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Form BOE-1400a Fillable Contribution Disclosure for Party (Taxpayer or Appellant)
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)(1 List all "doing business as" or other corporate names used during the previous 12 months:) (1 List all "doing business as" or other corporate names used during the previous 12 months:;) (ADDRESS (city state zip code)) (CLEAR) CLEAR (CONTRIBUTION AMOUNT) (CONTRIBUTION AMOUNT) (CONTRIBUTION AMOUNT) (CONTRIBUTION DATE) (CONTRIBUTION DATE) (CONTRIBUTION DATE) (CONTRIBUTIONS (Do not include contributions from Politial Action Committees) Row 1 NAME CONTRIBUTED UNDER) (CONTRIBUTIONS (Do not include contributions from Politial Action Committees) Row 2 NAME CONTRIBUTED UNDER) (CONTRIBUTIONS (Do not include contributions from Politial Action Committees) Row 3 NAME CONTRIBUTED UNDER) (CONTRIBUTIONS (Do not include contributions from Politial Action Committees) Row 4 NAME CONTRIBUTED UNDER) (CONTRIBUTIONS (Do not include contributions from Politial Action Committees) Row 5 NAME CONTRIBUTED UNDER) (CONTRIBUTIONS (Do not include contributions from Politial Action Committees) Row 6 NAME CONTRIBUTED UNDER) (DATE) (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 Michelle Steel Jerome E Horton State Controller John Chiang and Acting Member Barbara Alby CASE ID ) (MAJORITY SHAREHOLDER NAME) (NAME OF MEMBER) (NAME OF MEMBER) (NAME OF MEMBER) (NAME OF PARTY) (NAME(S) AND TITLE; ) (PHONE NUMBER) (PRINT) PRINT (Taxpayer or Appellant) (text) 1 List all "doing business as" or other corporate names used during the previous 12 months: 2 Has the party made any contribution(s) to any State Board of Equalization Member in the past 12 months? If YES 3 Is the party a corporation? If YES go to item 4; if NO skip to item 7 4 Is the corporation a close corporation? If YES go to item 5; if NO skip to item 7 5 MAJORITY SHAREHOLDER NAME 6 Has the majority shareholder made any contribution(s) to any State Board of Equalization Member in the past 12 7 This form must be signed by the majority shareholder (if any) party or an authorized representative based on ADDRESS (city state zip code) BOE 1400 A REV 12 (1 03) STATE OF CALIFORNIA CASE ID CONTRIBUTION DISCLOSURE FOR PARTY BOARD OF EQUALIZATION CONTRIBUTIONS (Do not include contributions from Political Action Committees) FOR OFFICE USE ONLY (CLIENT ID) 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 months? If YES please complete information about the contribution(s) at the bottom of this form NAME CONTRIBUTED UNDER CONTRIBUTION DATE CONTRIBUTION AMOUNT NAME OF MEMBER NAME OF PARTY NAME(S) AND TITLE participant or his or her agent to any Member of the Board PHONE NUMBER please complete information about the contribution(s) at the bottom of this form shall disclose on the record of the proceeding any contribution or contributions made within the preceding 12 months by the party or SIGNATURE(S) specific information from the majority shareholder (if any) and party State Controller John Chiang The Members of the State Board of Equalization are Betty T Yee Sen George Runner (Ret ) Michelle Steel Jerome E Horton and YES NO