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011400056 NFII-0056
<br /> CALIFORMA FORMMU
<br /> SCHEDUL,E B FAIR POUTICAL PRACTICES C0111103311014
<br /> Interests in Real Property Name
<br /> (Indkidilng Rental Incorne)
<br /> -PH AN, THAT VIET
<br /> 10 ASSESSOR'S PARCEL INUMIBER OR STREET ADDRESS ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS
<br /> 2680 West, Segerstrom Avenue
<br /> CITY UTY
<br /> Santa Ana
<br /> FAIR MARKET VALUE IF APPLICABLE, Lis r DATE': FAIR!MARKETVALLIE DF APPLICABLE, LIST DATE':
<br /> F-] $2,000 $10,00,13 E] S2,000 $1 0,D00
<br /> $
<br /> 10'r ioi $1010,000 ....... 2'"0" F $10,1001 $1100,00 0 -------j...............j2_0- --------/...............1-2 0
<br /> [—X1 $100,001 $1,0,00,0100 ACQUIRED DISPOSED ❑ $100,001 $1,0100,000, ACQUIRED DISPOSED
<br /> E1.] over!S1,000,00o F1 Over$1,000,000
<br /> NATURE OF INTEREST NATURE OF INTEREST
<br /> [:] OwnershjpD�eed ol'Truist Owners h ilp/Deed of Trust F- sorrent Ea Easement
<br /> Leasehdd Leasalhaid, E]
<br /> Yrs,renvk0nq other yrs, rernainkyu 004(mr
<br /> IF RENTAL PROPERTY,GROSS INCOME RECEIVED IF RENTAL PROPERTY,GROSS INCOME RECEIVED
<br /> so $49 F] $500 $1,000 [-] sl,00i $10„010,0 F] $0 $4,99 D$,5,00 $1,00o F] $1,DO1 $10,0010
<br /> ❑ $10,0101 s1olo,o0a ❑ OVER $100,000 El va,00s siloo,000 ❑ OVER$100,00)
<br /> SOURCES OF RENTAL INCOME If you own a 10%or gireater SOURCES OF REINTAIL INICOME: If you own to 10%,or greater
<br /> interest, fist the rmme o�f each termnt that is a s,IngIe source of k-iterest, list the name of each tenant that Is a singW source of
<br /> Income of$10,000 or more, Inoonie of$10,0010 or more,
<br /> Nonel ❑ Nom
<br /> You cure not reqUlred to repoirt loans frorn a commercial lendlinig institution imade in the lender's regular course of
<br /> bus,iness on,terms available to members of the Ipublic without regard to uir offici4l statuis. Personal loans and
<br /> loans received not in,a lender's regulair course of business must be disclosed as follows:
<br /> NAMIE OF LENDER* INAMIE OF LENDER'
<br /> AIDDRESS (Busirviss Ack1ress Accellabhj) ADDRESS (Bwskieoss Address Acerptabie)
<br /> BUSINESS ACTIVITY, IIIF ANY,OF LENIIDEIR BUSINESS ACTIVITY, IIF ANY,OF LEINDIER
<br /> INTEREST RATE TERM(MonthsfYeafs) IN rERES:r RATE TERM(MontWYears)
<br /> jNone ------------------------------------------------ None
<br /> HIIGHIE$T BALANCE DURING REPORTING PERIOD IHIGHEST BALANCE DURING REPORTING PERIOD
<br /> s5w 1„I�� f..al$1,0o1 $10,010o $51)o $1,000 $1,0o01 $110,000
<br /> $10,001 $100,DG0 ❑ OVER$100,000 ❑ $10,001 $100,0()o OVER $100,1000
<br /> Guarairdoir,If applicable Guarantor,ff applicable
<br /> Comments:
<br /> FPP C Form 700 Schedluile It (20120)2021i)
<br /> advIce@fppc.ca.gov#866-275-3772#www.fppc.ca.go,v
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