Schedule B, Interests in Real Property (Including Rental Income)

Filer's Name:

First Interest in Real Property

Assessor's Parcel Number or Street Address:
City:

Fair Market Value $2,000 to $10,000 $10,001 to $100,000 $100,001 to $1,000,000 Over $1,000,000

If Applicable, List Date If Applicable, Acquired Date in 2021: (enter month and day)
If Applicable, Disposed Date in 2021: (enter month and day)

Nature of Investment Ownership/Deed of Trust Easement Leasehold, If Leasehold checked, enter years remaining: Other, If other checked, describe other:

If rental property, gross income received $0 to $499 $500 to $1,000 $1,001 to $10,000 $10,001 to $100,000 Over $100,000

SOURCES OF RENTAL INCOME: If you own a 10% or greater interest, list the name of each tenant that is a single source of income of $10,000 or more. None Names listed below

If names listed below checked, list the name of each tenant that is a single source of income of $10,000 or more:

* You are not required to report loans from a commercial lending institution made in the lender’s regular course of business on terms available to members of the public without regard to your official status. Personal loans and loans received not in a lender’s regular course of business must be disclosed as follows:

Name of Lender*:
Address of Lender (Business Address Acceptable):
Business Activity, If any, of lender:
Interest rate (percent): No Interest
Term of Loan (Months and Years):

Highest balance during reporting period $500 to $1,000 $1,001 to $10,000 $10,001 to $100,000 Over $100,000

Guarantor, if applicable, Name of Guarantor

Second Interest in Real Property (If another one is applicable)