SCHEDULE E.

Income - Gifts Travel Payments, Advances, and Reimbursements

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

Na mt CLL.

You must 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. 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 ) k(4e;1. .4C- 41 ett. ADDRESS (Business Address AcceptaWe)

2
(

11. NAME OF ADOR.

(

URGE (Not an

_cronym)
4a SI .4
4

Business ddress Acceptable)

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

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

c7 (b OATEISI: _ (if gift)

r i

AMTS

I
p Income

DAT E(51: _t_i

1 ,1 - ,r2.- ____t____, 7, (5,- i'l-(if gill)

1361

S-247
Income

TYPE OF PAYMENT (rnu51 check one) Erg;II

--13 Made a Speech/Parllclpaled in a Panel

TYPE OF PAYMENT. (must check one)

ErMade a Speech/Parlicipaled In a Panel p Other - Provide Oescrlplion

p Olher

ovlde Description 1-4#S41/4--N:CrOtAi tl--1 1 0 )'&41./.

V
ll

-.4./ 1..1 N

qe-,
L /

()A-4/1,-- 6,6,.........:
hi 't O.

......*

V
(

getir.:0111.

11. NAME OF SOURCE (Not en Acron )

1.- NAME OF SOURCE ADDRESS

(

L6I frl \ AOORr i'Business Address Acceptable)

Not en Acronym)

Business Address Acceptable)

CITY ANO STATE BUSINESS ACTIVITY. IF ANY, OF SOURCE p 501 1c1131

CITY AND STATE BUSINESS ACTIVITY, IF ANY. OF SOURCE p 501 (c1(31

CATE'S'.

1 ./.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