Leaving Office: Date Left I
(Check one)
O The period covered is January 1, 2014, through the date of
leaving office.
O The period covered is I I through
the date of leaving office.
and office sought, if different than Part 1:
► Total number of pages including this cover page:
Schedule C - Income, Loans, & Business Positions — schedule attached
❑ Schedule D - Income — Gifts — schedule attached
❑ Schedule E - Income — Gifts — Travel Payments — schedule attached
'or-
0 None - No reportable interests on any schedule
5. Verification
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business or Agency Address Recommended - Public Document)
UAT 1 Wt 1 tLtNYWNt NUPMtK t -MAIL AUUKt55
(y'og > 891 " 4'2a`fi wood ward c� . �� /moo cci . �S
1 have used all reasonable diligence in preparing this statement. I have reviewed this ttatement and to the best of my knowle a 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
FPPC Form 700(2014/2015)
FPPC Advice Email: advice @fppc.ca.gov
FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov
SCHEDULE A -1
Investments
Stocks, Bonds, and Other Interests
(Ownership Interest is Less Than 10 %)
Do not attach brokerage or financial statements.
► NAME OF BUSINESS ENTITY
POF 50LG71(7,yS' 7�,-)c.
GENERAL DESCRIPTION OF THIS BUSINESS
� I f
SCan.Co��JG�f C.s><!S ✓��'^�� 3 ,SeT- }watt
FAIR MARKET VALUE
❑ $2,000 - $10,000 ❑ $10,001 - $100,000
$100,001 - $1,000,000 ❑ Over $1,000,000
NATURE OF INVESTMENT
Stock ❑ Other
(Describe)
❑ Partnership O Income Received of $0 - $499
Q Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
� / 14 _�_1 14
ACQUIRED DISPOSED
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE
❑ $2,000 - $10,000 ❑ $10,001 - $100,000
❑ $100,001 - $1,000,000 ❑ Over $1,000,000
NATURE OF INVESTMENT
❑ Stock ❑ Other
(Describe)
❑ Partnership Q Income Received of $0 - $499
Q Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
� / 14 _/ / 14
ACQUIRED DISPOSED
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE
❑ $2,000 - $10,000 ❑ $10,001 - $100,000
❑ $100,001 - $1,000,000 ❑ Over $1,000,000
NATURE OF INVESTMENT
❑ Stock ❑ Other
(Describe)
❑ Partnership O Income Received of $0 - $499
Q Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
I/ 14 / 14
ACQUIRED DISPOSED
Comments:
CALIFORNIA FORM 71
FAIR POLITICAL PRACTICES COMMIS
Name
•i ) �
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE
❑ $2,000 - $10,000 ❑ $10,001 - $100,000
❑ $100,001 - $1,000,000 ❑ Over $1,000,000
NATURE OF INVESTMENT
❑ Stock ❑ Other
(Describe)
❑ Partnership Q Income Received of $0 - $499
Q Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
/ _/ 14 14
ACQUIRED DISPOSED
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE
❑ $2,000 - $10,000 ❑ $10,001 - $100,000
❑ $100,001 - $1,000,000 ❑ Over $1,000,000
NATURE OF INVESTMENT
❑ Stock ❑ Other
(Describe)
❑ Partnership Q Income Received of $0 - $499
Q Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
14 14
ACQUIRED DISPOSED
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE
❑ $2,000 - $10,000 ❑ $10,001 - $100,000
❑ $100,001 - $1,000,000 ❑ Over $1,000,000
NATURE OF INVESTMENT
❑ Stock ❑ Other
(Describe)
❑ Partnership Q Income Received of $0 - $499
Q Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
/ 14 14
ACQUIRED DISPOSED
FPPC Form 700 (2014/2015) Sch. A -1
FPPC Advice Email: advice @fppc.ca.gov
FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov
SCHEDULE A -2
Investments, Income, and Assets
of Business Entities /Trusts
(Ownership Interest is 10% or Greater)
op. 1. BUSINESS ENTITY OR TRUST
Name 'i
T ►�►2/� Lbw L vp i X 7'"1 ' . �,4-
:'4
Address (Business Address Acceptable) ��
4�1�
Check one -)(df / `
❑ Trust, go to 2 I�L Business Entity, complete the box, then go to 2
GENERAL DESCRIPTION OF THIS BUSINESS
Lhw F1j�tA
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
❑ $0 - $1,999
❑ $2,000 - $10,000 /14 /14
❑ $10,001 - $100,000 ACQUIRED DISPOSED
❑ $100,001 - $1,000,000
Over $1,000,000
NATURE OF INVESTMENT
Partnership ❑ Sole Proprietorship ❑
-he
t r
61C-V60--+L P{4RT�E12
YOUR BUSINESS POSITION
W 2. IDENTIFY THE GROSS INCOME RECEIVED (INCLUDE YOUR PRO RATA
SHARE OF -• SS INCOME TO THE ENTITY/TRUST)
❑ $0 - $499 ❑ $10,001 - $100,000
❑ $500 - $1,000 ❑ OVER $100,000
❑ $1,001 - $10,000
PP. 3. LIST THE NAME OF ••• TABLE SINGLE SOURCE OF
INCOME OF $10,000 OR MORE (Attach a separate sheet if necessary.)
❑ None or IJ Names listed below
5 E E A- TTAC.We 0
PROPERTY W 4. INVESTMENTS AND INTERESTS IN REAL HELD OR
LEASED THE BUSINESS ENTITY OR TRUST
LY
Check one box:
❑ INVESTMENT ❑ REAL PROPERTY
Name of Business Entity, if Investment, Q
Assessor's Parcel Number or Street Address of Real Property
Description of Business Activity or
City or Other Precise Location of Real Property
FAIR MARKET VALUE IF APPLICABLE, LIST DATE.
❑ $2,000 - $10,000
❑ $10,001 - $100,000
❑ $100,001 - $1,000,000 ACQUIRED DISPOSED
❑ Over $1,000,000
NATURE OF INTEREST
❑ Property Ownership /Deed of Trust ❑ Stock ❑ Partnership
❑ Leasehold ❑ Other
Yrs. remaining
❑ Check box if additional schedules reporting investments or real property
are attached
Comments:
CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
W 1. BUSINESS ENTITY OR TRUST
Name
Address (Business Address Acceptable)
Check one
❑ Trust, go to 2 ❑ Business Entity, complete the box, then go to 2
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
❑ $0 - $1,999
❑ $2,000 - $10,000 _J_/ 14 �_ /14
❑ $10,001 - $100,000 ACQUIRED DISPOSED
❑ $100,001 - $1,000,000
❑ Over $1,000,000
NATURE OF INVESTMENT
❑ Partnership ❑ Sole Proprietorship ❑
Other
YOUR BUSINESS POSITION
IDENTIFY • • • (INCLUDE YOUR • RATA
SHARE OF -• SS INCOME TO THE ENTITYITRUST)
❑ $0 - $499 ❑ $10,001 - $100,000
❑ $500 - $1,000 ❑ OVER $100,000
❑ $1,001 - $10,000
lo- 3. LIST THE NAME OF • RTABLE SINGLE SOURCE OF
INCOME OF $10,000 OR MORE (Attach a ..Pa,ate h-t it ecessary.)
None or Names listed below
lo- 4. INVESTMENTS • INTERESTS IN REAL PROPERTY HELD .-
Check one box:
❑ INVESTMENT ❑ REAL PROPERTY
Name of Business Entity, if Investment, or
Assessor's Parcel Number or Street Address of Real Property
Description of Business Activity gl
City or Other Precise Location of Real Property
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
❑ $2,000 - $10,000
❑ $10,001 - $100,000 --J--J_14 --J--J-14
❑ $100,001 - $1,000,000 ACQUIRED DISPOSED
❑ Over $1,000,000
NATURE OF INTEREST
O Property Ownership /Deed of Trust ❑ Stock ❑ Partnership
❑ Leasehold ❑ Other
Yrs. remaining
❑ Check box if additional schedules reporting investments or real property
are attached
FPPC Form 700 (2014/2015) Sch. A -2
FPPC Advice Email: advice @fppc.ca.gov
FPPCToll- FreeHelpline:866 /275 -3772 www.fppc.ca.gov
A r7-,Ac 14MF, , T
Waldtraut Betchart
Terri Morrison
Karen Peck / Mike Nisen
First Citizens Bank
Manning Distribution Svc.
Stanley Blumenfeld
William Stuart
Marla Esperanca
Provalue, Inc.
Belmont Rock Holdings, LLC
James Welch
Alex Sanchez
Brian Pirzadeh
Nancy Norris
Jerry Hume
PRECA Shoreway, LLC
Ingrid Mann
Cookie Company, Inc.
To 5c14 Erg ,11 C - A- 2-
CA L fo KN, -70 0
Pc991.( wOOOwA,e!!)
1tNA2 CH 25 Z 0/ S
SCHEDULE B
Interests in Real Property
(Including Rental Income)
► ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS
^1' '57-4 5-rP EET
CITY O`
GI c)e o'(, CA
FAIR MARKET VALUE
❑ $2,000 - $10,000
❑ $10,001 - $100,000
$100,001 - $1,000,000
❑ Over $1,000,000
NATURE OF INTEREST
r,�
p,�l Ownership /geed -6r I' 9r-
❑ Leasehold
rrs. remaining
IF APPLICABLE, LIST DATE:
--J--J-14 /14
ACQUIRED DISPOSED
❑ Easement
Other
IF RENTAL PROPERTY, GROSS INCOME RECEIVED
❑ $0 - $499 ❑ $500 - $1,000 ❑ $1,001 - $10,000
$10,001 - $100,000 ❑ OVER $100,000
SOURCES OF RENTAL INCOME: If you own a 10% or greater
interest, list the name of each tenant that is a single source of
income of $10,000 or more.
❑ None
hrgVk 1-3a o2.�-
Eva. 1V,, -4, ,vc Z
Name
f QZW1 GU60191-Jkt210
► ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS
7(6/ fiogESr _5-r0_ ET
CITY
G /G►zayj CA
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
❑ $2,000 - $10,000
❑ $10,0o1 - $100,000 / 14 --/---/-L4-
JEJ1100,001 - $1,000,000 ACQUIRED DISPOSED
❑ Over $1,000,000
NATURE OF INTEREST
fi�bwnership /Deed-DT•'Rust ❑ Easement
❑ Leasehold ❑
Yrs. remaining
Other
IF RENTAL PROPERTY, GROSS INCOME RECEIVED
❑ $0 - $499 ❑ $500 - $1,000 ❑ $1,0ol - $10,000
$10,001 - $100,000 ❑ OVER $100,000
SOURCES OF RENTAL INCOME: If you own a 10% or greater
interest, list the name of each tenant that is a single source of
income of $10,000 or more.
❑ None
UlAt,, , CA A o,L ra P� A
//ot OS # LiN o s r-Y C q!C
II
* 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:
NAME OF LENDER' NAME OF LENDER'
ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY,' OF LENDER BUSINESS ACTIVITY, IF ANY, OF LENDER
INTEREST RATE TERM (Months/Years)
❑ None
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500 - $1,000 ❑ $1,001 - $10,000
❑ $10,001 - $100,000 ❑ OVER $100,000
❑ Guarantor, if applicable
Comments:
INTEREST RATE TERM (Months/Years)
"/° ❑ None
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $50o - $1,000 ❑ $1,001 - $10,000
❑ $10,001 - $100,000 ❑ OVER $100,000
❑ Guarantor, if applicable
FPPC Form 700 (2014/2015) Sch. B
FPPC Advice Email: advice @fppc.ca.gov
FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov
SCHEDULE C
Income, Loans, & Business
Positions
(Other than Gifts and Travel Payments)
NAME OF SOURCE OF INCOME
%K tZA 1_4 w t L ►O
ADDRESS (Business Address Acceptable)
177 PAr2K ALIE 3Rh FL SRa JoS
BUSINESS ACTIVITY, IF ANY, OF SOURCE
1 tv Ei gM
YOUR BUSINESS POSITION
PA-R7_AJE0_
GROSS INCOME RECEIVED
❑ $500 - $1,000 ❑ $1,001 - $10,000
❑ $10,001 - $100,000 OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
Salary ❑ Spouse's or registered domestic partner's income
(For self - employed use Schedule A -2.)
❑ Partnership (Less than 10% ownership. For 10% or greater use
Schedule A -2.)
❑ Sale of
(Real propertyo, car, boat, etc.)
❑ Loan repayment
❑ Commission or ❑ Rental Income, list each source or $10,000 or more
Name
PE42 k 1 1-100 ow aV_0
NAME OF SOURCE OF INCOME
C ITT (f (l oeo )l
ADDRESS (Business Address Acceptable)
7351 20SAN,-JA- 97 b'11.2c`►�
BUSINESS ACTIVITY. IF ANY OF SOURCE
YOUR BUSINESS POSITION
Cotr'ictL '06"'4re e
GROSS INCOME RECEIVED
❑ $500 - $1,000 ❑ $1,001 - $10,000
$10,001 - $100,000 ❑ OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
Salary ❑ Spouse's or registered domestic partner's income
(For self - employed use Schedule A -2.)
❑ Partnership (Less than 10% ownership. For 10% or greater use
Schedule A -2.)
❑ Sale of
(Real property, car, boat, etc.)
❑ Loan repayment
❑ Commission or ❑ Rental Income, list each source of $10,000 or more
(Describe) (Describe)
t�t
Xher 7 f T ❑ Other
�-"� (Describe) (Describe)
mo. -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'
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF LENDER
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500 - $1,000
❑ $1,001 - $10,000
❑ $10,001 - $100,000
❑ OVER $100,000
Comments:
INTEREST RATE TERM (Months/Years)
?/o ❑ None
SECURITY FOR LOAN
❑ None ❑ Personal residence
❑ Real Property
❑ Guarantor
❑ Other
Sheet address
City
(Describe)
FPPC Form 700 (2014/2015) Sch. C
FPPC Advice Email: advice @fppc.ca.gov
FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov
SCHEDULE C
Income, Loans, & Business
Positions
(Other than Gifts and Travel Payments)
NAME OF SOURCE OF INCOME
5ANr/A cc,4" ✓AL-LgY r QA- 5Parq,4TI c ) A—TN+le4
ADDRESS (Business Address Acceptable)
333, A' . I sr 5Tr2r ,6i S4a J05L-:
BUSINESS ACTIVITY, IF ANY. OF SOURCE
YOUR BUSINESS POSITION
a0 k le � M � �✓► r� L %�2
GROSS INCOME RECEIVED
❑ $500 - $1,000 11001 - $10,000
❑ $10,001 - $100,000 ❑ OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
Salary ❑ Spouse's or registered domestic partner's income
(For self - employed use Schedule A -2.)
❑ Partnership (Less than 10% ownership. For 10% or greater use
Schedule A -2.)
❑ Sale of
(Real property, car, boat, etc.)
❑ Loan repayment
❑ Commission or ❑ Rental Income, list each source of $10,000 or more
(Describe)
Name
PCN r2 Y Woa A,44 --le 0
NAME OF SOURCE OF INCOME
P&JAJwsvc/k coer_%Jofc Jol PQw *mss go,+p10
ADDRESS (Business Address Acceptable)
U-So -IAA CArzc.e; s Avt' SAIl cAle1cv s
BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOUR BUSINESS POSITION
13 0AW_ O M , -l3E12
GROSS INCOME RECEIVED
$500 - $1,000 ❑ $1,001 - $10,000
❑ $10,001 - $100,000 ❑ OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
'Salary ❑ Spouse's or registered domestic partner's income
(For self - employed use Schedule A -2.)
❑ Partnership (Less than 10% ownership. For 10% or greater use
Schedule A -2.)
❑ Sale of
(Real property, car, boat, etc.)
❑ Loan repayment
❑ Commission or ❑ Rental Income, list each source of $10,000 or more
(Describe)
❑ Other I I ❑ Other
(Describe) (Describe)
LOANS 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`
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF LENDER
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500 - $1,000
❑ $1,001 - $10,000
❑ $10,001 - $100,000
❑ OVER $100,000
Comments:
INTEREST RATE TERM (Months/Years)
❑ None
SECURITY FOR LOAN
❑ None ❑ Personal residence
❑ Real Property
❑ Guarantor
❑ Other
Street address
City
(Describe)
FPPC Form 700 (2014/2015) Sch. C
FPPC Advice Email: advice @fppc.ca.gov
FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov
SCHEDULE C CALIFORNIA FORM 1
Income, Loans, & Business FAIR POLITICAL PRACTICES COMMISSU
Positions Name
(Other than Gifts and Travel Payments) ?ERIi Y W 00 p vAl2 0
NAME OF SOURCE OF INCOME
ADDRESS (Business Address Acceptable)
3 33 W. :5R,u cAPto5 51- #700 � SAJ
BUSINESS ACTIVITY, IF ANY, OF SOURCE
SeMICo,u0t,c7d►4 Co�s��TI`1 # ScFTw ,4r2
YOUR BUSINESS POSITION
C�C -AAL (:5-ovt)SEL
GROSS INCOME RECEIVED
❑ $500 - $1,000 ❑ $1,001 - $10,000
❑ $10,001 - $100,000 --R�VER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
❑ Salary Spouse's or registered domestic partner's income
"`"���'� (For self - employed use Schedule A -2.)
❑ Partnership (Less than 10% ownership. For 10% or greater use
Schedule A -2.)
❑ Sale of
(Real property, car, boat, etc.)
❑ Loan repayment
❑ Commission or ❑ Rental Income, list each source of $10,000 or more
❑ Other
(Describe)
(Describe)
NAME OF SOURCE OF INCOME
ADDRESS (Business Address Acceptable)
)5E
BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOUR BUSINESS POSITION
GROSS INCOME RECEIVED
❑ $500 - $1,000 ❑ $1,001 - $10,000
❑ $10,001 - $100,000 ❑ OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
❑ Salary ❑ Spouse's or registered domestic partner's income
(For self - employed use Schedule A -2.)
❑ Partnership (Less than 10% ownership. For 10% or greater use
Schedule A -2.)
❑ Sale of
(Real property, car, boat, etc.)
❑ Loan repayment
❑ Commission or ❑ Rental Income, list each source or $10,000 or more
❑ Other
(Describe)
(Describe)
* 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'
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF LENDER
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500 - $1,000
❑ $1,001 - $10,000
❑ $10,001 - $100,000
❑ OVER $100,000
Comments:
INTEREST RATE TERM (MonthsNears)
❑ None
SECURITY FOR LOAN
❑ None ❑ Personal residence
❑ Real Property
❑ Guarantor
❑ Other
Street address
City
(Describe)
FPPC Form 700 (2014/2015) Sch. C
FPPC Advice Email: advice @fppc.ca.gov
FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov