SCHEDULE E.

Income - Gifts Travel Payments, Advances, and Reimbursements

You must mark either the gift or income box.

ell Ark CALIFORNIA FORM FAIR r-tnrig:AL PRACTICES crialsmSatoN

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. These payments are not subject to the $440 gift limit, but may result in a disqualifying conflict of interest.
11. NAME OF SOURCE

Not an Acronym)

11. NAME OF ADOR.

(

ADDRESS (Cfu , , iness A d ess A e CITY ANO STATE

~p 1 FT

c p

4c

URGE (Not an

_cronym)
4a SI ~4 4

taWe)

Business ddress Acceptable)

CITY ANO STATE p 501 (c1131 BUSINESS ACTIVITY, IF ANY, OF SOURCE 501 (c1131

BUSINESS ACTIVITY, IF ANY. OF SOURCE

r

OATEISI:

c7 (~

gift)

AMTS

1 ,1 - ,r2. 7, (5 , i'l-DAT E(51: _t_i - ____t____, (if gi l)

TYPE OF PAYMENT. (must check one) 1361 ErMade a Speech/Parlicipaled In a Panel p Other - Provide Oescrlplion

~~~~~
Income

TYPE OF PAYMENT (rnu51 check one) Erg;II p Income 13 Made a Speech/Parllclpaled in a Panel p Olher ovlde Description 1- 4#S41/4--N:CrOtAi tl-----

0)'&41./1

V
ll

.4./ 1..1 N ~ V
.

--

qe-

, ()A-4/1,

-- 6 6,

getir.:0111.~

L /

hi 't O.

11. NAME OF SOURCE (Not en Acron )

AOORr i'Business Address Acceptable)

L6I frl
~

1.- NAME OF SOURCE (Not en Acronym) ADDRESS (Business Address Acceptable) CITY AND STATE p 501 1c1131 BUSINESS ACTIVITY, IF ANY. OF SOURCE p 501 (c1(31

CITY ANO STATE BUSINESS ACTIVITY. IF ANY, OF SOURCE

CATE'S'.

./.1/_._
fir

AMT. S 1

%-

1 .71:9

CAT E (SI : _______/ /.

(tf gin)

- ____/.___/_._ AMT. S p Gift Income

TYPE OF PAYMENT: (must check one)

p Gift p Income

TYPE OF PAYMENT: (mos' check one)

p Made a Speech/Participaled in a Panel K Olher - Provide Oescrlplion

p Made a SpeachiPartIcipaled in a Panel Olher - Provide Oescriplion

(-0 EA,
Comments

FPPC Form 7110 (2012120131 Sch. E FPPC Advice Email: advice0(ppc.ca,gov FPPC Toll-Free HelplIne- B661275-3772 www.(ppc.ca,gov