Main Navigation
Form BOE-1400b Fillable Contribution Disclosure for Participant (Witnesses, etc)
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)(2 List all "doing business as" or other corporate names used during the previous 12 months:) (6 MAJORITY SHAREHOLDER NAME) (ADDRESS (city state zip code)) (CLEAR) CLEAR (CONTRIBUTION AMOUNT) (CONTRIBUTION AMOUNT) (CONTRIBUTION AMOUNT) (CONTRIBUTION DATE) (CONTRIBUTION DATE) (CONTRIBUTIONS (Do not include contributions from Political Action Committees) Row 1 NAME CONTRIBUTED UNDER) (CONTRIBUTIONS (Do not include contributions from Political Action Committees) Row 2 NAME CONTRIBUTED UNDER) (CONTRIBUTIONS (Do not include contributions from Political Action Committees) Row 3 NAME CONTRIBUTED UNDER) (CONTRIBUTIONS (Do not include contributions from Political Action Committees) Row 4 NAME CONTRIBUTED UNDER) (CONTRIBUTIONS (Do not include contributions from Political Action Committees) Row 5 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 ) (NAME OF MEMBER) (NAME OF MEMBER) (NAME OF MEMBER) (NAME OF PARTICIPANT) (NAME(S) AND TITLE) (PHONE NUMBER) (PRINT) PRINT (text) (Witnesses Etc ) 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 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 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 7 Has the majority shareholder made any contribution(s) to any State Board of Equalization Member in the past 12 8 This form must be signed by the majority shareholder (if any) or participant ADDRESS (city state zip code) BOE 1400 B REV 14 (1 03) STATE OF CALIFORNIA CASE ID complete information about the contribution(s) at the bottom of this form CONTRIBUTION AMOUNT CONTRIBUTION DATE CONTRIBUTION DISCLOSURE FOR PARTICIPANT BOARD OF EQUALIZATION CONTRIBUTIONS (Do not include contributions from Political Action Committees) do you plan to testify before the Board on this matter; or have you acted to influence the Board's decision in this 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 If you answered YES to both 1a & 1b go to item 2; if NO skip to item 8 matter? months? If YES please complete information about the contribution(s) at the bottom of this form NAME CONTRIBUTED UNDER NAME OF MEMBER NAME OF PARTICIPANT NAME(S) AND TITLE participant or his or her agent to any Member of the Board PHONE NUMBER shall disclose on the record of the proceeding any contribution or contributions made within the preceding 12 months by the party or SIGNATURE(S) 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