FPPC Form 806 (1/18)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
Comment:
A Public Document
Appt Date and
Length of Term
Agency Report of:
Public Official Appointments
2. Appointments
3. Verification
I have read and understand FPPC Regulation 18702.5. I have verified that the appointment and information identified above is true to the best of my information and belief.
Signature of Agency Head or Designee Print Name Title (Month, Day, Year) Agency Boards and
Commissions Name of Appointed Person Per Meeting/Annual Salary/Stipend (Last, First)
(Last, First)
(Last, First)
(Last, First)
Alternate, if any
Alternate, if any
Alternate, if any
Alternate, if any
(Last, First)
(Last, First)
(Last, First)
(Last, First)
Name
Name
Name
Name
$0-$1,000
$0-$1,000
$0-$1,000
$0-$1,000
$1,001-$2,000
$1,001-$2,000
$1,001-$2,000
$1,001-$2,000
$2,001-$3,000
$2,001-$3,000
$2,001-$3,000
$2,001-$3,000
Other
Other
Other
Other
California
Form
1. Agency Name
Designated Agency Contact (Name,Title)
E-mail
Division, Department, or Region (If Applicable)
806
For Official Use Only
Area Code/Phone Number
(Month, Day, Year)
_____________
Appt Date
_____________
Appt Date
_____________
Appt Date
_____________
Appt Date
Length of Term
Length of Term
Length of Term
Length of Term
Estimated Annual:
Estimated Annual:
Estimated Annual:
Estimated Annual:
$ Per Meeting:
$ Per Meeting:
$ Per Meeting:
$ Per Meeting:
Page _____ of _____
Date Posted: