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HomeMy WebLinkAbout2016.08.12_Irons_Jamie_ Form 700STATEMENT OF ECONOMIC INTERESTS COVER PAGE Please type or print in ink. RECEIVED DatPUtO MiKTFR Lived Official Use Only Administration NAME OF FILER (LAST) (FIRST) (MIDDLE) Rom JAMIF 1. Office, Agency, or Court Agency Name (Do not use acronyms) C1 7t/ OF 004RD �A' Division, Board, Department, District, if applicable Your Position G 11 TY aIJOL rVldY(P ► If filing for multiple positions, list below or on an attachment. (Do not use acronyms) Agency 2. Jurisdiction of Office (Check at least one box) ❑ State ❑ Multi- County -91 City of J►'6t7e.ko SAY 3. Type of Statement (Check at least one box) ❑ Annual: The period covered is January 1, 2015, through December 31, 2015. .or- The period covered is December 31, 2015. ❑ Assuming Office: Date assumed Position: ❑ Judge or Court Commissioner (Statewide Jurisdiction) ❑ County of ❑ Other ❑ Leaving Office: Date Left I (Check one) through O The period covered is January 1, 2015, through the date of -or- leaving office. O The period covered is l I through the date of leaving office. [C] Candidate: Election year 2o1 and office sought, if different than Part 1: 4. Schedule Summary (must complete) ► Total number of pages including this cover page: Schedules attached .& Schedule A -1 - Investments — schedule attached ❑ Schedule A -2 - Investments — schedule attached g Schedule B - Real Property — schedule attached .or- El None - No reportable interests on any schedule 5. Verification MAILING ADDRESS STREET CITY (Business or Agency Address Recommended - Public Document) Schedule C - Income, Loans, & Business Positions — schedule attached Schedule D - Income — Gifts — schedule attached ❑ Schedule E - Income — Gifts — Travel Payments — schedule attached STATE ZIP CODE DAYTIME E -MAIL ADDRESS ( 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. certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date Signed �`i b Signature (month, day, year) (File the originally signed statement with your filing ofriciaL) FPPC Form 700 (2015/2016) 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 'i�t:A kRrx,V- Eomi i j GENERAL DESCRIPTION OF THIS BUSINESS t'GA AQVIl9,'ic-,17 I j4j 7012 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. O Income Received of $500 or More (Report on Schedule C) IF APPLICABLE, LIST DATE: / 15 1 / 15 ACQUIRED DISPOSED ► NAME OF BUSINESS ENTITY GENERAL DESCRIPTION OF THIS BUSINESS A av KEl AMY 2f 2ol2 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 O Income Received of $500 or More (Report on Schedule C) IF APPLICABLE, LIST DATE: / / 15 _ J / 15 ACQUIRED DISPOSED ► NAME OF BUSINESS ENTITY Lo 92 4Z5J- T vAUvt F GENERAL DESCRIPTION OF THIS BUSINESS �J A AaIA tPF-0 MAY 21 2012 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 O Income Received of $500 or More (Report on Schedule C) IF APPLICABLE, LIST DATE: I /, 15 —J— 1 15 ACQUIRED DISPOSED Comments: Name I �tIE `RUNS ► NAME OF BUSINESS ENTITY MK61A2e INTL Pt4PP GENERAL DESCRIPTION OF THIS BUSINESS SAW AQvttREP WAY D! 2012 - 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 O Income Received of $500 or More (Report on Schedule C) IF APPLICABLE, LIST DATE: / 15 _�� 15 ACQUIRED DISPOSED ► NAME OF BUSINESS ENTITY FIOW F42, f 16MIEF -2 GENERAL DESCRIPTION OF THIS BUSINESS Wfi 4QI4I9FV 94& 21 2D12- 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 O Income Received of $500 or More (Report on Schedule C) IF APPLICABLE, LIST DATE: I / 15 _�� 15 ACQUIRED DISPOSED ► NAME OF BUSINESS ENTITY ?RINCIPLF FD5I/vc/' E -/ GENERAL DESCRIPTION OF THIS BUSINESS N% A&. &i ► je -2-- D 0AY 21 2-o t 2 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 O Income Received of $500 or More (Report on Schedule C) IF APPLICABLE, LIST DATE: —/15 15 ACQUIRED DISPOSED FPPC Form 700 (2015/2016) Sch. A -1 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 _5j�1/U 6441-T4 L GENERAL DESCRIPTION OF THIS BUSINESS ►J/R AQvt IREP VWANI 2-1 2612 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: /_J 15 J_l 15 ACQUIRED DISPOSED ► NAME OF BUSINESS ENTITY yt JZ70� PIiAL GENERAL DESCRIPTION OF THIS BUSINESS t4 igawf ap rdv 21 2D12 FAIR MARKET VALUE ❑ $2,000 $10,000 $io,001 - $100,000 ❑ $100,001 - $1,000xo 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: — /'15 1 /.15 ACQUIRED DISPOSED ► NAME OF BUSINESS ENTITY VoyA 62L.o3 ,4L 'nEi4L E5747E GENERAL DESCRIPTION OF THIS BUSINESS N14 4 Lo2 1A 1 R F P MAY Zl 2012 FAIR MARKET VALUE ❑ $2,000 - $10,000 fA $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: —l. 15 �, 15 ACQUIRED DISPOSED Comments: Name A-Mte lKoN5 ► NAME OF BUSINESS ENTITY '3,,a cK 2n cK �T)ZA i u l c GENERAL DESCRIPTION OF THIS BUSINESS 1414 A142(412ER -10N 2013 FAIR MARKET VALUE ❑ $2,000 - $10,000 $10,001 - $100,000- El $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: l / 15 ACQUIRED DISPOSED ► NAME OF BUSINESS ENTITY gARTTo,2D FMEC6]A/ GENERAL DESCRIPTION OF THIS BUSINESS NlA I&Nf2Fi7 YW,4/ 2l 2Dl2 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: // 15 15 ACQUIRED DISPOSED ► NAME OF BUSINESS ENTITY 25 r LO Ali,$1 C, GENERAL DESCRIPTION OF THIS BUSINESS Al 1t4 AQ N l i2£;) 11YAY :21 2012 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: 1 1. 15 _ /_J 15 ACQUIRED DISPOSED FPPC Form 700 (2015/2016) Sch. A -1 FPPC Advice Email: advice @fppc.ca.gov FPPC Toll -Free Helpline: 8661275 -3772 www.fppc.ca.gov SCHEDULE B Interests in Real Property (Including Rental Income) ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS ( CITY , /nj _- t!V �D Quo T2AY CA IM47, FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 ❑ $10,001 - $10o,000 $100,001 - $1,000,000 ACQUIRED DISPOSED ❑ Over $1,000,000 NATURE OF INTEREST © Ownership /Deed of Trust ❑ Easement ❑ Leasehold ❑ Yrs. remaining 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 �A'�►I!� I �o�s Name II JA 441E LK12 0-5 ► ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS , CITY � V0049, '64,/ 1.4, 8344 Z FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 ❑ $10,001 - $100,0oo /.15 ® $100,001 - $1,000,000 ACQUIRED DISPOSED ❑ Over $1,000,000 NATURE OF INTEREST ® Ownership /Deed of Trust ❑ Easement ❑ Leasehold ❑ Yrs. remaining Other IF RENTAL PROPERTY, GROSS INCOME RECEIVED ❑ $0 - $499 ❑ $500 - $1,000 ❑ $1,001 - $10,000 R) $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 C 86) G Qt , 4 Ju L(F 14E42 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` rE js F,4&o _K4nyr ADDRESS (Business Address Acceptable) ?o fox 441j ;,rs lylor",s 14.5o3o6 BUSINESS ACTIVITY, IF ANY, OF LENDER INTEREST RATE TERM (Months/Years) - ';'7L0/6 ❑ None 3�6 HIGHEST BALANCE DURING REPORTING PERIOD ❑ $5o0 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 OVER $100,000 ❑ Guarantor, if applicable Comments: NAME OF LENDER` V19U-5 �#V ,o SAyr ADDRESS (Business Address Acceptable), n �D _i;bX 14411 N `D[ rf FS 1A, 5o3oc. BUSINESS ACTIVITY, IF ANY, OF LENDER INTEREST RATE TERM (Months/Years) 4 % ❑ None 30 HIGHEST BALANCE DURING REPORTING PERIOD ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 OVER $100,000 ❑ Guarantor, if applicable FPPC Form 700 (2015/2016) Sch. B FPPC Advice Email: advice @fppc.ca.gov FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov SCHEDULE B Interests in Real Property (Including Rental Income) ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS CITY irV QP_A;> -6A,1 C4 N42 FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 ❑ $10,001 - $1oo,000 $100,001 - $1,000,000 ACQUIRED DISPOSED ❑ Over $1,000,000 NATURE OF INTEREST R Ownership /Deed of Trust ❑ Easement ❑ Leasehold ❑ Yrs. remaining 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 Name JA MJE [KodS ► ASSESSOR'S PARCEL NUMBER OR STREETADDRESS CITY Add, ?RY (4. 2Y4k FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 ❑ $10,001 - $100,000 15 __J___J 15 ® $100,001 - $1,000,000 ACQUIRED DISPOSED ❑ Over $1,000,000 NATURE OF INTEREST r] Ownership /Deed of Trust ❑ Easement ❑ Leasehold ❑ Yrs. remaining 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 A6tutt2=r7 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 andt loans received not in a lender's regular course of business must be disclosed as follows: NAME OF LENDER' - �Alg L bb , Eiiy'o -74r/K ADDRESS (Business Address Acceptable) ?b Ax Ail . Tts Mow In BUSINESS ACTIVITY, IF ANY, OF LENDER F6 3 0(p INTEREST RATE TERM (Months/Years) 4 % ❑ None � 6 HIGHEST BALANCE DURING REPORTING PERIOD ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 OVER $100,000 ❑ Guarantor, if applicable Comments: NAME OF /LENDER* r W b I.(.5 f' QC� ll AhIIC ADDRESS (Business Address Acceptable) �0 6M 14411 r7.- -s Yvlalt)FT /A 5-0304 BUSINESS ACTIVITY, IF ANY, OF LENDER INTEREST RATE TERM (Months/Years) 7`� 2 3.75 % ❑ None ga HIGHEST BALANCE DURING REPORTING PERIOD ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 OVER $100,000 ❑ Guarantor, if applicable FPPC Form 700 (2015/2016) Sch. B FPPC Advice Email: advice @fppc.ca.gov FPPC Toll -Free Helpline: 866 /275 -3772 www.fppc.ca.gov SCHEDULE B Interests in Real Property (Including Rental Income) ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS D6, o t) c) 7 CITY Ms QP_h !f2,4y FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 ❑ $10,001 - $100,000 __j 15 � __j__j 15 ® $100,001 - $1,000,0o0 ACQUIRED DISPOSED ❑ Over $1,000,000 NATURE OF INTEREST Ownership /Deed of Trust ❑ Easement ❑ Leasehold ❑ Yrs. remaining - 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 ACALAtgii,J 6-26 -13 Name J4d4iF- 19D OS ► ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS CITY FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 ❑ $10,001 - $100,000 115 _/ /15 ❑ $100,001 - $1,000,000 ACQUIRED DISPOSED ❑ Over $1,000,000 NATURE OF INTEREST ❑ Ownership /Deed of Trust ❑ Easement ❑ Leasehold ❑ Yrs. remaining Other IF RENTAL PROPERTY, GROSS INCOME RECEIVED .0$0-$499 ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $1oo,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 * 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* ADDRESS (Business Address Acceptable) 1222 �i n►e- y '12045o f1o3Li 5 6A . 13446 BUSINESS ACTIVITY, IF ANY, OF LENDER INTEREST RATE % ❑ None TERM (Months/Years) HIGHEST BALANCE DURING REPORTING PERIOD ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 FZ OVER $100,000 ❑ Guarantor, if applicable Comments: NAME OF LENDER" ADDRESS (Business Address Acceptable) 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 FPPC Form 700 (2015/2016) 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 MF NAPA CNTZW FIB 15F-5 r_LC ADDRESS (Business Address Acceptable) 11 wo $DAY G4 BUSINESS ACTIVITY, IF ANY, OF SOURCE 4344 2 (MF}NA(,1,j4 70 -DIFA 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.) WLoan repayment ❑ Commission or ❑ Rental Income, list each source of $10,000 or more (Describe) Name J464 ) E NAME OF SOURCE OF INCOME ADDRESS (Business Address Acceptable) 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 of $10,000 or more (Describe) Other Other ❑ ❑ (Describe) (Describe) 10- 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 (MonthsiYears) % ❑ None SECURITY FOR LOAN ❑ None ❑ Personal residence ❑ Real Property ❑ Guarantor ❑ Other Street address city (Describe) FPPC Form 700 (2015/2016) Sch. C FPPC Advice Email: advice @fppc.ca.gov FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov SCHEDULE D Income — Gifts ► NAME OF SOURCE (Not an Acronym) C AAof�n/F_ 60tALOM0 ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF SOURCE �I��loM rPicjttgi_7 yrRAmi�j(7 DATE (mm /dd /yy) VALUE DESCRIPTION OF GIFT(S) $ 170. - �r�flwtF� C�IPP!►�C, ► NAME OF SOURCE (Not an Acronym) ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY OF SOURCE DATE (mm /dd /yy) VALUE DESCRIPTION OF GIFT(S) ► NAME OF SOURCE (Not an Acronym) ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY OF SOURCE DATE (mm /dd /yy) VALUE DESCRIPTION OF GIFT(S) Comments: Name ► NAME OF SOURCE (Not an Acronym) ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF SOURCE DATE (mm /dd /yy) VALUE DESCRIPTION OF GIFT(S) ► NAME OF SOURCE (Not an Acronym) ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF SOURCE DATE (mm /dd /yy) VALUE DESCRIPTION OF GIFT(S) 0-. NAME OF SOURCE (Not an Acronym) ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF SOURCE DATE (mm /dd /yy) VALUE DESCRIPTION OF GIFT(S) FPPC Form 700 (2015/2016) Sch. D FPPC Advice Email: advice @fppc.ca.gov FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov