Fill - Free fillable 2019-2020 Statement of Economic Interests (CITY OF LA HABRA) PDF form

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

• 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 year’s 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

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

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

 

 

 

     

      

  

     

      

  



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

lender’s 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

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

4600 24th Street

Sacramento

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

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

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





 

     

     

     

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)

 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

Page - 13

Clear Page

Print

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

employer’s 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

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

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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

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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

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