December 2019
2019-2020
Statement of
Economic Interests
Form 700
California Fair Political Practices Commission
1102 Q Street, Suite 3000 • Sacramento, CA 95811
Email Advice: advice@fppc.ca.gov
Toll-free advice line: 1 (866) ASK-FPPC • 1 (866) 275-3772
Telephone: (916) 322-5660 • Website: www.fppc.ca.gov
A Public Document
Table of Contents
Quick Start Guide .................................................... p.2
Who? Where? How? When? .................................... p.3
Types of Statements ................................................. p.4
Cover Page and Schedules
Cover Page ........................................................ p.5
Schedule A-1 (Investments) ............................... p.7
Schedule A-2 (Business Entities/Trusts) ............ p.9
Schedule B (Real Property) ...............................p.11
Schedule C (Income) .........................................p.13
Schedule D (Gifts) ..............................................p.15
Schedule E (Travel Payments) ........................... p.17
Restrictions and Prohibitions ....................................p.19
Q & A ........................................................................p.20
Helpful Resources
• Video Tutorials
• Reference Pamphlet
• Excel Version
• FAQs
• Gift and Travel Fact
Sheet for State and
LocalOcials
Quick Start Guide
Detailed instructions begin on page 3.
WHEN IS THE ANNUAL STATEMENT DUE?
• March2–ElectedStateOcers,JudgesandCourtCommissioners,StateBoardandCommission
members listed in Government Code Section 87200
• April1–Mostotherlers
WHERE DO I FILE?
MostpeopleletheForm700withtheiragency.Ifyou’renotsurewheretoleyourForm700,contactyour
lingocerorthepersonwhoaskedyoutocompleteit.
ITEMS TO NOTE!
• TheForm700isapublicdocument.
• Onlylersservinginactivemilitarydutymayreceiveanextensiononthelingdeadline.
• Youmustalsoreportinterestsheldbyyourspouseorregistereddomesticpartner.
• Youragency’sconictofinterestcodewillhelpyoutocompletetheForm700.Youareencouragedtoget
yourconictofinterestcodefromthepersonwhoaskedyoutocompletetheForm700.
NOTHING TO REPORT?
Markthe“Noreportableinterests”boxonPart4oftheCoverPage,andsubmitonlythesignedCoverPage.
Please review each schedule carefully!
Schedule
Common
Reportable Interests
Common
Non-Reportable Interests
A-1:
Investments
Stocks,includingthoseheldinanIRA
or 401K. Each stock must be listed.
Insurancepolicies,governmentbonds,diversied
mutualfunds,fundssimilartodiversiedmutual
funds.
A-2:
Business
Entitites/Trusts
Businessentities,soleproprietorships,
partnerships,LLCs,corporationsand
trusts.(e.g.,Form1099lers).
Savingsandcheckingaccounts,andannuities.
B:
Real Property
Rentalpropertyinler’sjurisdiction,or
within two miles of the boundaries of
thejurisdiction.
A residence used exclusively as a personal
residence(suchasahomeorvacationproperty).
C:
Income
Non-governmentalsalaries.Notethat
lersarerequiredtoreportonlyhalfof
theirspouse’sorpartner’ssalary.
Governmentalsalary(fromschooldistrict,for
example).
D:
Gifts
Giftsfrombusinesses,vendors,or
othercontractors(meals,tickets,etc.).
Gifts from family members.
E:
Travel
Payments
Travel payments from third parties (not
youremployer).
Travel paid by your government agency.
Note:Likereportableinterests,non-reportableinterestsmayalsocreateconictsofinterestandcouldbe
groundsfordisqualicationfromcertaindecisions.
QUESTIONS?
• advice@fppc.ca.gov
• (866)275-3772Mon-Thurs,9-11:30a.m.
E-FILING ISSUES?
• Ifusingyouragency’ssystem,pleasecontacttechnicalsupportatyouragency.
• IfusingFPPC’se-lingsystem,writetoform700@fppc.ca.gov.
FPPC Form 700 (2019/2020)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
Page - 2
What’s New
Gift Limit Increase
The gift limit increased to $500 for calendar years 2019
and 2020.
Who must le:
• Electedandappointedocialsandcandidateslistedin
Government Code Section 87200
• Employees,appointedocials,andconsultantsling
pursuanttoaconictofinterestcode(“codelers”).
Obtain your disclosure categories, which describe
the interests you must report, from your agency;
they are not part of the Form 700
• Candidatesrunningforlocalelectiveocesthatare
designatedinaconictofinterestcode(e.g.,county
sheris,cityclerks,schoolboardtrustees,andwater
boardmembers)
Exception:
• Candidates for a county central committee are not
requiredtoletheForm700.
• Membersofnewlycreatedboardsand
commissionsnotyetcoveredunderaconictof
interest code
• Employees in newly created positions of existing
agencies
Formoreinformation,seeReferencePamphlet,page3,at
www.fppc.ca.gov.
Where to le:
87200 Filers
Stateoces  Youragency
Judicialoces  The clerk of your court
RetiredJudges  Directly with FPPC
Countyoces  Yourcountylingocial
Cityoces  Yourcityclerk
Multi-Countyoces  Youragency
Code Filers — State and Local Ocials, Employees,
and Consultants Designated in a Conict of Interest
Code:Filewithyouragency,board,orcommissionunless
otherwisespeciedinyouragency’scode(e.g.,Legislative
stalesdirectlywithFPPC).Inmostcases,theagency,
board,orcommissionwillretainthestatements.
Members of Boards and Commissions of Newly
Created Agencies: File with your newly created agency
orwithyouragency’scodereviewingbody.
Employees in Newly Created Positions of Existing
Agencies:Filewithyouragencyorwithyouragency’s
codereviewingbody.(SeeReferencePamphlet,page3.)
Candidates:Filewithyourlocalelectionsoce.
How to le:
The Form 700 is available at www.fppc.ca.gov. Form
700 schedules are also available in Excel format. All
statementsmusthaveanoriginal“wet”signatureorbe
dulyauthorizedbyyourlingocertoleelectronically
under Government Code Section 87500.2.
When to le:
Annual Statements
March 2, 2020
- ElectedStateOcers
- JudgesandCourtCommissioners
- State Board and StateCommissionMemberslisted
in Government Code Section 87200
April 1, 2020
- Mostotherlers
Individualslingunderconictofinterestcodesincityand
countyjurisdictionsshouldverifytheannuallingdatewith
theirlocallingocers.
Statementspostmarkedbythelingdeadlineare
consideredledontime.
Statements of 30 pages or less may be emailed or faxed
by the deadline as long as the originally signed paper
versionissentbyrstclassmailtothelingocialwithin
24 hours.
Assuming Oce and Leaving Oce Statements
Mostlerslewithin30daysofassumingorleavingoce
orwithin30daysoftheeectivedateofanewlyadopted
oramendedconictofinterestcode.
Exception:
IfyouassumedocebetweenOctober1, 2019,and
December31, 2019,andledanassumingoce
statement,youarenotrequiredtoleanannual
statementuntilMarch
2,2021,orApril1,2021,
whichever is applicable. The annual statement will cover
thedayafteryouassumedocethroughDecember31,
2020.(SeeReferencePamphlet,page6,foradditional
exceptions.
Candidate Statements
Filenolaterthanthenallingdateforthedeclaration
of candidacy or nomination documents. A candidate
statementisnotrequiredifyouledanassumingoceor
annualstatementforthesamejurisdictionwithin60days
beforelingadeclarationofcandidacyorothernomination
documents.
Late Statements
Thereisnoprovisionforlingdeadlineextensionsunless
thelerisservinginactivemilitaryduty.(Seepage19for
informationonpenaltiesandnes.)
Amendments
Statementsmaybeamendedatanytime.Youareonly
requiredtoamendtheschedulethatneedstoberevised.
Itisnotnecessarytoamendtheentireledform.Obtain
amendment schedules at www.fppc.ca.gov.
FPPC Form 700 (2019/2020)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
Page - 3
Types of Statements
Assuming Oce Statement:
Ifyouareanewlyappointedocialorarenewlyemployed
inapositiondesignated,orthatwillbedesignated,in
astateorlocalagency’sconictofinterestcode,your
assumingocedateisthedateyouweresworninor
otherwiseauthorizedtoserveintheposition.Ifyouarea
newlyelectedocial,yourassumingocedateisthedate
you were sworn in.
• Report:Investments,interestsinrealproperty,and
business positions held on the date you assumed the
oceorpositionmustbereported.Inaddition,income
(includingloans,gifts,andtravelpayments)received
during the 12 months prior to the date you assumed the
oceorposition.
ForpositionssubjecttoconrmationbytheStateSenate
ortheCommissiononJudicialAppointments,your
assumingocedateisthedateyouwereappointedor
nominated to the position.
• Example:MariaLopezwasnominatedbytheGovernor
toserveonastateagencyboardthatissubjecttostate
Senateconrmation.Theassumingocedateisthe
dateMaria’snominationissubmittedtotheSenate.
Mariamustreportinvestments,interestsinreal
property,andbusinesspositionssheholdsonthatdate,
andincome(includingloans,gifts,andtravelpayments)
received during the 12 months prior to that date.
Ifyouroceorpositionhasbeenaddedtoanewly
adoptedornewlyamendedconictofinterestcode,use
theeectivedateofthecodeoramendment,whicheveris
applicable.
• Report:Investments,interestsinrealproperty,and
businesspositionsheldontheeectivedateofthe
codeoramendmentmustbereported.Inaddition,
income(includingloans,gifts,andtravelpayments)
receivedduringthe12monthspriortotheeectivedate
of the code or amendment.
Annual Statement:
Generally,theperiodcoveredisJanuary1,2019,
throughDecember31,2019.Iftheperiodcoveredby
thestatementisdierentthanJanuary1,2019,through
December31,2019,(forexample,youassumedoce
betweenOctober1,2018,andDecember31,2018 or you
arecombiningstatements),youmustspecifytheperiod
covered.
• Investments,interestsinrealproperty,business
positionsheld,andincome(includingloans,gifts,and
travelpayments)receivedduringtheperiodcovered
by the statement must be reported. Do not change the
preprinteddatesonSchedulesA-1,A-2,andBunless
youarerequiredtoreporttheacquisitionordisposition
of an interest that did not occur in 2019.
• Ifyourdisclosurecategorychangesduringareporting
period,discloseundertheoldcategoryuntilthe
eectivedateoftheconictofinterestcodeamendment
and disclose under the new disclosure category through
the end of the reporting period.
Leaving Oce Statement:
Generally,theperiodcoveredisJanuary1,2019,
through the date you stopped performing the duties of
yourposition.IftheperiodcovereddiersfromJanuary
1,2019,throughthedateyoustoppedperformingthe
dutiesofyourposition(forexample,youassumedoce
between October1,2018,andDecember31,2018,or
youarecombiningstatements),theperiodcoveredmust
bespecied.Thereportingperiodcancoverpartsoftwo
calendar years.
• Report:Investments,interestsinrealproperty,business
positionsheld,andincome(includingloans,gifts,and
travelpayments)receivedduringtheperiodcoveredby
the statement. Do not change the preprinted dates on
SchedulesA-1,A-2,andBunlessyouarerequiredto
reporttheacquisitionordispositionofaninterestthat
did not occur in 2019.
Candidate Statement:
Ifyouarelingastatementinconnectionwithyour
candidacyforstateorlocaloce,investments,interests
inrealproperty,andbusinesspositionsheldonthedate
oflingyourdeclarationofcandidacymustbereported.
Inaddition,income(includingloans,gifts,andtravel
payments)receivedduringthe12monthsprior to the date
oflingyourdeclarationofcandidacyisreportable.Donot
changethepreprinteddatesonSchedulesA-1,A-2,andB.
Candidates running for local elective oces(e.g.,county
sheris,cityclerks,schoolboardtrustees,orwater
districtboardmembers)mustlecandidatestatements,
asrequiredbytheconictofinterestcodefortheelected
position. The code may be obtained from the agency of
the elected position.
Amendments:
Ifyoudiscovererrorsoromissionsonanystatement,le
anamendmentassoonaspossible.Youareonlyrequired
to amend the schedule that needs to be revised; it is not
necessarytoreletheentireform.Obtainamendment
schedules from the FPPC website at www.fppc.ca.gov.
Note: Onceyouleyourstatement,youmaynotwithdraw
it. All changes must be noted on amendment schedules.
FPPC Form 700 (2019/2020)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
Page - 4
Leaving Ofce: Date Left / /
(Check one circle.)
The period covered is January 1, 2019, through the date of
leaving ofce.
The period covered is / / , through
the date of leaving ofce.
Annual: The period covered is January 1, 2019, through
December 31, 2019.
The period covered is
/ / , through
December 31, 2019.
Statement of economic intereStS
cover Page
A PUBLIC DOCUMENT
I have used all reasonable diligence in preparing this statement. I have reviewed this statement and to the best of my knowledge the information contained
herein and in any attached schedules is true and complete. I acknowledge this is a public document.
I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date Signed
(month, day, year)
3. Type of Statement (Check at least one box)
State
Judge, Retired Judge, Pro Tem Judge, or Court Commissioner
(Statewide Jurisdiction) (Statewide Jurisdiction)
Multi-County
County of
City of
Other
2. Jurisdiction of Ofce (Check at least one box)
Candidate: Date of Election and ofce sought, if different than Part 1:
Assuming Ofce: Date assumed / /
DateInitial FilingReceived
Filing Ocial Use Only
Please type or print in ink.
700
FAIR POLITICAL PRACTICES COMMISSION
CALIFORNIA FORM
Agency Name (Do not use acronyms)
Division, Board, Department, District, if applicable Your Position
1. Ofce, Agency, or Court
name of filer (laSt) (firSt) (middle)
MAILING ADDRESS STREET CITY STATE ZIP CODE
()
DAYTIME TELEPHONE NUMBER
EMAIL ADDRESS
(Business or Agency Address Recommended - Public Document)
Signature
(File the originally signed paper statement with your ling ofcial.)
5. Verication
If ling for multiple positions, list below or on an attachment. (Do not use acronyms)
Agency:
Position:
-or-
-or-
None - No reportable interests on any schedule
4. Schedule Summary (must complete)
Schedules attached
Schedule A-1 - Investments – schedule attached
Schedule A-2 - Investments – schedule attached
Schedule B - Real Property – schedule attached
Total number of pages including this cover page:
-or-
Schedule C - Income, Loans, & Business Positions – schedule attached
Schedule D - Income Gifts – schedule attached
Schedule E - Income Gifts Travel Payments – schedule attached
FPPC Form 700 - Cover Page (2019/2020)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
Page - 5
Clear Page
Print
• Ifyouragencyisamulti-countyoce,listeachcountyin
whichyouragencyhasjurisdiction.
• Ifyouragencyisnotastateoce,court,countyoce,city
oce,ormulti-countyoce(e.g.,schooldistricts,special
districtsandJPAs),checkthe“other”boxandenterthe
countyorcityinwhichtheagencyhasjurisdiction.
Example:
Thislerisamemberofawaterdistrictboardwithjurisdiction
inportionsofYubaandSutterCounties.
Part 3. Type of Statement
Check at least one box. The period covered by a statement
isdeterminedbythetypeofstatementyouareling.Ifyou
are completing a 2019 annualstatement,do not change the
pre-printeddatestoreect2020.Yourannualstatementis
used for reporting the previous years economic interests.
EconomicinterestsforyourannuallingcoveringJanuary1,
2020,throughDecember31,2020,willbedisclosedonyour
statementledin2021. SeeReferencePamphlet,page4.
Combining Statements: Certain types of statements may be
combined.Forexample,ifyouleaveoceafterJanuary1,
butbeforethedeadlineforlingyourannualstatement,you
maycombineyourannualandleavingocestatements.File
bytheearliestdeadline.Consultyourlingocerorthe
FPPC.
Part 4. Schedule Summary
• Complete the Schedule Summary after you have reviewed
each schedule to determine if you have reportable
interests.
• Enter the total number of completed pages including the
cover page and either check the box for each schedule you
use to disclose interests; or if you have nothing to disclose
onanyschedule,checkthe“Noreportableinterests”box.
Please do not attach any blank schedules.
Part 5. Verication
Completethevericationbysigningthestatementand
entering the date signed. All statements must have an original
“wet”signatureorbedulyauthorizedbyyourlingocerto
leelectronicallyunderGovernmentCodeSection87500.2.
When you sign your statement, you are stating, under
penalty of perjury, that it is true and correct.Onlytheler
has authority to sign the statement. An unsigned statement
isnotconsideredledandyoumaybesubjecttolateling
penalties.
Instructions
Cover Page
Enteryourname,mailingaddress,anddaytimetelephone
number in the spaces provided. Because the Form 700 is
a public document, you may list your business/oce
address instead of your home address.
Part 1. Oce, Agency, or Court
• Enterthenameoftheocesoughtorheld,ortheagency
or court. Consultants must enter the public agency name
ratherthantheirprivaterm’sname.(Examples:State
Assembly;BoardofSupervisors;OceoftheMayor;
DepartmentofFinance;HopeCountySuperiorCourt)
• Indicatethenameofyourdivision,board,ordistrict,if
applicable.(Examples:DivisionofWasteManagement;
BoardofAccountancy;District45).Do not use acronyms.
• Enter your position title. (Examples: Director; Chief
Counsel;CityCouncilMember;StaServicesAnalyst)
• Ifyouholdmultiplepositions(i.e.,acitycouncilmember
whoalsoisamemberofacountyboardorcommission),
youmayberequiredtolestatementswitheachagency.
Tosimplifyyourlingobligations,youmaycompletean
expanded statement.
• Todothis,enterthenameoftheotheragency(ies)
withwhichyouarerequiredtoleandyourposition
title(s)inthespaceprovided.Do not use acronyms.
Attach an additional sheet if necessary. Complete
onestatementcoveringthedisclosurerequirements
for all positions. Each copy must contain an original
signature.Therefore,beforesigningthestatement,
make a copy for each agency. Sign each copy with an
originalsignatureandlewitheachagency.
Ifyouassumeorleaveapositionafteralingdeadline,
youmustcompleteaseparatestatement.Forexample,a
city council member who assumes a position with a county
specialdistrictaftertheAprilannuallingdeadlinemustle
aseparateassumingocestatement.Insubsequentyears,
thecitycouncilmembermayexpandhisorherannuallingto
include both positions.
Example:
Brian Bourne is a city council member for the City of Lincoln
andaboardmemberfortheCampFarWestIrrigation
District–amulti-countyagencythatcoversPlacerand
Yubacounties.Brian will complete one Form 700 using full
disclosure(asrequiredforthecityposition)andcovering
interestsinbothPlacerandYubacounties(asrequiredfor
themulti-countyposition)andlistbothpositionsontheCover
Page.Beforesigningthestatement,Brian will make a copy
andsignbothstatements.Onestatementwillbeledwith
CityofLincolnandtheotherwillbeledwithCampFarWest
IrrigationDistrict.Bothwillcontainanoriginalsignature.
Part 2. Jurisdiction of Oce
• Checktheboxindicatingthejurisdictionofyouragency
and,ifapplicable,identifythejurisdiction.Judges,judicial
candidates,andcourtcommissionershavestatewide
jurisdiction.AllotherlersshouldreviewtheReference
Pamphlet,page13,todeterminetheirjurisdiction.
State
Judge or Court Commissioner (Statewide Jurisdiction)
Multi-County
County of
City of
Other
2. Jurisdiction of Ofce (Check at least one box)
Agency Name (Do not use acronyms)
Division, Board, Department, District, if applicable Your Position
1. Ofce, Agency, or Court
If ling for multiple positions, list below or on an attachment. (Do not use acronyms)
Agency:
Position:
x
Yuba & Sutter Counties
Board MemberN/A
N/A
Feather River Irrigation District
FPPC Form 700 - Cover Page (2019/2020)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
Page - 6
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 
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 
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 
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 
19 19
19
19
1919
19
1919

 

 

 

 

 

 

Comments:
SCHEDULE A-1
Investments


Investments must be itemized.
Do not attach brokerage or nancial statements.
700
FAIR POLITICAL PRACTICES COMMISSION
CALIFORNIA FORM

     
   Over

     
   Over

     
   Over

     
   Over

     
   Over

     
   Over
19

Stock Other

Partnership
Received of $0 - $499
   (Report on Schedule C)

Stock Other

Partnership
  
   (Report on Schedule C)

Stock Other

Partnership
  
   (Report on Schedule C)

Stock Other

Partnership
Received of $0 - $499
   (Report on Schedule C)

Stock Other

Partnership
Received of $0 - $499
   (Report on Schedule C)

Stock Other

Partnership
  
   (Report on Schedule C)
19
19
FPPC Form 700 - Schedule A-1 (2019/2020)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
Page - 7
Clear Page
Print
Instructions – Schedules A-1 and A-2
Investments
“Investment”meansanancialinterestinanybusiness
entity (including a consulting business or other independent
contractingbusiness)thatislocatedin,doingbusinessin,
planningtodobusinessin,orthathasdonebusinessduring
theprevioustwoyearsinyouragency’sjurisdictioninwhich
you,yourspouseorregistereddomesticpartner,oryour
dependentchildrenhadadirect,indirect,orbenecialinterest
totaling$2,000ormoreatanytimeduringthereporting
period.(SeeReferencePamphlet,page13.)
Reportable investments include:
• Stocks,bonds,warrants,andoptions,includingthoseheld
in margin or brokerage accounts and managed investment
funds(SeeReferencePamphlet,page13.)
• Sole proprietorships
• Yourownbusinessoryourspouse’sorregistered
domesticpartner’sbusiness(SeeReferencePamphlet,
page8,forthedenitionof“businessentity.”)
• Yourspouse’sorregistereddomesticpartner’s
investments even if they are legally separate property
• Partnerships(e.g.,alawrmorfamilyfarm)
• Investmentsinreportablebusinessentitiesheldina
retirementaccount(SeeReferencePamphlet,page15.)
• Ifyou,yourspouseorregistereddomesticpartner,
anddependentchildrentogetherhada10%orgreater
ownership interest in a business entity or trust (including
alivingtrust),youmustdiscloseinvestmentsheldbythe
businessentityortrust.(SeeReferencePamphlet,page
16,formoreinformationondisclosingtrusts.)
• Business trusts
You are not required to disclose:
• Governmentbonds,diversiedmutualfunds,certain
fundssimilartodiversiedmutualfunds(suchas
exchangetradedfunds)andinvestmentsheldincertain
retirementaccounts.(SeeReferencePamphlet,page13.)
(Regulation18237)
• Bankaccounts,savingsaccounts,moneymarketaccounts
andcerticatesofdeposits
• Insurancepolicies
• Annuities
• Commodities
• Shares in a credit union
• Governmentbonds(includingmunicipalbonds)
• Retirement accounts invested in non-reportable interests
(e.g.,insurancepolicies,mutualfunds,orgovernment
bonds)(SeeReferencePamphlet,page15.)
• Governmentdened-benetpensionplans(suchas
CalPERSandCalSTRSplans)
• Certain interests held in a blind trust (See Reference
Pamphlet,page16.)
Use Schedule A-1toreportownershipoflessthan10%
(e.g.,stock).ScheduleC(Income)mayalsoberequiredif
the investment is not a stock or corporate bond. (See second
examplebelow.)
Use Schedule A-2toreportownershipof10%orgreater
(e.g.,asoleproprietorship).
To Complete Schedule A-1:
Donotattachbrokerageornancialstatements.
• Disclose the name of the business entity.
• Provide a general description of the business activity of
theentity(e.g.,pharmaceuticals,computers,automobile
manufacturing,orcommunications).
• Check the box indicating the highest fair market value of
yourinvestmentduringthereportingperiod.Ifyouare
lingacandidateoranassumingocestatement,indicate
thefairmarketvalueonthelingdateorthedateyoutook
oce,respectively.(Seepage20formoreinformation.)
• Identifythenatureofyourinvestment(e.g.,stocks,
warrants,options,orbonds).
• Anacquiredordisposedofdateisonlyrequiredifyou
initiallyacquiredorentirelydisposedoftheinvestment
interest during the reporting period. The date of a stock
dividendreinvestmentorpartialdisposalisnotrequired.
Generally,thesedateswillnotapplyifyouarelinga
candidateoranassumingocestatement.
Examples:
Frank Byrdholdsastateagencyposition.Hisconictof
interestcoderequiresfulldisclosureofinvestments.Frank
mustdisclosehisstockholdingsof$2,000ormoreinany
companythatislocatedinordoesbusinessinCalifornia,
as well as those stocks held by his spouse or registered
domestic partner and dependent children.
Alice Lanceisacitycouncilmember.Shehasa4%interest,
worth$5,000,inalimitedpartnershiplocatedinthecity.Alice
must disclose the partnership on Schedule A-1 and income of
$500 or more received from the partnership on Schedule C.
Reminders
• Doyouknowyouragency’sjurisdiction?
• Did you hold investments at any time during the period
covered by this statement?
• Codelers–yourdisclosurecategoriesmayonly
requiredisclosureofspecicinvestments.
FPPC Form 700 (2019/2020)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
Page - 8

/ / / /
 

/ / / /
 

/ / / /
 

/ / / /
 
19 19
19 1919 19
SCHEDULE A-2
Investments, Income, and Assets
of Business Entities/Trusts

Comments:

Address (Business Address Acceptable)

Address (Business Address Acceptable)

  
  
  
  
Over 

  
  
  
  
Over 


 
   or
   
Description of Business Activity or
City or Other Precise Location of Real Property
 
   or
   
Description of Business Activity or
City or Other Precise Location of Real Property
4. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD OR
LEASED BY THE BUSINESS ENTITY OR TRUST
4. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD OR
LEASED BY THE BUSINESS ENTITY OR TRUST
Check one
go to 2 complete the box, then go to 2
Check one
go to 2 complete the box, then go to 2
2. IDENTIFY THE GROSS INCOME RECEIVED (INCLUDE YOUR PRO RATA
SHARE OF THE GROSS INCOME TO THE ENTITY/TRUST)
2. IDENTIFY THE GROSS INCOME RECEIVED (INCLUDE YOUR PRO RATA
SHARE OF THE GROSS INCOME TO THE ENTITY/TRUST)

700
Check one box: Check one box:



  
  
  
Over 

  
  
  
Over 
$0 - $499
 
 
$0 - $499
 
 
  

  

FAIR POLITICAL PRACTICES COMMISSION
CALIFORNIA FORM
1. BUSINESS ENTITY OR TRUST
1. BUSINESS ENTITY OR TRUST

Property Ownership/Deed of Trust Stock Partnership
Leasehold Other
Check box if additional schedules reporting investments or real property
are attached


Property Ownership/Deed of Trust Stock Partnership
Leasehold Other
Check box if additional schedules reporting investments or real property
are attached

19 19
Other

Partnership Sole Proprietorship
Other

Partnership Sole Proprietorship


or
or
 
 
3. LIST THE NAME OF EACH REPORTABLE SINGLE SOURCE OF
INCOME OF $10,000 OR MORE (Attach a separate sheet if necessary.)
3. LIST THE NAME OF EACH REPORTABLE SINGLE SOURCE OF
INCOME OF $10,000 OR MORE (Attach a separate sheet if necessary.)
FPPC Form 700 - Schedule A-2 (2019/2020)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
Page - 9
Clear Page
Print
Instructions – Schedule A-2
Investments, Income, and Assets of Business Entities/Trusts
Use Schedule A-2 to report investments in a business
entity (including a consulting business or other independent
contractingbusiness)ortrust(includingalivingtrust)in
whichyou,yourspouseorregistereddomesticpartner,
andyourdependentchildren,togetherorseparately,hada
10%orgreaterinterest,totaling$2,000ormore,duringthe
reportingperiodandwhichislocatedin,doingbusinessin,
planningtodobusinessin,orwhichhasdonebusinessduring
theprevioustwoyearsinyouragency’sjurisdiction.(See
ReferencePamphlet,page13.)Atrustlocatedoutsideyour
agency’sjurisdictionisreportableifitholdsassetsthatare
locatedinordoingbusinessinthejurisdiction.Donotreport
atrustthatcontainsnon-reportableinterests.Forexample,
a trust containing only your personal residence not used in
wholeorinpartasabusiness,yoursavingsaccount,and
somemunicipalbonds,isnotreportable.
Also report on Schedule A-2 investments and real property
held by that entity or trust if your pro rata share of the
investmentorrealpropertyinterestwas$2,000ormore
during the reporting period.
To Complete Schedule A-2:
Part 1. Disclose the name and address of the business entity
ortrust.Ifyouarereportinganinterestinabusinessentity,
check“BusinessEntity”andcompletetheboxasfollows:
• Provide a general description of the business activity of the
entity.
• Check the box indicating the highest fair market value of
your investment during the reporting period.
• Ifyouinitiallyacquiredorentirelydisposedofthisinterest
duringthereportingperiod,enterthedateacquiredor
disposed.
• Identifythenatureofyourinvestment.
• Disclosethejobtitleorbusinesspositionyouheldwiththe
entity,ifany(i.e.,ifyouwereadirector,ocer,partner,
trustee,employee,orheldanypositionofmanagement).A
business position held by your spouse is not reportable.
Part 2. Check the box indicating your pro rata share of the
gross income received by the business entity or trust. This
amount includes your pro rata share of the gross income
fromthebusinessentityortrust,aswellasyourcommunity
propertyinterestinyourspouse’sorregistereddomestic
partner’sshare.Gross income is the total amount of income
beforedeductingexpenses,losses,ortaxes.
Part 3. Disclose the name of each source of income that is
locatedin,doingbusinessin,planningtodobusinessin,or
that has done business during the previous two years in your
agency’sjurisdiction,asfollows:
• Disclose each source of income and outstanding loan
to the business entity or trustidentiedinPart1if
your pro rata share of the gross income (including your
communitypropertyinterestinyourspouse’sorregistered
domesticpartner’sshare)tothebusinessentityortrust
fromthatsourcewas$10,000ormoreduringthereporting
period.(SeeReferencePamphlet,page11,forexamples.)
Incomefromgovernmentalsourcesmaybereportable
if not considered salary. See Regulation 18232. Loans
fromcommerciallendinginstitutionsmadeinthelender’s
regular course of business on terms available to members
ofthepublicwithoutregardtoyourocialstatusarenot
reportable.
• Disclose each individual or entity that was a source
ofcommissionincomeof$10,000ormoreduringthe
reportingperiodthroughthebusinessentityidentiedin
Part1.(SeeReferencePamphlet,page8.)
Youmayberequiredtodisclosesourcesofincomelocated
outsideyourjurisdiction.Forexample,youmayhaveaclient
whoresidesoutsideyourjurisdictionwhodoesbusinessona
regularbasiswithyou.Suchaclient,ifareportablesourceof
$10,000ormore,mustbedisclosed.
Mark“None”ifyoudonothaveanyreportable$10,000
sources of income to disclose. Phrasessuchas“various
clients”or“notdisclosingsourcespursuanttoattorney-client
privilege”arenotadequatedisclosure. (See Reference
Pamphlet,page14,forinformationonprocedurestorequest
anexemptionfromdisclosingprivilegedinformation.)
Part 4. Report any investments or interests in real property
held or leased by the entity or trustidentiedinPart1ifyour
proratashareoftheinterestheldwas$2,000ormoreduring
the reporting period. Attach additional schedules or use
FPPC’sForm700Excelspreadsheetifneeded.
• Check the applicable box identifying the interest held as
real property or an investment.
• Ifinvestment,providethenameanddescriptionofthe
business entity.
• Ifrealproperty,reportthepreciselocation(e.g.,an
assessor’sparcelnumberoraddress).
• Check the box indicating the highest fair market value
of your interest in the real property or investment during
the reporting period. (Report the fair market value of the
portion of your residence claimed as a tax deduction if you
areutilizingyourresidenceforbusinesspurposes.)
• Identifythenatureofyourinterest.
• Enterthedateacquiredordisposedonlyifyouinitially
acquiredorentirelydisposedofyourinterestinthe
property or investment during the reporting period.
FPPC Form 700 (2019/2020)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
Page - 10
*
ADDRESS (Business Address Acceptable)


/ / / /
 

/ / / /
 
19 1919 19
SCHEDULE B
Interests in Real Property


  STREET ADDRESS
  STREET ADDRESS
 
 

     
      
  
     
      
  

Ownership/Deed of Trust Easement
Leasehold

Other

Ownership/Deed of Trust Easement
Leasehold

Other
Comments:

  
  
  
Over 

  
  
  
Over 


   $0 - $499   
  


   $0 - $499   
  

 

     
  
700
FAIR POLITICAL PRACTICES COMMISSION
CALIFORNIA FORM
*
ADDRESS (Business Address Acceptable)

 

 


     
  
*  a 




FPPC Form 700 - Schedule B (2019/2020)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
Page - 11
Clear Page
Print
disclose the number of years remaining on the lease.
• Ifyoureceivedrentalincome,checktheboxindicatingthe
gross amount you received.
• Ifyouhada10%orgreaterinterestinrealpropertyand
receivedrentalincome,listthenameofthesource(s)if
your pro rata share of the gross income from any single
tenantwas$10,000ormoreduringthereportingperiod.If
youreceivedatotalof$10,000ormorefromtwoormore
tenantsactinginconcert(inmostcases,thiswillapply
tomarriedcouples),disclosethenameofeachtenant.
Otherwise,mark“None.”
• Loans from a private lender that total $500 or more and
are secured by real property may be reportable. Loans
from commercial lending institutions made in the
lenders regular course of business on terms available
to members of the public without regard to your ocial
status are not reportable.
When reporting a loan:
- Provide the name and address of the lender.
- Describethelender’sbusinessactivity.
- Disclose the interest rate and term of the loan. For
variableinterestrateloans,disclosetheconditions
oftheloan(e.g.,Prime+2)ortheaverageinterest
rate paid during the reporting period. The term of
a loan is the total number of months or years given
for repayment of the loan at the time the loan was
established.
- Check the box indicating the highest balance of the
loan during the reporting period.
- Identifyaguarantor,if
applicable.
Ifyouhavemorethanone
reportable loan on a single
pieceofrealproperty,report
theadditionalloan(s)on
Schedule C.
Example:
Allison Gande is a city
planning commissioner.
Duringthereportingperiod,
she received rental income of
$12,000,fromasingletenant
who rented property she
ownedinthecity’sjurisdiction.
IfAllisonreceived$6,000
eachfromtwotenants,the
tenants’nameswouldnotbe
requiredbecausenosingle
tenantpaidher$10,000or
more. A married couple is
considered a single tenant.
Instructions – Schedule B
Interests in Real Property
Reminders
• IncomeandloansalreadyreportedonScheduleBare
notalsorequiredtobereportedonScheduleC.
• RealpropertyalreadyreportedonScheduleA-2,Part4
isnotalsorequiredtobereportedonScheduleB.
• Codelers– doyourdisclosurecategoriesrequire
disclosure of real property?
Reportinterestsinrealpropertylocatedinyouragency’s
jurisdictioninwhichyou,yourspouseorregistereddomestic
partner,oryourdependentchildrenhadadirect,indirect,or
benecialinteresttotaling$2,000ormoreanytimeduring
the reporting period. Real property is also considered to be
“withinthejurisdiction”ofalocalgovernmentagencyifthe
property or any part of it is located within two miles outside
theboundariesofthejurisdictionorwithintwomilesofany
land owned or used by the local government agency. (See
ReferencePamphlet,page13.)
Interests in real property include:
• Anownershipinterest(includingabenecialownership
interest)
• Adeedoftrust,easement,oroptiontoacquireproperty
• Aleaseholdinterest(SeeReferencePamphlet,page14.)
• A mining lease
• An interest in real property held in a retirement account
(SeeReferencePamphlet,page15.)
• An interest in real property held by a business entity or
trustinwhichyou,yourspouseorregistereddomestic
partner,andyourdependentchildrentogetherhada10%
orgreaterownershipinterest(ReportonScheduleA-2.)
• Yourspouse’sorregistereddomesticpartner’sinterestsin
real property that are legally held separately by him or her
You are not required to report:
• Aresidence,suchasahomeorvacationcabin,used
exclusivelyasapersonalresidence(However,aresidence
in which you rent out a room or for which you claim a
businessdeductionmaybereportable.Ifreportable,
report the fair market value of the portion claimed as a tax
deduction.)
• Some interests in real property held through a blind trust
(SeeReferencePamphlet,page16.)
Please note: A non-reportable property can still
begroundsforaconictofinterestandmaybe
disqualifying.
To Complete Schedule B:
• Reportthepreciselocation(e.g.,anassessor’sparcel
numberoraddress)oftherealproperty.
• Check the box indicating the fair market value of your
interest in the property (regardless of what you owe on the
property).
• Enterthedateacquiredordisposedonlyifyouinitially
acquiredorentirelydisposedofyourinterestinthe
property during the reporting period.
• Identifythenatureofyourinterest.Ifitisaleasehold,
FPPC Form 700 (2019/2020)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
Page - 12
NAME OF LENDER
*
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF LENDER
IF APPLICABLE, LIST DATE:
/ /
/ /
ACQUIRED DISPOSED
IF APPLICABLE, LIST DATE:
/ /
/ /
ACQUIRED DISPOSED
18 1818 18
SCHEDULE B
Interests in Real Property
(Including Rental Income)
Name
ASSESSOR’S PARCEL NUMBER OR STREET ADDRESS
ASSESSOR’S PARCEL NUMBER OR STREET ADDRESS
CITY
CITY
INTEREST RATE TERM (Months/Years)
%
None
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.
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.
NATURE OF INTEREST
Ownership/Deed of Trust
Easement
Leasehold
Yrs. remaining
Other
NATURE OF INTEREST
Ownership/Deed of Trust
Easement
Leasehold
Yrs. remaining
Other
Comments:
FAIR MARKET VALUE
$2,000 - $10,000
$10,001 - $100,000
$100,001 - $1,000,000
Over $1,000,000
FAIR MARKET VALUE
$2,000 - $10,000
$10,001 - $100,000
$100,001 - $1,000,000
Over $1,000,000
IF RENTAL PROPERTY, GROSS INCOME RECEIVED
OVER $100,000
$500 - $1,000
$0 - $499
$1,001 - $10,000
$10,001 - $100,000
IF RENTAL PROPERTY, GROSS INCOME RECEIVED
OVER $100,000
$500 - $1,000
$0 - $499
$1,001 - $10,000
$10,001 - $100,000
HIGHEST BALANCE DURING REPORTING PERIOD
Guarantor, if applicable
OVER $100,000
$500 - $1,000
$1,001 - $10,000
$10,001 - $100,000
FPPC Form 700 (2017/2018) Sch. B
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
700
FAIR POLITICAL PRACTICES COMMISSION
CALIFORNIA FORM
NAME OF LENDER
*
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF LENDER
INTEREST RATE TERM (Months/Years)
%
None
Guarantor, if applicable
HIGHEST BALANCE DURING REPORTING PERIOD
OVER $100,000
$500 - $1,000
$1,001 - $10,000
$10,001 - $100,000
*
You are not required to report loans from commercial lending institutions made in the lender’s regular course of
business on terms available to members of the public without regard to your ofcial status. Personal loans and
loans received not in a lender’s regular course of business must be disclosed as follows:
None
None
4600 24th Street
Henry Wells
Sophia Petroillo
2121 Blue Sky Parkway, Sacramento
Restaurant Owner
8
15 Years
NAME OF LENDER
*
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF LENDER
IF APPLICABLE, LIST DATE:
/ /
/ /
ACQUIRED DISPOSED
IF APPLICABLE, LIST DATE:
/ /
/ /
ACQUIRED DISPOSED
18 1818 18
SCHEDULE B
Interests in Real Property
(Including Rental Income)
Name
ASSESSOR’S PARCEL NUMBER OR STREET ADDRESS
ASSESSOR’S PARCEL NUMBER OR STREET ADDRESS
CITY CITY
INTEREST RATE TERM (Months/Years)
%
None
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.
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.
NATURE OF INTEREST
Ownership/Deed of Trust
Easement
Leasehold
Yrs. remaining
Other
NATURE OF INTEREST
Ownership/Deed of Trust
Easement
Leasehold
Yrs. remaining
Other
Comments:
FAIR MARKET VALUE
$2,000 - $10,000
$10,001 - $100,000
$100,001 - $1,000,000
Over $1,000,000
FAIR MARKET VALUE
$2,000 - $10,000
$10,001 - $100,000
$100,001 - $1,000,000
Over $1,000,000
IF RENTAL PROPERTY, GROSS INCOME RECEIVED
OVER $100,000
$500 - $1,000
$0 - $499
$1,001 - $10,000
$10,001 - $100,000
IF RENTAL PROPERTY, GROSS INCOME RECEIVED
OVER $100,000
$500 - $1,000
$0 - $499
$1,001 - $10,000
$10,001 - $100,000
HIGHEST BALANCE DURING REPORTING PERIOD
Guarantor, if applicable
OVER $100,000
$500 - $1,000
$1,001 - $10,000
$10,001 - $100,000
FPPC Form 700 (2017/2018) Sch. B
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
700
FAIR POLITICAL PRACTICES COMMISSION
CALIFORNIA FORM
NAME OF LENDER
*
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF LENDER
INTEREST RATE TERM (Months/Years)
%
None
Guarantor, if applicable
HIGHEST BALANCE DURING REPORTING PERIOD
OVER $100,000
$500 - $1,000
$1,001 - $10,000
$10,001 - $100,000
*
You are not required to report loans from commercial lending institutions made in the lender’s regular course of
business on terms available to members of the public without regard to your ofcial status. Personal loans and
loans received not in a lender’s regular course of business must be disclosed as follows:
None
None
4600 24th Street
Sacramento
Henry Wells
Sophia Petroillo
2121 Blue Sky Parkway, Sacramento
Restaurant Owner
8
15 Years
(Real property, car, boat, etc.) (Real property, car, boat, etc.)
SCHEDULE C
Income, Loans, & Business
Positions


oncome - Business Position Only
oncome - Business Position Only


 
     
     
     
700
FAIR POLITICAL PRACTICES COMMISSION
CALIFORNIA FORM
1. INCOME RECEIVED

ADDRESS (Business Address Acceptable)


1. INCOME RECEIVED

ADDRESS (Business Address Acceptable)



ADDRESS (Business Address Acceptable)

 


  
  
  

Comments:
2. LOANS RECEIVED OR OUTSTANDING DURING THE REPORTING PERIOD
*  a 


regular course of business must be disclosed as follows:

 Personal residence
Real Property
Guarantor
Other
Street address
City
(Describe)

Salary   
   
       

Sale of
Other

Salary   
   
       

Sale of
Other
(Describe) (Describe)
(Describe) (Describe)
 list each source of $10,000 or more  list each source of $10,000 or moreCommission or Commission or
Loan repayment Loan repayment
FPPC Form 700 - Schedule C (2019/2020)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
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Instructions – Schedule C
Income, Loans, & Business Positions
(Income Other Than Gifts and Travel Payments)
Reporting Income:
Report the source and amount of gross income of $500 or
more you received during the reporting period. Gross income
isthetotalamountofincomebeforedeductingexpenses,
losses,ortaxesandincludesloansotherthanloansfroma
commerciallendinginstitution.(SeeReferencePamphlet,
page11.)Youmustalsoreportthesourceofincometoyour
spouse or registered domestic partner if your community
property share was $500 or more during the reporting period.
The source and income must be reported only if the source
islocatedin,doingbusinessin,planningtodobusinessin,
or has done business during the previous two years in your
agency’sjurisdiction.(SeeReferencePamphlet,page13.)
Reportable sources of income may be further limited by
yourdisclosurecategorylocatedinyouragency’sconictof
interest code.
Reporting Business Positions:
Youmustreportyourjobtitlewitheachreportablebusiness
entity even if you received no income during the reporting
period. Use the comments section to indicate that no income
was received.
Commonly reportable income and loans include:
• Salary/wages,perdiem,andreimbursementforexpenses
including travel payments provided by your employer
• Communitypropertyinterest(50%)inyourspouse’s
orregistereddomesticpartner’sincome-report the
employers name and all other required information
• Incomefrominvestmentinterests,suchaspartnerships,
reported on Schedule A-1
• Commissionincomenotrequiredtobereportedon
ScheduleA-2(SeeReferencePamphlet,page8.)
• Grossincomefromanysale,includingthesaleofahouse
orcar(Reportyourproratashareofthetotalsaleprice.)
• RentalincomenotrequiredtobereportedonScheduleB
• Prizes or awards not disclosed as gifts
• Payments received on loans you made to others
• Anhonorariumreceivedpriortobecomingapublicocial
(SeeReferencePamphlet,page10.)
• Incentivecompensation(SeeReferencePamphlet,page
12.)
You are not required to report:
• Salary,reimbursementforexpensesorperdiem,or
socialsecurity,disability,orothersimilarbenetpayments
received by you or your spouse or registered domestic
partnerfromafederal,state,orlocalgovernmentagency.
• Stock dividends and income from the sale of stock unless
thesourcecanbeidentied.
• IncomefromaPERSretirementaccount.
(SeeReferencePamphlet,page12.)
To Complete Schedule C:
Part 1. Income Received/Business Position Disclosure
• Disclose the name and address of each source of income
or each business entity with which you held a business
position.
• Provide a general description of the business activity if the
source is a business entity.
• Check the box indicating the amount of gross income
received.
• Identifytheconsiderationforwhichtheincomewas
received.
• Forincomefromcommissionsales,checkthebox
indicating the gross income received and list the name of
eachsourceofcommissionincomeof$10,000ormore.
(SeeReferencePamphlet,page8.)Note: If you receive
commission income on a regular basis or have an
ownership interest of 10% or more, you must disclose
the business entity and the income on Schedule A-2.
• Disclosethejobtitleorbusinessposition,ifany,thatyou
heldwiththebusinessentity,evenifyoudidnotreceive
income during the reporting period.
Part 2. Loans Received or Outstanding During the
Reporting Period
• Provide the name and address of the lender.
• Provide a general description of the business activity if the
lender is a business entity.
• Check the box indicating the highest balance of the loan
during the reporting period.
• Disclose the interest rate and the term of the loan.
- Forvariableinterestrateloans,disclosetheconditions
oftheloan(e.g.,Prime+2)ortheaverageinterestrate
paid during the reporting period.
- The term of the loan is the total number of months or
years given for repayment of the loan at the time the
loan was entered into.
• Identifythesecurity,ifany,fortheloan.
Reminders
• Codelers–yourdisclosurecategoriesmaynotrequire
disclosure of all sources of income.
• Ifyouoryourspouseorregistereddomesticpartnerare
self-employed,reportthebusinessentityonScheduleA-2.
• DonotdiscloseonScheduleCincome,loans,orbusiness
positions already reported on Schedules A-2 or B.
FPPC Form 700 (2019/2020)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
Page - 14
SCHEDULE D
Income – Gifts
Comments:
Name
700
FAIR POLITICAL PRACTICES COMMISSION
CALIFORNIA FORM
► NAMEOFSOuRCE(Not an Acronym)
ADDRESS (Business Address Acceptable)
 BuSINESSACTIvITY,IFANY,OFSOuRCE
DATE (mm/dd/yy) vALuE DESCRIPTIONOFGIFT(S)
/ / $
/ / $
/ / $
► NAMEOFSOuRCE(Not an Acronym)
ADDRESS (Business Address Acceptable)
 BuSINESSACTIvITY,IFANY,OFSOuRCE
DATE (mm/dd/yy) vALuE DESCRIPTIONOFGIFT(S)
/ / $
/ / $
/ / $
► NAMEOFSOuRCE(Not an Acronym)
ADDRESS (Business Address Acceptable)
 BuSINESSACTIvITY,IFANY,OFSOuRCE
DATE (mm/dd/yy) vALuE DESCRIPTIONOFGIFT(S)
/ / $
/ / $
/ / $
► NAMEOFSOuRCE(Not an Acronym)
ADDRESS (Business Address Acceptable)
 BuSINESSACTIvITY,IFANY,OFSOuRCE
DATE (mm/dd/yy) vALuE DESCRIPTIONOFGIFT(S)
/ / $
/ / $
/ / $
► NAMEOFSOuRCE(Not an Acronym)
ADDRESS (Business Address Acceptable)
 BuSINESSACTIvITY,IFANY,OFSOuRCE
DATE (mm/dd/yy) vALuE DESCRIPTIONOFGIFT(S)
/ / $
/ / $
/ / $
► NAMEOFSOuRCE(Not an Acronym)
ADDRESS (Business Address Acceptable)
 BuSINESSACTIvITY,IFANY,OFSOuRCE
DATE (mm/dd/yy) vALuE DESCRIPTIONOFGIFT(S)
/ / $
/ / $
/ / $
FPPC Form 700 - Schedule D (2019/2020)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
Page - 15
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Instructions – Schedule D
Income – Gifts
Reminders
• $500 limit in
2019
•  you only need to report gifts from
reportable sources.
Gift Tracking Mobile Application
• FPPC has created a gift tracking app for mobile

and easy way to upload the information to the Form

A gift is anything of value for which you have not provided


multiple gifts totaling $50 or more received during the
reporting period from a single source must be reported.



gave it away to another person.





business activity of both the donor and the intermediary.



of Schedule D.
Commonly reportable gifts include:
 Tickets/passes to sporting or entertainment events
 Tickets/passes to amusement parks
 
 
provided in direct connection with your attendance at a

gathering
 Rebates/discounts not made in the regular course of

status
 
 



Reference 
 
 Forgiveness of a loan received by you
You are not required to disclose:
 

charitable organization or government agency without
being claimed by you as a charitable contribution for tax
purposes
 

certain other family members (See Regulation 18942 for a

was acting as an agent or intermediary for a reportable
source who was the true donor.
 Gifts of similar value exchanged between you and an


 Gifts of informational material provided to assist you in the


 
investments or real property may be reportable on other

 
less than $250
 Campaign contributions
 

for an organization exempt from taxation under Section

be received from the organization or committee holding the
fundraiser.
 Gifts given to members of your immediate family if the
source has an established relationship with the family
member and there is no evidence to suggest the donor had

 



the admission is provided by the person who organizes the
event.
 

made by an individual who is not a lobbyist registered to

gift was made because of an existing personal or business

is no evidence whatsoever at the time the gift is made to

To Complete Schedule D:
 

 
disclose the fair market value and description of the gift.
FPPC Form 700 (2019/2020)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
Page - 16
SCHEDULE E
Income – Gifts
Travel Payments, Advances,
and Reimbursements

Comments:
700
FAIR POLITICAL PRACTICES COMMISSION
CALIFORNIA FORM
Mark either the gift or income box.
Mark the “501(c)(3)” box for a travel payment received from a nonprot 501(c)(3) organization
or the “Speech” box if you made a speech or participated in a panel. Per Government Code
Section 89506, these payments may not be subject to the gift limit. However, they may result
in a disqualifying conict of interest.
For gifts of travel, provide the travel destination.
 / / - / / 
(If gift)

/ / - / / 
(If gift)
 (Not an Acronym)
ADDRESS (Business Address Acceptable)
 

 (Not an Acronym)
ADDRESS (Business Address Acceptable)
 

 (Not an Acronym)
ADDRESS (Business Address Acceptable)
 

 (Not an Acronym)
ADDRESS (Business Address Acceptable)
 

 
   
Other - Provide Description
Gift -or- 
   
 
   
Other - Provide Description
Gift -or- 
   
 
   
Other - Provide Description
Gift -or- 
   
 
   
Other - Provide Description
Gift -or- 
   

/ / - / / 
(If gift)
 / / - / / 
(If gift)
FPPC Form 700 - Schedule E (2019/2020)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
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Travel payments reportable on Schedule E include advances

including lodging and meals.



or the perception that you have received a gift in excess of

the purpose of your travel. (See the FPPC fact sheet entitled

to read about travel payments under section

You are not required to disclose:
 


reimbursement for travel on agency business from your
government agency employer.
 
government agency and related per diem expenses when

programs or purposes.
 Travel payments received from your employer in the
normal course of your employment that are included in the
income reported on Schedule C.
 




board member.
Note: Certain travel payments may not be reportable
if reported via email on Form 801 by your agency.
To Complete Schedule E:
 
source of the travel payment.
 
entity.
 

Travel payments are gifts if you did not provide


$50 or more from a single source during the period
covered by the statement.

provide a description of the giftthe date(s) received
and the travel destination.
Travel payments are income if you provided services


$500 or more from a single source during the period

proving the payments are income rather than gifts.

describe the services you provided in exchange for the

for travel paymen
ts that are income.
Example:
City council member  Chandler is the chair of a
and the association pays for her
travel to attend its meetings. Because  is deemed

payment by virtue of

payment may be reported
as income. Payments
for  to attend
other events for which she
is not providing services
are likely considered
gifts. 


Example:






creation and economic
activity in China and in

is reasonably related to
a governmental purpose.


but the gift is exempt from

the travel payments are

because the source is
a foreign government and because the travel is reasonably



Government for 12 months. Also note that if China Silicon





Instructions – Schedule E
Travel Payments, Advances,
and Reimbursements
FPPC Form 700 (2019/2020)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
Page - 18

Income – Gifts

and Reimbursements
Name

FPPC Form 700 (2016/2017) Sch. E
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
700

CALIFORNIA FORM





DATE(S): / / - / / AMT: $
(If gift)
DATE(S):
/ / - / / AMT: $
(If gift)
►NAME OF SOURCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
CITYAND STATE
501(c)(3)orDESCRIBEBuSINESSACTIvITY,IFANY,OFSOuRCE
►NAME OF SOURCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
CITYAND STATE
501(c)(3)orDESCRIBEBuSINESSACTIvITY,IFANY,OFSOuRCE
►NAME OF SOURCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
CITYAND STATE
501(c)(3)orDESCRIBEBuSINESSACTIvITY,IFANY,OFSOuRCE
►NAME OF SOURCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
CITYAND STATE
501(c)(3)orDESCRIBEBuSINESSACTIvITY,IFANY,OFSOuRCE
►MuST CHECK ONE:
Made aSpeech/Participated in a Panel
Other - Provide Description
Gift  Income
►If Gift, Provide Travel Destination
►MuST CHECK ONE:
Made aSpeech/Participated in a Panel
Other - Provide Description
Gift  Income
►If Gift, Provide Travel Destination
►MuST CHECK ONE:
Made aSpeech/Participated in a Panel
Other - Provide Description
Gift  Income
►If Gift, Provide Travel Destination
►MuST CHECK ONE:
Made aSpeech/Participated in a Panel
Other - Provide Description
Gift  Income
►If Gift, Provide Travel Destination
DATE(S):
/ / - / / AMT: $
(If gift)
DATE(S):
/ / - / / AMT: $
(If gift)
Health Services Trade Association
1230 K Street, Suite 610
Sacramento, CA
Association of Healthcare Workers
550.00
Travel reimbursement for
board meeting.
Chengdu Municipal People's Government
2 Caoshi St, CaoShiJie, Qingyang Qu, Chengdu Shi,
Sichuan Sheng, China, 610000
09
04
09
08
3,874.38
Travel reimbursement for
trip to China.
Sichuan Sheng, China
XX
XX
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
Income – Gifts

and Reimbursements
Name

FPPC Form 700 (2016/2017) Sch. E
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
700

CALIFORNIA FORM





DATE(S): / / - / / AMT: $
(If gift)
DATE(S):
/ / - / / AMT: $
(If gift)
►NAME OF SOURCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
CITYAND STATE
501(c)(3)orDESCRIBEBuSINESSACTIvITY,IFANY,OFSOuRCE
►NAME OF SOURCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
CITYAND STATE
501(c)(3)orDESCRIBEBuSINESSACTIvITY,IFANY,OFSOuRCE
►NAME OF SOURCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
CITYAND STATE
501(c)(3)orDESCRIBEBuSINESSACTIvITY,IFANY,OFSOuRCE
►NAME OF SOURCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
CITYAND STATE
501(c)(3)orDESCRIBEBuSINESSACTIvITY,IFANY,OFSOuRCE
►MuST CHECK ONE:
Made aSpeech/Participated in a Panel
Other - Provide Description
Gift  Income
►If Gift, Provide Travel Destination
►MuST CHECK ONE:
Made aSpeech/Participated in a Panel
Other - Provide Description
Gift  Income
►If Gift, Provide Travel Destination
►MuST CHECK ONE:
Made aSpeech/Participated in a Panel
Other - Provide Description
Gift  Income
►If Gift, Provide Travel Destination
►MuST CHECK ONE:
Made aSpeech/Participated in a Panel
Other - Provide Description
Gift  Income
►If Gift, Provide Travel Destination
DATE(S):
/ / - / / AMT: $
(If gift)
DATE(S):
/ / - / / AMT: $
(If gift)
Health Services Trade Association
1230 K Street, Suite 610
Sacramento, CA
Association of Healthcare Workers
550.00
Travel reimbursement for
board meeting.
Chengdu Municipal People's Government
2 Caoshi St, CaoShiJie, Qingyang Qu, Chengdu Shi,
Sichuan Sheng, China, 610000
09
04
09
08
3,874.38
Travel reimbursement for
trip to China.
Sichuan Sheng, China
XX
XX
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Restrictions and Prohibitions
The Political Reform Act (Gov. Code Sections 81000-
91014)requiresmoststateandlocalgovernmentocials
and employees to publicly disclose their personal assets
andincome.Theyalsomustdisqualifythemselves
fromparticipatingindecisionsthatmayaecttheir
personal economic interests. The Fair Political Practices
Commission(FPPC)isthestateagencyresponsiblefor
issuingtheattachedStatementofEconomicInterests,
Form700,andforinterpretingthelaw’sprovisions.
Gift Prohibition
Giftsreceivedbymoststateandlocalocials,employees,
andcandidatesaresubjecttoa limit. In2019-2020,thegift
limit is $500 from a single source during a calendar year.
Additionally,stateocials,statecandidates,andcertain
stateemployeesaresubjecttoa$10limitpercalendar
monthongiftsfromlobbyistsandlobbyingrmsregistered
withtheSecretaryofState.SeeReferencePamphlet,
page 10.
Stateandlocalocialsandemployeesshouldcheckwith
their agency to determine if other restrictions apply.
Disqualication
Publicocialsare,undercertaincircumstances,required
todisqualifythemselvesfrommaking,participatingin,or
attemptingtoinuencegovernmentaldecisionsthatwill
aecttheireconomicinterests.Thismayincludeinterests
theyarenotrequiredtodisclose.Forexample,apersonal
residenceisoftennotreportable,butmaybegroundsfor
disqualication.Specicdisqualicationrequirements
applyto87200lers(e.g.,citycouncilmembers,members
ofboardsofsupervisors,planningcommissioners,etc.).
Theseocialsmustpubliclyidentifytheeconomicinterest
thatcreatesaconictofinterestandleavetheroombefore
a discussion or vote takes place at a public meeting. For
moreinformation,consultGovernmentCodeSection
87105,Regulation18707,andtheGuidetoRecognizing
ConictsofInterestpageatwww.fppc.ca.gov.
Honorarium Ban
Moststateandlocalocials,employees,andcandidates
are prohibited from accepting an honorarium for any
speechgiven,articlepublished,orattendanceata
conference,convention,meeting,orlikegathering.(See
ReferencePamphlet,page10.)
Loan Restrictions
Certainstateandlocalocialsaresubjecttorestrictions
onloans.(SeeReferencePamphlet,page14.)
Post-Governmental Employment
There are restrictions on representing clients or employers
before former agencies. The provisions apply to elected
stateocials,moststateemployees,localelectedocials,
countychiefadministrativeocers,citymanagers,
includingthechiefadministratorofacity,andgeneral
managers or chief administrators of local special districts
andJPAs.TheFPPCwebsitehasfactsheetsexplaining
the provisions.
Late Filing
Thelingocerwhoretainsoriginally-signedor
electronicallyledstatementsofeconomicinterestsmay
imposeonanindividualaneforanystatementthatisled
late.Theneis$10perdayuptoamaximumof$100.
Latelingpenaltiesmaybereducedorwaivedundercertain
circumstances.
PersonswhofailtotimelyletheirForm700maybe
referredtotheFPPC’sEnforcementDivision(and,insome
cases,totheAttorneyGeneralordistrictattorney)for
investigationandpossibleprosecution.Inadditiontothe
latelingpenalties,aneofupto$5,000perviolationmay
be imposed.
For assistanceconcerningreporting,prohibitions,and
restrictions under the Act:
• Emailquestionstoadvice@fppc.ca.gov.
• CalltheFPPCtoll-freeat(866)275-3772.
Form 700 is a Public Document
Public Access Must Be Provided
StatementsofEconomicInterestsarepublic
documents.Thelingocermustpermitany
member of the public to inspect and receive a copy
of any statement.
• Statements must be available as soon as possible
duringtheagency'sregularbusinesshours,but
in any event not later than the second business
day after the statement is received. Access to the
Form700isnotsubjecttothePublicRecordsAct
procedures.
• Noconditionsmaybeplacedonpersonsseeking
access to the forms.
• Noinformationoridenticationmayberequired
from persons seeking access.
• Reproduction fees of no more than 10 cents per
page may be charged.
FPPC Form 700 (2019/2020)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
Page - 19
Questions and Answers
General
Q. What is the reporting period for disclosing interests

statement?
 

business positions held on the date you assumed









candidacy.


economic interests?
 
one statement listing the county and the two boards on
the Cover Page or an attachment as the agencies for





and distribute one original to the county and to each
of the two boards. Remember to complete separate
statements for positions that you leave or assume
during the year.


 


they are or may be performing the duties of the
position.



property?
 
economic interests until such time as dissolution of

property agreement has been reached prior to that

be reported. Contact the FPPC for more information.



 
statement for the new agency.
Investment Disclosure



company?
 






disclosure. How is this trust disclosed?
 


with the SEC are not reportable.

that contains stocks through an account managed by


which stocks to purchase?
 


Q. The value of my stock changed during the reporting

 

use your monthly statements to determine the highest


keep a record of where you found the reported value.

report the value of the stock on the date you assumed

FPPC Form 700 (2019/2020)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
Page - 20
Questions and Answers
Continued





contract does not have resale value because of its

the fair market value for my business on Schedule A-2
of the Form 700?
 tangible







goodwill that generates income are not without a

precise fair market value; it is only necessary to check
a box indicating the broad range within which the value
falls.





 


or more or when you dispose of the entire investment.

investment.




 
entire reporting period.





Q. We have a Section 529 account set up to save money

 

interests are reportable (not the actual Section 529

then nothing is reported.
Income Disclosure


all clients from whom my pro rata share of income is

 


clients from whom my pro rata share of income is


names?
 

disclosed if disclosure of the name would violate a
legally recognized privilege under California or Federal
law. This regulation may be obtained from our website
at www.fppc.ca.gov. (


reportable based on my limited disclosure category.


disclose this income?
 
reportable sources of income to the law practice of

would be disclosed on Schedule C with a note in the

is not a reportable investment. The note would be for

FPPC Form 700 (2019/2020)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
Page - 21
Questions and Answers
Continued

disclose my income - on Schedule A-2 or Schedule C?
A. Sources of income to a business in which you have an



all of his business is based on his own billings and

community property interest in this business and the
income generated in this manner?
 





reported.


A. Report the name of the employer as a source of income
on Schedule C.


patients or their insurance carriers considered sources
of income?
 





 
reportable.


report this loan repayment on my Form 700?
 
member are not reportable.
Real Property Disclosure
Q. During this reporting period we switched our principal




date?
 


the property was not previously reported because it was
used exclusively as your residence. This would be for



need to report this property interest?
 
it is located within 2 miles of the boundaries of the city
you manage.

for my daughter?
 
personal residence for a family member unless you




property on my Form 700?
 
does not create a reportable interest in real property for
you.
Gift Disclosure
Q. 


reporting obligations?
 

disclose the gift on Schedule D.
FPPC Form 700 (2019/2020)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
Page - 22
Q.  and 

spouse considered a separate source for purposes of
the gift limit and disclosure?
A. 
limit 2019

the supervisor artwork valued at no more than $.
The supervisor must identify  and  Benson as
the sources of the gift.



basket valued at $120. The gift basket was donated by



reportable gifts?
A. Because the gift basket was donated by an outside

reportable gift valued at $110 (the value of the basket

is Doug Brewer and the agency is disclosed as the





the applicant provided food and beverages. Would
the food and beverages be considered gifts to the
employees? These employees are designated in our

reportable source of income under the code.


same source during the reporting period total $50 or


limit.



considered informational material?
 


Questions and Answers
Continued
FPPC Form 700 (2019/2020)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
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