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Please type or print in ink. 700 FAIR POLITICAL PRACTICES COMMISSION CALIFORNIA FORM A M E N D M E N T Leaving Office: Date Left / / (Check one circle.) The period covered is January 1, 2022, through the date of leaving office. The period covered is / / , through the date of leaving office. STATEMENT OF ECONOMIC INTERESTS COVER PAGE 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 (month, day, year) 3. Type of Statement (Check at least one box) 2. Jurisdiction of Office (Check at least one box) Candidate: Date of Election and office sought, if different than Part 1: Assuming Office: Date assumed / / Date Initial Filing Received Filing Official Use...

NOTE: The conflict of interest code for your agency requires you to disclose an investment, source of income, interest in real property, or business position in a business entity if you were assigned or participated in a case involving that economic interest. Complete Part 1 or 1a, or if disclosure is required complete Part 2. NAME (LAST) (FIRST) (MIDDLE) ZIP CODE ( ) DAYTIME TELEPHONE NUMBER Position: 3. Disclosure Statement1. Full Name of Agency 2. Type of Statement (Check at least one box) Date Received Official Use Only Please type or print in ink. A Public Document FAIR POLITICAL PRACTICES COMMISSION 700-ACALIFORNIA FORM STATEMENT OF ECONOMIC INTERESTS FOR AUDITORS, CLAIMS MANAGERS/ADJUSTERS, AND OTHER ELIGIBLE FILERS* Annual Statement (Year ): You are required to file a statement by April 1 of the current year, disclosing reportable interests held or received from January 1 through December 31, of the previous year. If you began work after January 1, report in...

Form E-530 must be filed to disclose payment(s) for communications that identify or feature a state candidate but do not expressly advocate the candidate’s election. On-line E-530 reports must be filed by: y Anyone spending or promising to pay $50,000 or more for a communication disseminated within 45 days of an election, if The communication clearly identifies a candidate for state elective office but does not expressly advocate the election or defeat of that candidate. Example: An association has promoted a bill on children’s bicycle safety and wants to tell the public about a certain legislator’s authorship of the bill. The association purchases space on a billboard for $100,000 that says, “Thank you, Senator Park, for supporting SB 1234!” If the communication thanking Senator Park is made within 45 days of the election in which Park is a state candidate, the association must file an E-530 with the Secretary of State disclosing the payment for the billboard. Form E-530 must be filed onl...

Filer’s Verification Print Name Office, Agency or Court Statement Type 2024/2025 Annual Assuming Leaving Annual 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 (month, day, year) Filer’s Signature IF APPLICABLE, LIST DATE: / / / / ACQUIRED DISPOSED IF APPLICABLE, LIST DATE: / / / / ACQUIRED DISPOSED IF APPLICABLE, LIST DATE: / / / / ACQUIRED DISPOSED IF APPLICABLE, LIST DATE: / / / / ACQUIRED DISPOSED IF APPLICABLE, LIST DATE: / / / / ACQUIRED DISPOSED 24 24 24 24 24 24 24 24 ► NAME OF BUSINESS ENTITY GENERAL DESCRIPTION OF THIS BUSINESS ► NAME OF BUSINESS ENTITY GENERAL DESCRIPTION OF THIS BUSINESS ► NAME OF BUSINESS ENTITY GENERAL DESCRIPTION OF THIS BUSINESS...

□ Agency Report of: Consultants A Public Document California Form 805 1. Agency Name (Also include, Division, Department, or Region (if applicable)) Amendment Agency Contact Date of Original Filing: (month, day, year) Phone Number Email 2. Firm Information Firm Name Firm Address Email (optional) Email (optional) Describe General Purpose of Contract 3. Consultant Information Assuming/Start Date Leaving/End Date (if known) Consultant Name Assigned Category OR Disclosure Requirement Start End m / d / yr m / d / yr Start End m / d / yr m / d / yr Start End m / d / yr m / d / yr 4. Verification I have read and understand FPPC Regulations 18700.3 and 18734. I have verified that the disclosure assignment(s) set forth above, is in accordance with its provisions. Signature Name Title (month, day, year) Comment: (Use this space or an attachment for any additional information.) FPPC Form 805 (2/16) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)...

700 FAIR POLITICAL PRACTICES COMMISSION CALIFORNIA FORM A M E N D M E N T SCHEDULE E Income – Gifts Travel Payments, Advances, and Reimbursements Comments: • Mark either the gift or income box. • Mark the “501(c)(3)” box for a travel payment received from a nonprofit 501(c)(3) organization or the “Speech” box if you made a speech or participated in a panel. Per Government Code Section 89506, these payments may not be subject to the gift limit. However, they may result in a disqualifying conflict of interest. • For gifts of travel, provide the travel destination. DATE(S): / / - / / AMT: $ (If gift) DATE(S): / / - / / AMT: $ (If gift) DATE(S): / / - / / AMT: $ (If gift) ► NAME OF SOURCE (Not an Acronym) ADDRESS (Business Address Acceptable) CITY AND STATE 501 (c)(3) or DESCRIBE BUSINESS ACTIVITY, IF ANY, OF SOURCE ► NAME OF SOURCE (Not an Acronym) ADDRESS (Business Address Acceptable) CITY AND STATE 501 (c)(3) or DESCRIBE BUSINESS ACTIVITY, IF ANY, OF...

700 FAIR POLITICAL PRACTICES COMMISSION CALIFORNIA FORM A M E N D M E N T SCHEDULE E Income – Gifts Travel Payments, Advances, and Reimbursements Comments: • Mark either the gift or income box. • Mark the “501(c)(3)” box for a travel payment received from a nonprofit 501(c)(3) organization or the “Speech” box if you made a speech or participated in a panel. Per Government Code Section 89506, these payments may not be subject to the gift limit. However, they may result in a disqualifying conflict of interest. • For gifts of travel, provide the travel destination. DATE(S): / / - / / AMT: $ (If gift) DATE(S): / / - / / AMT: $ (If gift) DATE(S): / / - / / AMT: $ (If gift) ► NAME OF SOURCE (Not an Acronym) ADDRESS (Business Address Acceptable) CITY AND STATE 501 (c)(3) or DESCRIBE BUSINESS ACTIVITY, IF ANY, OF SOURCE ► NAME OF SOURCE (Not an Acronym) ADDRESS (Business Address Acceptable) CITY AND STATE 501 (c)(3) or DESCRIBE BUSINESS ACTIVITY, IF ANY, OF SOURCE ► NAME OF SOURCE (Not an Acrony...

700 Fair Political Practices Commission CALIFORNIA FORM A m e n d m e n t if applicable, list date: / / / / acquired Disposed if applicable, list date: / / / / acquired Disposed 17 1717 17 Schedule B Interests in Real Property (Including Rental Income) ► ASSESSOR’S PARCEL NUMBER OR street address ► ASSESSOR’S PARCEL NUMBER OR street address city city interest rate Term (Months/Years) % None 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. 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. Nature of interest Ownership/Deed of Trust Easement Leasehold Yrs. remaining Other Nature of interest Ownership/Deed of Trust Easement Leasehold Yrs. remaining Other Comments: fair market value $2,000 - $...

NAME OF LENDER* ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF LENDER IF APPLICABLE, LIST DATE: / / / / ACQUIRED DISPOSED IF APPLICABLE, LIST DATE: / / / / ACQUIRED DISPOSED 25 2525 25 SCHEDULE B Interests in Real Property (Including Rental Income) ► ASSESSOR’S PARCEL NUMBER OR STREET ADDRESS ► ASSESSOR’S PARCEL NUMBER OR STREET ADDRESS CITY CITY INTEREST RATE TERM (Months/Years) % None 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. 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. NATURE OF INTEREST Ownership/Deed of Trust Easement Leasehold Yrs. remaining Other NATURE OF INTEREST Ownership/Deed of Trust Easement Leasehold Yrs. remaining Other Comments: FAIR MARKET VALUE $2,000 - $10,000 $10,001 - $100,000 $100,001 - $1,000,000 Over $1,000,000 FAIR M...

2017-18 Amendment Form 700 Amendment_700_2017.pdf SEI (Form 700) Admin and SEI Information Document Forms 2017