Free Contribution Disclosure for Participant - California


File Size: 61.3 kB
Pages: 1
Date: November 16, 2007
File Format: PDF
State: California
Category: Tax Forms
Word Count: 368 Words, 2,179 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.boe.ca.gov/pdf/boe1400b.pdf

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BOE-1400-B REV. 14 (1-03)

STATE OF CALIFORNIA

CONTRIBUTION DISCLOSURE FOR PARTICIPANT (Witnesses, Etc.)

BOARD OF EQUALIZATION
FOR OFFICE USE ONLY (DISCLOSURE ID)

Government Code Section 15626(e) requires that a party to, or a participant in, an adjudicatory proceeding pending before the Board shall disclose on the record of the proceeding any contribution or contributions made within the preceding 12 months by the party or participant, or his or her agent, to any Member of the Board. The Members of the State Board of Equalization are Betty T. Yee, Bill Leonard, Michelle Steel, Judy Chu, Ph.D. and State Controller John Chiang.
CASE ID FOR OFFICE USE ONLY (CLIENT ID)

NAME OF PARTICIPANT

ADDRESS (city, state, zip code)

YES

NO

1a. Do you have a financial interest in this matter? 1b. Have you lobbied a Member or his or her deputy, or an employee of the Board, on this matter; or have you testified, or do you plan to testify before the Board on this matter; or have you acted to influence the Board's decision in this matter? If you answered YES to both, 1a & 1b, go to item 2; if NO skip to item 8. 2. List all "doing business as" or other corporate names used during the previous 12 months: 3. Have you made any contribution(s) to any State Board of Equalization Member in the past 12 months? If YES, please complete information about the contribution(s) at the bottom of this form. 4. Is the participant a corporation? If YES, go to item 5; if NO skip to item 8. 5. Is the corporation a close corporation? If YES, go to item 6; if NO skip to item 8. 6.
MAJORITY SHAREHOLDER NAME FOR OFFICE USE ONLY (CLIENT ID)

ADDRESS (city, state, zip code)

7. Has the majority shareholder made any contribution(s) to any State Board of Equalization Member in the past 12 months? If YES, please complete information about the contribution(s) at the bottom of this form.

8. This form must be signed by the majority shareholder (if any) or participant.
SIGNATURE(S) DATE

NAME(S) AND TITLE

PHONE NUMBER

CONTRIBUTIONS (Do not include contributions from Political Action Committees)
NAME CONTRIBUTED UNDER CONTRIBUTION DATE CONTRIBUTION AMOUNT NAME OF MEMBER

CLEAR

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