Statement Of Economic Interests For Auditors Claims Managers-Adjusters {700-A} | Pdf Fpdf Docx | California

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Statement Of Economic Interests For Auditors Claims Managers-Adjusters {700-A} | Pdf Fpdf Docx | California

Last updated: 5/2/2022

Statement Of Economic Interests For Auditors Claims Managers-Adjusters {700-A}

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Description

NOTE:or NAME þ (LAST) þ (FIRST) þ ( þMM IDD þlL E) þp þc ( ) þD þt þt þp FPPC Form 700-A (2018/2019)FPPC Advice þEE mail: advice@fppc.ca.govFPPC þTT oll-Free Helpline: 866/275-3772 www.fppc.ca.gov 3. þ Disclosure Statement1. Full Name of Agency2. þT T ype of Statement þ þD þR A Public document F þaA IR POLITI þcaCA L PR þacAC TI þcC E þsS COMMI þssSS IO þnN 700-ACA þLILI F þOROR N þII A F þORMORM STATEMENT OF þEE CONOMIC þII NTERE þsS T þsS FOR þAA UDITOR þsS , CLAIM þsS MANAGER þsS /ADJU þsS TER þsS , AND OTHER ELIGIBLE FILER þsS * þ Annual Statement (Year ): þY þA þD þI / / þD þ þY / / þY þ Note: þA þR Number of pages completed including this cover page: Part 1. No Disclosure þRR equired þ þI þI Part 2. Disclosure þRR equired þI þI þI þO þR þ þA þ þA þ þB þ þ þ þD þ þE -or- þ þI þI þII certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.Date Signed Signature Part 1a. No Disclosure þRR equired (Board of þEE qualization only) þ þI þI þI þI þA þI þR (Business or Agency Address Recommended - Public Document) þE þss þM þg þA þssst þtc þt þA þE American LegalNet, Inc. www.FormsWorkFlow.com

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