Fillable Form 700 201 2017 Form Only (California State University Channel Islands)

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Form 700 201 2017 Form Only (California State University Channel Islands)

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The Form 700 201 2017 Form Only (California State University Channel Islands) form is 1 page long and contains:

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  • 19 check-boxes
  • 35 other fields

Country of origin: US
File type: PDF

U.S.A. forms for California State University Channel Islands

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 Date Left / /
(Check one)
The period covered is January 1, 2016, through the date of
leaving ofce.
The period covered is / / , through
the date of leaving ofce.
 The period covered is January 1, 2016, through
December 31, 2016.
The period covered is / / , through
December 31, 2016.


FPPC Form 700 (2016/2017)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
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.


(month, day, year)
 (Check at least one box)
State
Judge or Court Commissioner (Statewide Jurisdiction)
Multi-County
County of
City of
Other
 (Check at least one box)
 Election year and ofce sought, if different than Part 1:
 Date assumed / /
DateInitial FilingReceived
Ofcial Use Only
Please type or print in ink.
700
FAIr POLITICAL PrACTICES COMMISSION
CALIFORNIA FORM
Agency Name (Do not use acronyms)
Division, Board, Department, District, if applicable Your Position

   
MAILING ADDRESS STREET CITY STATE ZIP CODE
( )
DAYTIME TELEPHONE NUMBER
E-MAIL ADDRESS
(Business or Agency Address Recommended - Public Document)

(File the originally signed statement with your ling ofcial.)

A PuBLIC DOCuMENT
► If ling for multiple positions, list below or on an attachment. (Do not use acronyms)
Agency:
Position:
-or-
-or-
None - No reportable interests on any schedule
 
Schedules attached
 Investments – schedule attached
 Investments – schedule attached
 Real Property – schedule attached
►
Total number of pages including this cover page:
-or-
 Income, Loans, & Business Positions – schedule attached
 Income – Gifts – schedule attached
 Income – Gifts – Travel Payments – schedule attached
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Form 700 201 2017 Form Only (California State University Channel Islands)

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Completed 20 July 2020

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