8/14/2019 UC Regent Ruiz - Financial Disclosure
1/9
'CALI~ORNIA FORM 700FAIR POLITICAL PRACTICES COMMISSION
NAME (FIRST) (MIDDLE)
S T AT E M E NT O F E C O N O M IC IN T E RE S TS
C O V E R P A G E
Please type or print in ink.- S f ; ; : i J . t = iiiihlic Document
(LAST)
RUIZ FREDERICK RIVADENEYRA ( 559 ) 591-5510
MAILING ADDRESS STREET(May use business address)
CITY OPTIONAL: FAX / E-MAIL ADDRESS
501 S. Alta Ave., Dinuba
1. Office, Agency, or Court
Name of Office, Agency, or Court:
Regents of the University of California
Division, Board, District, if applicable:
State Board
Your Position:
Board Member
~ If filing for multiple positions, list additional agency(ies)/
position(s): (Attach a separate sheet if necessary.)
Agency: California Partnership for San Joaquin Valley
Position: Board Member
2. Jurisdiction of Office (Check at least one box)
!Z I State
oCounty of _
o City of _
o MUlti-County _o Other _
3. Type of Statement (Check at least one box)
o Assuming Office/Initial Date: ---.1---.1 __
!Z I Annual: The period covered is January 1, 2008,
through December 31, 2008.
-or-O The period covered is ---.1---.1 __ ,through
December 31, 2008.
o Leaving Office Date Left: ---.1---.1 __(Check one)
a The period covered is January 1, 2008, through the
date of leaving office.
-or-
O The period covered is ---.1---.1__ ,throughthe date of leaving office.
o Candidate Election Year:
STATE ZIP CODE
Ca 93618 FAX(559) 591-6329
4. Schedule Surnmary
~ Total number of pages 8including this cover page: _
~ Check applicable schedules or "No reportable
interests."
I have disclosed interests on one or more of the
attached schedules:
Schedule A-1 !Z I Yes - schedule attached
Investments (Less than 10% Ownership)
Schedule A-2 !Z I Yes - schedule attached
Investments (10%or greater Ownership)
Schedule B !Z I Yes - schedule attached
Real Property
Schedule C !Z I Yes - schedule attached
Income, Loans, & Business Positions (Income Other than Giftsand Travel Payments)
Schedule D !Z I Yes - schedule attached
Income - Gifts
Schedule E 0Yes - schedule attached
Income - Gifts - Travel Payments
-or-
o No reportable interests on any schedule
5.Verification
I haye 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 March 27, 2009(month, day, year)
~~(J \/\),~ Signature ~ ' \,--= - "e~
(File the originally signed statement with your filing official.)
FPPC Form 700 (2008/2009)
FPPC TolIFree Helpline: 866/ASK-FPPC www.fppc.ca.gov
http://www.fppc.ca.gov/http://www.fppc.ca.gov/8/14/2019 UC Regent Ruiz - Financial Disclosure
2/9
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
Wells Fargo
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
Financial Services
FAIR MARKET VALUE
o $2,000 - $10,000o $100,001 - $1,000,000
1 9 j $10,001 - $100,000DOver $1,000,000
NATURE OF INVESTMENT
~ Stock
o Other _(Describe)
IF APPLICABLE, LIST DATE:
__ L_......J...QlL
DISPOSED
~ NAME OF BUSINESS ENTITY
General Electric
NAME OF BUSINESS ENTITY
Agilent Technologies, Inc.
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
Hardware
FAIR MARKET VALUE
o $2.000 - $10,000o $100,001 - $1,000,000
~ $10,001 - $100,000
DOver $1.000,000
NATURE OF INVESTMENT
~ Stock
o Other _(Describe)
IF APPLICABLE, LIST DATE:
---.J~...QlLACQUIRED
---.J---.J...QlLDISPOSED
(
CALIFORNIA FORM 700FAIR POLITICAL PRACTICES COMMISSION
Name
Frederick R. Ruiz
~ NAME OF BUSINESS ENTITY
Verigy
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
Hardware
FAIR MARKET VALUE
~ $2,000 - $10,000
0$100,001 - $1,000,000
o $10,001 - $100.000DOver $1,000,000
NATURE OF INVESTMENT
1 9 j Stock
o Other ---- ---'-- _(Describe)
IF APPLICABLE, LIST DATE:
---.J~...QlLACQUIRED
~---.J...QlLDISPOSED
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
Industrial Materials
FAIR MARKET VALUE
o $2,000 - $10,000o $100,001 - $1,000,000
~ $10,001 - $100,000
DOver $1,000,000
NATURE OF INVESTMENT
I Z I Stock
o Other _(Describe)
IF APPLICABLE, LIST DATE:
---.J----'...QlLACQUIRED
----' ----,...QlLDISPOSED
NAME OF BUSINESS ENTITY
McClatchy Co.
~ NAME OF BUSINESS ENTITY
PG&E
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
MediaFAIR MARKET VALUE
I Z I $2,000 - $10,000
o $100,001 - $1,000,000o $10,001 - $100,00.0DOver $1,000,000
NATURE OF INVESTMENT
I Z I Stock
o Other (Describe)IF APPLICABLE, LIST DATE:
---.J~...QlLACQUIRED
----' ----'...QlLDISPOSED
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
UtilitiesFAI. MARKET VALUE
o $2,000 - $10,000o $100,001 - $1,000,000
I8 l $10,001 - $100,000DOver $1,000,000
(DeSCribe)
IF APPLICABLE, LIST DATE:
---.J---.J...QlLACQUIRED
----' ---.J...QlLDISPOSED
mments: ~-----------------
FPPC Form 700 (2008/2009) Sch. A-1
FPPC Toll-Free Helpline: 866/ASK-FPPC www.fppc.ca.gov
http://www.fppc.ca.gov/http://www.fppc.ca.gov/8/14/2019 UC Regent Ruiz - Financial Disclosure
3/9
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
Gottschalks, Inc.
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
Consumer Services
FAIR MARKET VALUE
I Z I $2,000 - $10,000o $100,001 - $1.000,000
o $10,001 - $100,000DOver $1,000,000
NATURE OF INVESTMENT
I Z I Stock
o Other _(Descnbe)
IF APPLICABLE, LIST DATE:
--1--1~
DISPOSED
~ NAME OF BUSINESS ENTITY
Blast Energy Services, Inc.
~ NAME OF BUSINESS ENTITY
Costco
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
Consumer Services
FAIR MARKET VALUE
o $2,000 - $10,000o $100,001 - $1,000,000
~ $10,001 - $100,000
DOver $1,000,000
NATURE OF INVESTMENT
Ig] Stock
o Other _(Describe)
IF APPLICABLE, LIST DATE:
--1--1~
ACQUIRED--1--1~
DISPOSED
~ NAME OF BUSINESS ENTITY
Sierra Bancorp
NAME OF BUSINESS ENTITY
Geopetro Resources Co.
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
Energy
FAIR MARKET VALUE
~ $2,000 - $10,000
o $100,001 - $1,000,000o $10.001 - $100,000DOver $1,000,000
NATURE OF INVESTMENT
Ig] Stock
o Other -- --;;= = :-:::::;-- _(Describe)
IF APPLICABLE, LIST DATE:
--1--1~
ACQUIRED--1--1~
DISPOSED
CALIFORNIA FORM 700FAIR POLITICAL PRACTICES COMMISSION
Name
Frederick R. Ruiz
~ NAME OF BUSINESS ENTITY
Capital Corp. of the West
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
Financial Services
FAIR MARKET VALUE
o $2,000 - $10,000o $100,001 - $1,000,000
I Z I $10,001 - $100,000
DOver $1,000,000
NATURE OF INVESTMENT
Ig] Stock
o Other _(Describe)
IF APPLICABLE, LIST DATE:
--1--1~
ACQUIRED
---.l--1~
DISPOSED
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
Energy
FAIR MARKET VALUE
o $2,000 - $10,0000$100,001 - $1,000,000
I Z I $10,001 - $100,000DOver $1,000,000
NATURE OF INVESTMENT
~ Stock
o Other - _(Describe)
IF APPLICABLE, LIST DATE:
--1--1~
ACQUIRED---.l--1~
DISPOSED
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
Financial Services
FAI&ty1ARKET VALUE
o $2,000 - $10,0000$100,001 - $1,000,000
I Z I $10,001 - $100.000
DOver $1,000,000
NATURE OF INVESTMENT
[8 J Stock
o Other -- --:- _(Describe)
IF APPLICABLE, LIST DATE:
--1--1~
ACQUIRED--1--1~
DISPOSED
mments: _
FPPC Form 700 (2008/2009) Sch. A-1FPPC Toll-Free Helpline: 866/ASK-FPPC www.fppc.ca.gov
http://www.fppc.ca.gov/http://www.fppc.ca.gov/8/14/2019 UC Regent Ruiz - Financial Disclosure
4/9
SCHEDULE A-1
Investments
Stocks, Bonds, and Other Interests(Ownership Interest is Less Than 10%)
Do not attach brokerage or financial statements.
AME OF BUSINESS ENTITY
Gottschalks, Inc.GENERAL DESCRIPTION OF BUSINESS ACTIVITY
Consumer Services
FAIR MARKET VALUE
gj $2,000 - $10,000
0$100,001 - $1,000,000
o $10,001 - $100,000DOver $1,000,000
NATURE OF INVESTMENT
gj Stock
o Other ------------------(Describe)
IF APPLICABLE, LIST DATE:
~~~ACQUIRED
~~~DISPOSED
~~~DISPOSED
NAME OF BUSINESS ENTITY
CostcoGENERAL DESCRIPTION OF BUSINESS ACTIVITY
Consumer Services
FAIR MARKET VALUE
o $2,000 - $10,0000$100,001 - $1,000,000
~ $10,001 - $100,000
DOver $1,000,000
NATURE OF INVESTMENT
~ Stock
o Other -----------------(DeScribe)
IF APPLICABLE, LIST DATE:
~~~ACQUIRED
~~~DISPOSED
NAME OF BUSINESS ENTITY
Geopetro Resources Co.GENERAL DESCRIPTION OF BUSINESS ACTIVITY
EnergyFAIR MARKET VALUE
[gj $2,000 - $10,000
o $100,001 - $1,000,000o $10,001 - $100,000DOver $1,000,000
NATURE OF INVESTMENT
[8 ] Stock
o Other-------~:::-=;::;------(Describe)
IF APPLICABLE, LIST DATE:
~~~ACQUIRED
~~~DISPOSED
CALIFORNIA FORM 700FAIR POUTlCAL PRACTICES COMMISSION
Name
Financial Services
Frederick R. Ruiz
.. NAME OF BUSINESS ENTITY
Capital Corp. of the West
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
FAIR MARKET VALUE
o $2,000 - $10,0000$100,001 - $1,000,000
NATURE OF INVESTMENT
~ Stock
[gj $10,001 - $100,000
DOver $1,000,000
o Other
IF APPLICABLE, LIST DATE:
~~~ACQUIRED
(Describe)
Energy
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
FAIR MARKET VALUE
o $2,000 - $10,000o $100,001 - $1,000,000
1 8 ! $10,001 - $100,000
DOver $1,000,000
NATURE OF INVESTMENT
[gj Stock
o Other ___
IF APPLICABLE, LIST DATE:
~~~ACQUIRED
(Describe)
--1--1~DISPOSED
Financial Services
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
FAIR MARKET VALUE
o $2,000 - $10,000o $100,001 - $1,000,000
\8 l $10,001 - $100,000
DOver $1,000,000
NATURE OF INVESTMENT
1 8 ! Stock
o Other ------------------(Describe)
IF APPLICABLE, LIST DATE:
~--1~ACQUIRED
~~~DISPOSED
C o m m e n t s : - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
.. NAME OF BUSINESS ENTITY
Blast Energy Services, Inc.
.. NAME OF BUSINESS ENTITY
Sierra Bancorp
FPPC Form 700 (2008/2009) Sch. A-1
FPPC Toll-Free Helpline: 866/ASK-FPPC www.fppc.ca.gov
http://www.fppc.ca.gov/http://www.fppc.ca.gov/8/14/2019 UC Regent Ruiz - Financial Disclosure
5/9
SCHEDULE A-2
Investments, Income, and Assets
of Business Entities/Trusts(Ownership Interest is 10% or Greater)
~ 1. BUSINESS ENTITY OR TRUST
Ruiz Foods
Name
501 S. Alta Ave., Dinuba, Ca 93618
Address
Check one
D Trust, go to 2 [8] Business Entity, complete the box, then go to2
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
IF APPLICABLE, LIST DATE:FAIR MARKET VALUE
o $2,000 - $10,000o $10,001 - $100,0000$100,001 - $1,000,000
[X l Over $1,000,000
----1----1 08
ACQUIRED
----1----1 08
DISPOSED
I NATURE OF INVESTMENT
10Sale Proprietorship 0Partnership
IYOUR BUSINESS POSITION _
[X l CorpOther
CALIFORNIA FORM 700FAIR POLITICAL PRACTICES COMMISSION
Name
Frederick R. Ruiz
Ruiz Generation3, LLC
~ 1. BUSINESS'ENTITY OR TRUST
Name
501 S. Alta Ave., Dinuba, Ca 93618
Address
Check one
D Trust, go to 2 [8] Business Entity, complete the box, then go to "
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
FAIR MARKET VALUE
o $2,000 - $10,000o $10,001 - $100,000o $100,001 - $1,000,000[X l Over $1,000,000
IF APPLICABLE, LIST DATE:
----1----1 08
DISPOSED
NATURE OF INVESTMENT
o Sole Proprietorship 0Partnership
0$0 - $499
0 $50 0 - $1 ,0 00
o $1,001 $10,000
0-----Other
YOUR BUSINESS POSITION ---------------
0$0 - $499
D$500 - $1,000o $1,001 - $10,000
o $10,001 - $100,000[X l OVER $100,000
~ 3. LIST THE NAME OF EACH REPORTABLE SINGLE SOURCE OF
INCOME OF $10,000 OR MORE (attach a separate sheet ,r necessary)
Ruiz Foods
~ 4. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD BY THE
BUSINESS ENTITY OR TRUST
Check one box;
o INVESTMENT ~ REAL PROPERTY
Name of Business Entity ill
Street Address or Assessor's Parcel Number of Real Property
Description of Business Activity ill
City or Other Precise Location of Real Property
FAIR MARKET VALUE
D$2,000 - $10,000o $10,001 - $100,0000$100,001 - $1,000,000
[X l Over $1,000,000
IF APPLICABLE, LIST DATE:
----1----1.1& ----1~~
ACQUIRED DISPOSED
NATURE OF INTEREST
o Property Ownership/Deed of Trust o Stock o Partnership
~ LeasehOld o Other ----------Yrs. remaining
o Check box if additional schedules reporting investments or real propertyare attached
D$10,001 - $100,000~ OVER $100,000
~ 3. LIST THE NAME OF EACH REPORTABLE SINGLE SOURCE OF
INCOME OF $10,000 OR MORE (attach a separate shoo"r necessary)
Ruiz Foods
~ 4. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD BY THE
BUSINESS ENTITY OR TRUST
Check one box;
~ INVESTMENT
Ruiz Food Products Stock
D REAL PROPERTY
Name of Business Entity ill
Street Address or Assessor's Parcel Number of Real Property
Description of Business Activity illCity or Other Precise Location of Real Property
FAIR MARKET VALUE
o $2,000 - $10,000o $10,001 - $100,0000$100,001 - $1,000,000
[X I Over $1,000,000
IF APPLICABLE, LIST DATE:
----1----1~ ----1----1 ~ACQUIRED DISPOSED
NATURE OF INTEREST
o Property Ownership/Deed of Trust
DLeaseholdYrs. remaining
o Check box if additional schedules reporting investments or real propertyare attached
o Stock DPartnership
o Other ----------
Comments: FPPC Form 700 (2008/2009) Sch. A-2
FPPC Toll-Free Helpline: 866/ASK-FPPC www.fppc.ca.gov
http://www.fppc.ca.gov/http://www.fppc.ca.gov/8/14/2019 UC Regent Ruiz - Financial Disclosure
6/9
8/14/2019 UC Regent Ruiz - Financial Disclosure
7/9
SCHEDULE C
Income, Loans, & Business
Positions(Other than Gifts and Travel Payments)
CALIFORNIA FORM 700FAIR POLITICAL PRACTICES COMMISSION
Name
Frederick R. Ruiz
NAME OF SOURCE OF INCOME
.. 1. INCOME RECEIVED .. 1. INCOME RECEIVED
NAME OF SOURCE OF INCOME
RG3
ADDRESS
501 S. Alta Ave., Dinuba, Ca 93618
BUSINESS ACTIVITY, IF ANY, OF SOURCE
Food Distribution
YOUR BUSINESS POSITION
Managing Member
GROSS INCOME RECEIVED
0$500 - $1,000 0 $1,001 - $10,000
o $10,001 - $100,000 IZ l OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
o Salary 0Spouse's or registered domestic partner's incomeo Loan repaymento Sale of ---- _
(Property car. boat, etc.)
o Commission or 0Rental Income, lise each source of 510,000 or more
1 8 1 Other Tax Reimbursement(Describe)
Gottschalks
ADDRESS
7 River Park Place, Fresno, Ca 93720
BUSINESS ACTIVITY, IF ANY, OF SOURCE
Consumer Services
YOUR BUSINESS POSITION
Board Member
GROSS INCOME RECEIVED
0$500 - $1,000 0$1,001 - $10,000
1 8 1 $10,001 - $100,000 0 OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
o Salary 0Spouse's or registered domestic partner's incomeo Loan repayment
o Sale of -------:-----------(Property car, boat, etc.)
o Commission or 0Rental Income, lise each source of $70,000 or more
~ Other Board Fees(Describe)
.. 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 partof 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'
Bank of America
ADDRESS
Jacksonville, FloridaBUSINESS ACTIVITY, IF ANY, OF LENDER
HIGHEST BALANCE DURING REPORTING PERIOD
o $500 - $1,000o $1,001 - $10,000o $10,001 - $100,000~ OVER $100,000
Comments:
INTEREST RATE TERM (MonthslYears)
4.710 360 monthso None%
SECURITY FOR LOANo J;!one ~ Personal residence
o Real Property Sereet address
City
o Guarnntor __
o Other (Describe)
FPPC Form 700 (2008/2009) Sch. C
FPPC TolIFree Helpline: 866/ASKFPPC www.fppc.ca.gov
http://www.fppc.ca.gov/http://www.fppc.ca.gov/8/14/2019 UC Regent Ruiz - Financial Disclosure
8/9
SCHEDULE C
Income, Loans, & Business
Positions(Other than Gifts and Travel Payments)
CALIFORNIA FORM 700FAIR POLITICAL PRACTICES COMMISSION
Name
Frederick R. Ruiz
NAME OF SOURCE OF INCOMENAME OF SOURCE OF INCOME
McClatchy
ADDRESS
P. O. Box 15779, Sacramento, Ca 95852
BUSINESS ACTIVITY, IF ANY, OF SOURCE
Media
YOUR BUSINESS POSITION
Board Member
GROSS INCOME RECEIVED
0$500 - $1,000 0 $1,001 - $10,000
~ $10,001 - $100,000 DOVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
o SalalY 0Spouse's or registered domestic partner's income
o Loan repayment
o Sale of -----------------(Property, car, boat, etc.)
o Commission or D Rental Income, list each source of $70,000 or more
~ Other Board Fees
(Describe)
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOUR BUSINESS POSITION
GROSS INCOME RECEIVED
0$500 - $1,000 0 $1,001 - $10,000
D $10,001 - $100,000 0 OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
D SalalY D Spouse's or registered domestic partner's income
D Loan repayment
D Sale of (Property, car, boat. etc.)
D Commission or 0Rental Income, list each source of $10.000 or more
o Other (Describe)
~ 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 palof 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 d isclosed as follows:
NAME OF LENDER*
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF LENDER
HIGHEST BALANCE DURING REPORTING PERIOD
0$500 - $1,000
0$1,001 - $10,000
o $10,001 - $100,000DOVER $100,000
Comments:
INTEREST RATE TERM (Months/Years)
____ % o None
SECURITY FOR LOAN
D&/one D Personal residence
D Real Property Street address
City
D Guarantor __
D Other (Describe)
FPPC Form 700 (2008/2009) Sch. C
FPPC Toll-Free Helpline: 8661f\SK-FPPC www.fppc.ca.gov
http://www.fppc.ca.gov/http://www.fppc.ca.gov/8/14/2019 UC Regent Ruiz - Financial Disclosure
9/9
CALIFORNIA FORM 700FAIR POLITICAL PRACTICES COMMISSION
SCHEDULE D
Income - Gifts
DATE (mmlddlyy) VALUE DESCRIPTION OF GIFT(S)DATE (mmlddlyy) VALUE DESCRIPTION OF GIFT(S)
---1---1_ $ ---1---1_ $
---1---1_ $ ---1---1_ $
---1~_ $ ---1---1_ $
~ NAME OF SOURCE~ NAME OF SOURCE
ADDRESS ADDRESS
~ NAME OF SOURCE
California Partnership for the San Joaquin Valley
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOURCE
Board Meeting Dinner
DATE (mmlddlyy) VALUE DESCRIPTION OF GIFT(S)
J 3 .J J .!. J 08 $ 13,00 wine & oil
---1---1_ $,----
---1---1_ $,----
~ NAME OF SOURCE
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOURCE
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mmlddlyy) VALUE DESCRIPTION OF GIFT(S)
---1---1_ $,----
---1---1_ $ , _
---1---1_ $ _
Name
Frederick R. Ruiz
~ NAME OF SOURCE
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mmlddlyy) VALUE DESCRIPTION OF GIFT(S)
---1---1- $,----
---1---1_ $,----
---1---1_ $,----
~ NAME OF SOURCE
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOURCE
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DA1E.(mmlddlyy) VALUE DESCRIPTION OF GIFT(S)
---1---1_ $,----
---1---1_ $----
Comments: __
FPPC Form 700 (2008/2009) Sch. D
FPPC Toll-Free Helpline: 866/ASK-FPPC www.fppc.ca.gov
http://www.fppc.ca.gov/http://www.fppc.ca.gov/