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Economic Interest 2014.2015

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December 2014
2014/2015
Statement of
Economic Interests
Form 700
California Fair Political Practices Commission
428 J Street, Suite 620 • Sacramento, CA 95814
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
Also available on the FPPC website:
•
Form700inExcelformat
• Reference Pamphlet for Form 700
What’s New
Gift Limit Increase
The gift limit increased to $460 for calendar years 2015 and
2016. The gift limit during 2014 was $440.
Who must le:
• Electedandappointedofcialsandcandidateslistedin
Government Code Section 87200
•
Employees,appointedof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
• C
andidatesrunningforlocalelectiveofcesthatare
designatedinaconictofinterestcode(e.g.,countysheriffs,
cityclerks,schoolboardtrustees,andwaterboardmembers)
• 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
See Reference Pamphlet, page 3, at www.fppc.ca.gov or
obtainfromyourlingofcer.
Where to le:
87200 Filers
Stateofces  Your agency
Judicialofces  The clerk of your court
Retired Judges  Directly with FPPC
Countyofces  Yourcountylingofcial
Cityofces  Your city clerk
Multi-Countyofces  Your agency
Code Filers — State and Local Of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conictofinterestcode(e.g.,
Legislativestaff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of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ofcertoleelectronicallyunderGovernment
CodeSection87500.2.Instructions,examples,FAQs,and
a reference pamphlet are available to help answer your
questions.
When to le:
Annual Statements
March 2, 2015
- ElectedStateOfcers
- Judges and Court Commissioners
- State Board and Commission Members listed in
Government Code Section 87200
April 1, 2015
- 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ofcers.
Statementspostmarkedbythelingdeadlineareconsidered
ledontime.
Assuming Ofce and Leaving Ofce Statements
Mostlerslewithin30daysofassumingorleavingofce
or within 30 days of the effective date of a newly adopted or
amendedconictofinterestcode.
Exception:
IfyouassumedofcebetweenOctober1, 2014, and December
31, 2014,andledanassumingofcestatement,youarenot
requiredtoleanannualstatementuntilMarch1, 2016, or April
1, 2016, whichever is applicable. The annual statement will
coverthedayafteryouassumedofcethroughDecember31,
2015. See Reference Pamphlet, pages 6 and 7, for additional
exceptions.
Candidate Statements
Filenolaterthanthenallingdateforthedeclarationof
candidacy or nomination documents.
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.
There is no provision for ling deadline extensions unless
the ler is serving in active military duty. (Regulation 18723)
Statements of 30 pages or less may be faxed by the deadline
aslongastheoriginallysignedpaperversionissentbyrst
classmailtothelingofcialwithin24hours.
Introduction
ThePoliticalReformAct(Gov.CodeSections81000-
91014)requiresmoststateandlocalgovernmentofcials
and employees to publicly disclose their personal assets
and income. They also must disqualify themselves
from participating in decisions that may affect 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ofcials,employees,
and candidates are subject to a limit. During 2013 and
2014, the gift limit was $440 from a single source per
calendar year. For years 2015-2016, the limit increased to
$460 from a single source during a calendar year.
Inaddition,stateof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ofcialsandemployeesshouldcheckwith
their agency to determine if other restrictions apply.
Disqualication
Publicofcialsare,undercertaincircumstances,required
to disqualify themselves from making, participating in, or
attemptingtoinuencegovernmentaldecisionsthatwill
affect their economic interests. This may include interests
theyarenotrequiredtodisclose(i.e.,apersonalresidence
isoftennotreportable,butmaybedisqualifying).Specic
disqualicationrequirementsapplyto87200lers(e.g.,
city councilmembers, members of boards of supervisors,
planningcommissioners,etc.).Theseofcialsmust
identifyorally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
18702.5,andtheOverviewoftheConictofInterestLaws
at www.fppc.ca.gov.
Honorarium Ban
Moststateandlocalof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of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ofcials,moststateemployees,localelectedofcials,
countychiefadministrativeof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of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.
FPPC Form 700 (2014/2015)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
Introducon
Form 700 is a Public Document
Public Access Must Be Provided
StatementsofEconomicInterestsarepublic
documents.Thelingof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.
Types of Form 700 Filings
Assuming Ofce Statement:
Ifyouareanewlyappointedof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ofcedateisthedateyouweresworninor
otherwiseauthorizedtoserveintheposition.Ifyouarea
newlyelectedofcial,yourassumingofcedateisthedate
you were sworn in.
•
Investments,interestsinrealproperty,andbusiness
positionsheldonthedateyouassumedtheof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
ofceorpositionisreportable.
ForpositionssubjecttoconrmationbytheStateSenate
or the Commission on Judicial Performance, your
assumingof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of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ofceorpositionhasbeenaddedtoanewly
adoptedornewlyamendedconictofinterestcode,use
the effective date of the code or amendment, whichever is
applicable.
•
Investments,interestsinrealproperty,andbusiness
positions held on the effective 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 effective date of the
code or amendment is reportable.
Annual Statement:
Generally, the period covered is January 1, 2014,
throughDecember31,2014.Iftheperiodcoveredby
the statement is different than January 1, 2014, through
December31,2014,(forexample,youassumedofce
between October 1, 2013, and December 31, 2013 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 2014.
• Ifyourdisclosurecategorychangesduringareporting
period, disclose under the old category until the
effectivedateoftheconictofinterestcodeamendment
and disclose under the new disclosure category through
the end of the reporting period.
Leaving Ofce Statement:
Generally, the period covered is January 1, 2014,
through the date you stopped performing the duties of
yourposition.IftheperiodcovereddiffersfromJanuary
1, 2014, through the date you stopped performing the
dutiesofyourposition(forexample,youassumedofce
between October 1, 2013, and December 31, 2013, or
youarecombiningstatements),theperiodcoveredmust
bespecied.Thereportingperiodcancoverpartsoftwo
calendar years.
•
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 2014.
Candidate Statement:
Ifyouarelingastatementinconnectionwithyour
candidacyforstateorlocalof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
ofces(e.g.,county
sheriffs, city clerks, school board trustees, and 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.
FPPC Form 700 (2014/2015)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
Types of Statements
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/ofce
address instead of your home address.
Part 1. Ofce, Agency, or Court
• Enterthenameoftheof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;Of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;Staff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1annuallingdeadlinemustle
aseparateassumingofcestatement.Insubsequentyears,
thecitycouncilmembermayexpandhisorherannuallingto
include both positions.
Example:
Scott Baker 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. Scott 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, Scott 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 Of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.
•
Ifyouragencyisamulti-countyofce,listeachcountyin
which your agency has jurisdiction.
•
Ifyouragencyisnotastateofce,court,countyofce,city
ofce,ormulti-countyof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 2014 annual statement, do not change the
pre-printeddatestoreect2015. Your annual statement is
used for reporting the previous year’s economic interests.
EconomicinterestsforyourannuallingcoveringJanuary 1,
2015, through December 31, 2015, will be disclosed on your
statementledin2016. See Reference Pamphlet, page 4.
Combining Statements: Certain types of statements may be
combined.Forexample,ifyouleaveofceafterJanuary1,
butbeforethedeadlineforlingyourannualstatement,you
maycombineyourannualandleavingofcestatements.File
bytheearliestdeadline.Consultyourlingofcerorthe
FPPC.
Part 4. Schedule Summary
• 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ofcerto
leelectronicallyunderGovernmentCodeSection87500.2.
Instructions,examples,FAQs,andareferencepamphletare
available to help answer your questions. 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.
FPPC Form 700 (2014/2015)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
Instrucons – 1
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
Leaving Ofce: Date Left / /
(Check one)
The period covered is January 1, 2014, 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, 2014, through
December 31, 2014.
The period covered is / / , through
December 31, 2014.
STATEMENT OF ECONOMIC INTERESTS
COVER PAGE
FPPC Form 700 (2014/2015)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
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 or Court Commissioner (Statewide Jurisdiction)
Multi-County
County of
City of
Other
2. Jurisdiction of Ofce (Check at least one box)
Candidate: Election year and ofce sought, if different than Part 1:
Assuming Ofce: Date assumed / /
DateInitialFiling
Received
Of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
4. Schedule Summary
NAME OF FILER (LAST) (FIRST) (MIDDLE)
Check applicable schedules or “None.”
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:
MAILING ADDRESS STREET CITY STATE ZIP CODE
()
DAYTIME TELEPHONE NUMBER
E-MAIL ADDRESS
(Business or Agency Address Recommended - Public Document)
Signature
(File the originally signed statement with your ling ofcial.)
5. Verication
Schedule C - Income, Loans, & Business Positions – schedule attached
Schedule D - Income – Gifts – schedule attached
Schedule E - Income – Gifts – Travel Payments – schedule attached
-or-
None - No reportable interests on any schedule
A PUBLIC DOCUMENT
► If ling for multiple positions, list below or on an attachment. (Do not use acronyms)
Agency:
Position:
-or-
Clear Page
Print Form
Which Schedule Do I Use?
FPPC Form 700 (2014/2015)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
Instrucons - 3
Common Reportable Interests
Schedule A-1 Stocks, includingthoseheldinanIRAora401K
Schedule A-2 Business entities (includingcertainindependentcontracting),soleproprietorships,
partnerships, LLCs, corporations, and trusts
Schedule B Rental property in the jurisdiction
Schedule C Non-governmental
salariesofpublicofcialandspouse/registereddomesticpartner
Schedule D Gifts from businesses (suchasticketstosportingorentertainmentevents)
Schedule E Travelpaymentsfromthirdparties(notyouremployer)
Common Non-Reportable Interests
Schedule A-1 Insurancepolicies,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, for detailed
information.(Regulation18237)
Schedule A-2 Savings and checking accounts and annuities
Schedule B
Aresidenceusedexclusivelyasapersonalresidence(suchasahome or vacation
cabin)
Schedule C Governmental
salary(suchasaschooldistrict)
Schedule D Gifts from family members
Schedule E Travel paid by your government agency
Remember:
9 Markthe“Noreportableinterests”boxonPart4oftheSchedule Summary on the Cover Page
ifyoudetermineyouhavenothingtodiscloseandletheCoverPageonly. Make sure you
carefully read all instructions to ensure proper reporting.
9 The Form 700 is a public document.
9 Most individuals must consult their agency’s conict of interest code for reportable
interests.
9 MostindividualsletheForm700withtheiragencies.
9 Whenyouleyourstatement,bringacopytohavedatestampedforyourrecords.
Questions and Answers
General
Q.Whatisthereportingperiodfordisclosinginterests
onanassumingofcestatementoracandidate
statement?
A. Onanassumingofcestatement,discloseall
reportable investments, interests in real property, and
business positions held on the date you assumed
ofce.Inaddition,youmustdiscloseincome(including
loans,giftsandtravelpayments)receivedduringthe12
monthspriortothedateyouassumedofce.
On a candidate statement, disclose all reportable
investments, interests in real property, and business
positionsheldonthedateyouleyourdeclarationof
candidacy.Youmustalsodiscloseincome(including
loans,giftsandtravelpayments)receivedduringthe
12monthspriortothedateyouleyourdeclarationof
candidacy.
Q.Iholdtwootherboardpositionsinadditiontomy
positionwiththecounty.MustIlethreestatementsof
economic interests?
A. Yes, three are required. However, you may complete
one statement listing the county and the two boards on
the Cover Page or an attachment as the agencies for
whichyouwillbeling.Reportyoureconomicinterests
using the largest jurisdiction and highest disclosure
requirements assigned to you by the three agencies.
Make two copies of the entire statement before
signing it, sign each copy with an original signature,
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.
Q.Iamadepartmentheadwhorecentlybeganactingas
citymanager.ShouldIleasthecitymanager?
A. Yes.Fileanassumingofcestatementascity
manager.Personsservingas“acting,”“interim,”or
“alternate”mustleasiftheyholdthepositionbecause
they are or may be performing the duties of the
position.
Q.Asadesignatedemployee,Ileftonestateagencyto
workforanotherstateagency.MustIlealeaving
ofcestatement?
A. Yes.Youmayalsoneedtoleanassumingofce
statement for the new agency.
Investment Disclosure
Q.Ihaveaninvestmentinterestinsharesofstockina
companythatdoesnothaveanofceinmyjurisdiction.
MustIstilldisclosemyinvestmentinterestinthis
company?
A. Probably.Thedenitionof“doingbusinessinthe
jurisdiction”isnotlimitedtowhetherthebusinesshas
anofceorphysicallocationinyourjurisdiction.See
Reference Pamphlet, page 13.
Q.MyspouseandIhavealivingtrust.Thetrustholds
rental property in my jurisdiction, our primary residence,
andinvestmentsindiversiedmutualfunds.Ihavefull
disclosure. How is this trust disclosed?
A. Disclose the name of the trust, the rental property and
its income on Schedule A-2. Your primary residence
andinvestmentsindiversiedmutualfundsregistered
with the SEC are not reportable.
Q.Iamrequiredtoreportallinvestments.IhaveanIRA
that contains stocks through an account managed by
abrokeragerm.MustIdisclosethesestockseven
thoughtheyareheldinanIRAandIdidnotdecide
which stocks to purchase?
A. Yes. Disclose on Schedule A-1 or A-2 any stock worth
$2,000 or more in a business entity located in or doing
business in your jurisdiction.
Q.IownstockinIBMandmustreportthisinvestment
onScheduleA-1.Iinitiallypurchasedthisstockin
theearly1990s;however,Iamconstantlybuying
andsellingshares.MustInotethesedatesinthe
“Acquired”and“Disposed”elds?
A. No.Youmustonlyreportdatesinthe“Acquired”or
“Disposed”eldswhen,duringthereportingperiod,you
initially purchase a reportable investment worth $2,000
or more or when you dispose of the entire investment.
You are not required to track the partial trading of an
investment.
FPPC Form 700 (2014/2015)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
Instrucons – 4
Questions and Answers
Continued
Q.Onlastyear’slingIreportedstockinEncoevaluedat
$2,000 - $10,000. Late last year the value of this stock
fell below and remains at less than $2,000. How should
thisbereportedonthisyear’sstatement?
A. You are not required to report an investment if the value
was less than $2,000 during the entire reporting period.
However, because a disposed date is not required for
stocks that fall below $2,000, you may want to report
thestockandnoteinthe“comments”sectionthatthe
value fell below $2,000. This would be for informational
purposes only; it is not a requirement.
Q.WehaveaSection529accountsetuptosavemoney
forourson’scollegeeducation.Isthisreportable?
A. IftheSection529accountcontainsreportableinterests
(e.g.,commonstockvaluedat$2,000ormore),those
interestsarereportable(nottheactualSection529
account).Iftheaccountcontainssolelymutualfunds,
then nothing is reported.
Income Disclosure
Q.IreportedabusinessentityonScheduleA-2.Clientsof
mybusinessarelocatedinseveralstates.MustIreport
all clients from whom my pro rata share of income is
$10,000 or more on Schedule A-2, Part 3?
A. No, only the clients doing business on a regular basis in
your jurisdiction must be disclosed.
Q.IbelieveIamnotrequiredtodisclosethenamesof
clients from whom my pro rata share of income is
$10,000 or more on Schedule A-2 because of their right
toprivacy.Isthereanexceptionforreportingclients’
names?
A. Regulation 18740 provides a procedure for requesting
anexemptiontoallowaclient’snamenottobe
disclosed if disclosure of the name would violate a
legallyrecognizedprivilegeunderCalifornialaw.This
regulation may be obtained from our website at
www.fppc.ca.gov. See Reference Pamphlet, page 14.
Q.Iamsoleownerofaprivatelawpracticethatisnot
reportable based on my limited disclosure category.
However, some of the sources of income to my law
practicearefromreportablesources.DoIhaveto
disclose this income?
A. Yes, even though the law practice is not reportable,
reportable sources of income to the law practice of
$10,000 or more must be disclosed. This information
would be disclosed on Schedule C with a note in the
“comments”sectionindicatingthatthebusinessentity
is not a reportable investment. The note would be for
informational purposes only; it is not a requirement.
Q.Iamthesoleownerofmybusiness.WheredoI
disclose my income - on Schedule A-2 or Schedule C?
A. Sources of income to a business in which you have an
ownership interest of 10% or greater are disclosed on
Schedule A-2. See Reference Pamphlet, page 8, for
thedenitionof“businessentity.”
Q.Myhusbandisapartnerinafour-personrmwhere
all of his business is based on his own billings and
collectionsfromvariousclients.HowdoIreportmy
community property interest in this business and the
income generated in this manner?
A. Ifyourhusband’sinvestmentinthermis10%or
greater, disclose 100% of his share of the business
on Schedule A-2, Part 1 and 50% of his income on
Schedule A-2, Parts 2 and 3. For example, a client of
yourhusband’smustbeasourceofatleast$20,000
during the reporting period before her name is reported.
Q.HowdoIdisclosemyspouse’sorregistereddomestic
partner’ssalary?
A. Report the name of the employer as a source of income
on Schedule C.
Q.Iamadoctor.Forpurposesofreporting$10,000
sources of income on Schedule A-2, Part 3, are the
patients or their insurance carriers considered sources
of income?
A. Ifyourpatientsexercisesufcientcontrolbyselecting
you instead of other doctors, then your patients, rather
than their insurance carriers, are sources of income to
you. See Reference Pamphlet, page 14, for additional
information.
Q.Ireceivedaloanfrommygrandfathertopurchasemy
home.Isthisloanreportable?
A. No. Loans received from family members are not
reportable.
FPPC Form 700 (2014/2015)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
Instrucons – 5
Questions and Answers
Continued
Q.Iamrunningforre-electiontocitycouncilandmade
apersonalloantomycampaigncommittee.Isthis
reportable on my Form 700?
A. No, the loan is not reportable on Form 700; however,
loan repayments from a campaign committee are
reported on Schedule C as income.
Q.Manyyearsago,Iloanedmyparentsseveralthousand
dollars,whichtheypaidbackthisyear.DoIneedto
report this loan repayment on my Form 700?
A. No. Payments received on a loan made to a family
member are not reportable.
Real Property Disclosure
Q.Duringthisreportingperiodweswitchedourprincipal
placeofresidenceintoarental.Ihavefulldisclosure
andthepropertyislocatedinmyagency’sjurisdiction,
soitisnowreportable.BecauseIhavenotreported
thispropertybefore,doIneedtoshowan“acquired”
date?
A. No,youarenotrequiredtoshowan“acquired”date
because you previously owned the property. However,
youmaywanttonoteinthe“comments”sectionthat
the property was not previously reported because it was
used exclusively as your residence. This would be for
informational purposes only; it is not a requirement.
Q.MydaughterisbuyingherrsthomeandIamtheco-
signerontheloan.Iwon’toccupythehome,butmy
daughterwill.Thehomeislocatedinmyagency’s
jurisdiction.MustIreportthisproperty?
A. No. Property occupied by a family member is not
reportable as long as you are not receiving rental
income or using the property for business purposes.
Gift Disclosure
Q.IfIreceivedareportablegiftoftwoticketstoaconcert
valued at $100 each, but gave the tickets to a friend
becauseIcouldnotattendtheconcert,doIhaveany
reporting obligations?
A. Yes. Since you accepted the gift and exercised
discretion and control of the use of the tickets, you must
disclose the gift on Schedule D.
Q.MaryandJoeBenson,amarriedcouple,wanttogivea
pieceofartworktoacountysupervisor.Iseachspouse
considered a separate source for purposes of the gift
limit and disclosure?
FPPC Form 700 (2014/2015)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
Instrucons – 6
A. Yes, each spouse may make a gift valued at the gift
limit during a calendar year. For example, during 2014
the gift limit was $440, so the Bensons may have given
the supervisor artwork valued at no more than $880.
The supervisor must identify Joe and Mary Benson as
the sources of the gift.
Q.IamaForm700lerwithfulldisclosure.Ouragency
holdsaholidayrafetoraisefundsforalocalcharity.
Ibought$10worthofrafeticketsandwonagift
basket valued at $120. The gift basket was donated by
DougBrewer,acitizeninourcity.Atthesameevent,
Iboughtrafeticketsfor,andwonaquiltvaluedat
$70. The quilt was donated by a coworker. Are these
reportable gifts?
A. Because the gift basket was donated by an outside
source(notanagencyemployee),youhavereceiveda
reportablegiftvaluedat$110(thevalueofthebasket
lesstheconsiderationpaid).Thesourceofthegift
is Doug Brewer and the agency is disclosed as the
intermediary. Because the quilt was donated by an
employee of your agency, it is not a reportable gift.
Q.Myagencyisresponsiblefordisbursinggrants.An
applicant(501(c)(3)organization)metwithagency
employees to present its application. At this meeting,
theapplicantprovidedfoodandbeverages.Would
the food and beverages be considered gifts to the
employees? These employees are designated in our
agency’sconictofinterestcodeandtheapplicantisa
reportable source of income under the code.
A.Yes.Ifthevalueofthefoodandbeveragesconsumed
byanyoneler,plusanyothergiftsreceivedfromthe
same source during the reporting period total $50 or
more, the food and beverages would be reported using
the fair market value and would be subject to the gift
limit.
Q.Ireceivedfreeadmissiontoaneducationalconference
relatedtomyofcialduties.Partoftheconference
feesincludedaroundofgolf.Isthevalueofthegolf
considered informational material?
A. No.Thevalueofpersonalbenets,suchasgolf,
attendance at a concert, or sporting event, are gifts
subject to reporting and limits.
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 that 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
15, for more information on disclosing trusts.
• Business trusts
You are not required to disclose:
• Insurancepolicies,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,fordetailedinformation.(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ofcestatement,indicate
thefairmarketvalueonthelingdateorthedateyoutook
ofce,respectively.
• 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ofcestatement.
Examples:
JohnSmithholdsastateagencyposition.Hisconictof
interest code requires full disclosure of investments. John
must disclose his stock holdings of $2,000 or more in any
company that does business in California, as well as those
stocks held by his spouse or registered domestic partner and
dependent children.
Susan Jones is a city council member. She has a 4%
interest, worth $5,000, in a limited partnership located in the
city. Susan 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 (2014/2015)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
Instrucons – 7
IFAPPLICABLE,LISTDATE:
/ / / /
ACQUIRED DISPOSED
IFAPPLICABLE,LISTDATE:
/ / / /
ACQUIRED DISPOSED
IFAPPLICABLE,LISTDATE:
/ / / /
ACQUIRED DISPOSED
IFAPPLICABLE,LISTDATE:
/ / / /
ACQUIRED DISPOSED
IFAPPLICABLE,LISTDATE:
/ / / /
ACQUIRED DISPOSED
IFAPPLICABLE,LISTDATE:
/ / / /
ACQUIRED DISPOSED
14 14
14
14
1414
14
1414
Name
► NAME OFBUSINESS ENTITY
GENERAL DESCRIPTION OFTHISBUSINESS
► NAME OFBUSINESS ENTITY
GENERAL DESCRIPTION OFTHISBUSINESS
► NAME OFBUSINESS ENTITY
GENERAL DESCRIPTION OFTHISBUSINESS
► NAME OFBUSINESS ENTITY
GENERAL DESCRIPTION OFTHISBUSINESS
► NAME OFBUSINESS ENTITY
GENERAL DESCRIPTION OFTHISBUSINESS
► NAME OFBUSINESS ENTITY
GENERAL DESCRIPTION OFTHISBUSINESS
Comments:
SCHEDULE A-1
Investments
Stocks,Bonds, andOtherInterests
(OwnershipInterest isLessThan10%)
Do not attach brokerage or nancial statements.
700
FAIR POLITICAL PRACTICES COMMISSION
CALIFORNIA FORM
FPPC Form 700 (2014/2015) Sch. A-1
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
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
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
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
14
NATUREOFINVESTMENT
Stock Other
(Describe)
Partnership
IncomeReceived of $0 - $499
IncomeReceived of $500or More (Report on Schedule C)
NATUREOFINVESTMENT
Stock Other
(Describe)
Partnership
IncomeReceived of $0- $499
IncomeReceived of $500or More (Report on Schedule C)
NATUREOFINVESTMENT
Stock Other
(Describe)
Partnership
IncomeReceived of $0- $499
IncomeReceived of $500or More (Report on Schedule C)
NATUREOFINVESTMENT
Stock Other
(Describe)
Partnership
IncomeReceived of $0 - $499
IncomeReceived of $500or More (Report on Schedule C)
NATUREOFINVESTMENT
Stock Other
(Describe)
Partnership
IncomeReceived of $0 - $499
IncomeReceived of $500or More (Report on Schedule C)
NATUREOFINVESTMENT
Stock Other
(Describe)
Partnership
IncomeReceived of $0- $499
IncomeReceived of $500or More (Report on Schedule C)
14
14
Clear Page
Print Form
Instructions – Schedule A-2
Investments, Income, and Assets of Business Entities/Trusts
FPPC Form 700 (2014/2015)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
Instrucons – 9
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 had a 10% or greater interest
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,of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of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, for an
explanation of commission income.
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.Usingphrasessuchas
“variousclients”or“notdisclosingsourcespursuantto
attorney-clientprivilege”maytriggerarequestforan
amendment to your statement. See Reference Pamphlet,
page 14, for details about requesting 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.
►3. LIST THE NAME OF EACH REPORTABLE SINGLE SOURCE OF
INCOME OF $10,000 OR MORE (Attach a separate sheet if necessary.)
IFAPPLICABLE,LISTDATE:
/ / / /
ACQUIRED DISPOSED
IFAPPLICABLE,LISTDATE:
/ / / /
ACQUIRED DISPOSED
IFAPPLICABLE,LISTDATE:
/ / / /
ACQUIRED DISPOSED
IFAPPLICABLE,LISTDATE:
/ / / /
ACQUIRED DISPOSED
14 14
14 1414 14
SCHEDULE A-2
Investments, Income, and Assets
of Business Entities/Trusts
(OwnershipInterest is10%or Greater)
Comments:
Name
Address (Business Address Acceptable)
Name
Address (Business Address Acceptable)
FAIRMARKETVALUE
$0 - $1,999
$2,000 - $10,000
$10,001 - $100,000
$100,001 - $1,000,000
Over $1,000,000
FAIRMARKETVALUE
$0 - $1,999
$2,000 - $10,000
$10,001 - $100,000
$100,001 - $1,000,000
Over $1,000,000
GENERAL DESCRIPTION OFTHISBUSINESS
GENERAL DESCRIPTION OFTHISBUSINESS
INVESTMENT REAL PROPERTY
Nameof Business Entity,ifInvestment, or
Assessor’s Parcel Numberor StreetAddressofReal Property
Description of Business Activity or
City or Other Precise Location of Real Property
INVESTMENT REAL PROPERTY
Nameof Business Entity,ifInvestment, or
Assessor’s Parcel Numberor StreetAddressofReal Property
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
Trust, go to 2 Business Entity, complete the box, then go to 2
Check one
Trust, go to 2 Business Entity, complete the box, then go to 2
►3. LIST THE NAME OF EACH REPORTABLE SINGLE SOURCE OF
INCOME OF $10,000 OR MORE (Attach a separate sheet if necessary.)
►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)
Name
700
Check one box: Check one box:
YOURBUSINESS POSITION
YOURBUSINESS POSITION
FPPC Form 700 (2014/2015) Sch. A-2
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
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
$0 - $499
$500 - $1,000
$1,001 - $10,000
$0 - $499
$500 - $1,000
$1,001 - $10,000
$10,001 - $100,000
OVER$100,000
$10,001 - $100,000
OVER$100,000
FAIR POLITICAL PRACTICES COMMISSION
CALIFORNIA FORM
►1. BUSINESS ENTITY OR TRUST
►
1. BUSINESS ENTITY OR TRUST
NATUREOFINTEREST
PropertyOwnership/DeedofTrust Stock Partnership
Leasehold Other
Check box if additional schedules reporting investments or real property
are attached
Yrs. remaining
NATUREOFINTEREST
PropertyOwnership/DeedofTrust Stock Partnership
Leasehold Other
Check box if additional schedules reporting investments or real property
are attached
Yrs. remaining
14 14
Other
NATUREOFINVESTMENT
Partnership Sole Proprietorship
Other
NATUREOFINVESTMENT
Partnership Sole Proprietorship
None
None
or
or
Names listed below
Names listed below
Clear Page
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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 of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:
Joe Nelson is a city planning commissioner. Joe received
rental income of $12,000
during the reporting period
from a single tenant who
rented property Joe owned
inthecity’sjurisdiction.IfJoe
had received the $12,000
from two or more tenants, the
tenants’nameswouldnotbe
required as long as no single
tenant paid $10,000 or more.
A married couple would be
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
are not also required to be reported on Schedule B.
•
Codelers– do your disclosure categories require
disclosure of real property?
FPPC Form 700 (2014/2015)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
Instrucons – 11
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. 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.)
Please note: A non-reportable residence can still be
groundsforaconictofinterestandmaybedisqualifying.
• Interestsinrealpropertyheldthroughablindtrust(See
ReferencePamphlet,page16,forexceptions.)
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,
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
ASSESSOR’S PARCEL NUMBER OR STREET ADDRESS
Easement
Ownership/Deed of Trust
IF RENTAL PROPERTY, GROSS INCOME RECEIVED
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 $10,00 or more.
Leasehold
NAME OF LENDER
*
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF LENDER
INTEREST RATE
NONE
NONE
TERM (Month/Years)
Other
Yrs. remaining
NATURE OF INTEREST
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
___/___/___ ___/___/___
ACQUIRED DISPOSED
14 14
Over $1,000,000
$100,001-$1,000,000
$10,001-$100,000
$2,000-$10,000
OVER $100,000
OVER $100,000
$10,001 - $100,000
$10,001 - $100,000
Guarantor, if applicable
HIGHEST BALANCE DURING REPORTING PERIOD
$1,001 - $10,000
$1,001 - $10,000
$500 - $1,000
$500 - $1,000
$0 - $499
City
4600 24th Street
Henry Wells
Henry Wells
8
15 Years
Sophia Petroillo
2121 Blue Sky Parkway, Sacramento
Restaurant Owner
x
x
x
x
%
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
14 1414 14
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 (2014/2015) 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
Clear Page
Print Form
Instructions – Schedule C
Income, Loans, & Business Positions
(Income Other Than Gifts and Travel Payments)
FPPC Form 700 (2014/2015)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
Instrucons – 13
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.
A source of 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,
for more information about doing business in the jurisdiction.
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, including
loanrepaymentsfromacampaigncommittee(includinga
candidate’sowncampaigncommittee)
• Anhonorariumreceivedpriortobecomingapublicofcial
(SeeReferencePamphlet,page10,concerningyourability
toreceivefuturehonoraria.)
• 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 11, for more exceptions to
income reporting.
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 (2014/2015) Sch. C
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
(Real property, car, boat, etc.) (Real property, car, boat, etc.)
SCHEDULE C
Income, Loans, & Business
Positions
(Otherthan GiftsandTravelPayments)
GROSSINCOME RECEIVED GROSSINCOME RECEIVED
Name
OVER$100,000 OVER$100,000
$500 - $1,000 $500 - $1,000 $1,001 - $10,000 $1,001 - $10,000
$10,001 - $100,000 $10,001 - $100,000
700
FAIR POLITICAL PRACTICES COMMISSION
CALIFORNIA FORM
► 1. INCOME RECEIVED
NAMEOF SOURCE OFINCOME
ADDRESS (Business Address Acceptable)
BUSINESSACTIVITY, IFANY,OF SOURCE
YOURBUSINESS POSITION
► 1. INCOME RECEIVED
NAMEOF SOURCE OFINCOME
ADDRESS (Business Address Acceptable)
BUSINESSACTIVITY, IFANY,OF SOURCE
YOURBUSINESS POSITION
NAME OF LENDER*
ADDRESS (Business Address Acceptable)
BUSINESSACTIVITY, IFANY,OF LENDER
INTERESTRATE TERM(Months/Years)
% None
HIGHESTBALANCEDURINGREPORTINGPERIOD
$500 - $1,000
$1,001 - $10,000
$10,001 - $100,000
OVER$100,000
Comments:
► 2. LOANS RECEIVED OR OUTSTANDING DURING THE REPORTING PERIOD
* You are not required to report loans from commercial lending institutions, or any indebtedness created as part of a
retailinstallmentorcreditcardtransaction,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:
SECURITYFORLOAN
None Personal residence
Real Property
Guarantor
Other
Street address
City
(Describe)
CONSIDERATIONFORWHICHINCOME WAS RECEIVED
Salary Spouse’sor registered domesticpartner’sincome
(Forself-employeduse ScheduleA-2.)
Partnership(Lessthan 10%ownership.For 10%orgreater use
ScheduleA-2.)
Sale of
Other
CONSIDERATIONFORWHICHINCOME WAS RECEIVED
Salary Spouse’sor registered domesticpartner’sincome
(For self-employeduse ScheduleA-2.)
Partnership(Lessthan 10%ownership.For 10%orgreater use
ScheduleA-2.)
Sale of
Other
(Describe) (Describe)
(Describe) (Describe)
RentalIncome, list each source of $10,000 or more RentalIncome, list each source of $10,000 or moreCommission or Commission or
Loan repayment Loan repayment
Clear Page
Print Form
Instructions – Schedule D
Income – Gifts
Reminders
• Gifts from a single source are subject to a $440 limit
during 2014. See Reference Pamphlet, page 10.
•
Codelers– you only need to report gifts from
reportable sources.
Gift Tracking Mobile Application
• FPPC has created a gift tracking app for mobile devices
thathelpslerstrackgiftsandprovidesaquickand
easy way to upload the information to the Form 700.
VisitFPPC’swebsitetodownloadtheapp.
FPPC Form 700 (2014/2015)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
Instrucons – 15
A gift is anything of value for which you have not provided
equal or greater consideration to the donor. A gift is
reportableifitsfairmarketvalueis$50ormore.Inaddition,
multiple gifts totaling $50 or more received during the
reporting period from a single source must be reported.
Itistheacceptanceofagift,nottheultimateusetowhichitis
put, that imposes your reporting obligation. Except as noted
below, you must report a gift even if you never used it or if you
gave it away to another person.
Iftheexactamountofagiftisunknown,youmustmakea
goodfaithestimateoftheitem’sfairmarketvalue.Listing
thevalueofagiftas“over$50”or“valueunknown”isnot
adequatedisclosure.Inaddition,ifyoureceivedagiftthrough
an intermediary, you must disclose the name, address, and
business activity of both the donor and the intermediary.
You
mayindicateanintermediaryeitherinthe“source”eld
afterthenameorinthe“comments”sectionatthebottom
of Schedule D.
Commonly reportable gifts include:
•
Tickets/passestosportingorentertainmentevents
• Tickets/passestoamusementparks
• Parkingpassesnotusedforofcialagencybusiness
• Food, beverages, and accommodations, including those
provided in direct connection with your attendance at a
convention, conference, meeting, social event, meal, or like
gathering
•
Rebates/discountsnotmadeintheregularcourseof
businesstomembersofthepublicwithoutregardtoofcial
status
•
Weddinggifts(SeeReferencePamphlet,page16)
• Anhonorariumreceivedpriortoassumingofce(Youmay
report an honorarium as income on Schedule C, rather
than as a gift on Schedule D, if you provided services of
equal or greater value than the payment received. See
Reference Pamphlet, page 10, regarding your ability to
receivefuturehonoraria.)
• Transportationandlodging(SeeScheduleE.)
• Forgiveness of a loan received by you
You are not required to disclose:
• Gifts that were not used and that, within 30 days after
receipt, were returned to the donor or delivered to a
charitableorganizationorgovernmentagencywithout
being claimed by you as a charitable contribution for tax
purposes
• Gifts from your spouse or registered domestic partner,
child, parent, grandparent, grandchild, brother, sister, and
certainotherfamlymembers(SeeRegulation18942fora
completelist.).Theexceptiondoesnotapplyifthedonor
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
individual, other than a lobbyist registered to lobby your
state agency, on holidays, birthdays, or similar occasions
• Gifts of informational material provided to assist you in the
performanceofyourofcialduties(e.g.,books,pamphlets,
reports,calendars,periodicals,oreducationalseminars)
• Amonetarybequestorinheritance(However,inherited
investments or real property may be reportable on other
schedules.)
•
Personalizedplaquesortrophieswithanindividualvalueof
less than $250
• Campaign contributions
•
Uptotwotickets,foryourownuse,toattendafundraiser
for a campaign committee or candidate, or to a fundraiser
foranorganizationexemptfromtaxationunderSection
501(c)(3)oftheInternalRevenueCode.Theticketmust
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
apurposetoinuenceyou.(SeeRegulation18943.)
• Freeadmission,food,andnominalitems(suchasapen,
pencil,mousepad,notepadorsimilaritem)availableto
allattendees,attheeventatwhichtheofcialmakesa
speech(asdenedinRegulation18950(b)(2)),solongas
theadmissionisprovidedbythepersonwhoorganizesthe
event.
•
Anyotherpaymentnotidentiedabove,thatwould
otherwisemeetthedenitionofgift,wherethepaymentis
made by an individual who is not a lobbyist registered to
lobbytheofcial’sstateagency,whereitisclearthatthe
gift was made because of an existing personal or business
relationshipunrelatedtotheofcial’spositionandthere
is no evidence whatsoever at the time the gift is made to
suggestthedonorhadapurposetoinuenceyou.
To Complete Schedule D:
• Disclosethefullname(notanacronym),address,and,ifa
business entity, the business activity of the source.
•
Providethedate(month,day,andyear)ofreceipt,and
disclose the fair market value and description of the gift.
SCHEDULE D
Income – Gifts
Comments:
Name
FPPC Form 700 (2014/2015) Sch. D
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 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)
/ / $
/ / $
/ / $
Clear Page
Print Form
FPPC Form 700 (2014/2015)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
Instrucons - 17
Travel payments reportable on Schedule E include advances
and reimbursements for travel and related expenses,
including lodging and meals.
Giftsoftravelmaybesubjecttothegiftlimit.Inaddition,
certain travel payments are reportable gifts, but are not
subject to the gift limit. To avoid possible misinterpretation
or the perception that you have received a gift in excess of
thegiftlimit,youmaywishtoprovideaspecicdescriptionof
the purpose of your travel. See the FPPC fact sheet entitled
“LimitationsandRestrictionsonGifts,Honoraria,Travel,and
Loans”atwww.fppc.ca.gov.
You are not required to disclose:
• Travel payments received from any state, local, or federal
government agency for which you provided services equal
or greater in value than the payments received, such as
reimbursement for travel on agency business from your
government agency employer.
• A payment for travel from another local, state, or federal
government agency and related per diem expenses when
the travel is for education, training or other inter-agency
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
•
Atravelpaymentthatwasreceivedfromanon-prot
entityexemptfromtaxationunderInternalRevenue
CodeSection501(c)(3)forwhichyouprovidedequalor
greater consideration, such as reimbursement for travel on
businessfora501(c)(3)organizationforwhichyouarea
board member.
Note: Effective January, 2014, certain travel payments
may not be reportable if reported on Form 801 by your
agency.
To Complete Schedule E:
• Disclosethefullname(notanacronym)andaddressofthe
source of the travel payment.
•
Identifythebusinessactivityifthesourceisabusiness
entity.
• Check the box to identify the payment as a gift or income,
reporttheamount,anddisclosethedate(s).
- Travel payments are gifts if you did not provide
services that were equal to or greater in value than the
payments received. You must disclose gifts totaling
$50 or more from a single source during the period
covered by the statement.
Whenreportingtravelpaymentsthataregifts,you
must provide a description of the gift and the date(s)
received.
- Travel payments are income if you provided services
that were equal to or greater in value than the
payments received. You must disclose income totaling
$500 or more from a single source during the period
covered by the statement. You have the burden of
proving the payments are income rather than gifts.
Whenreportingtravelpaymentsasincome,youmust
describe the services you provided in exchange for the
payment.Youarenotrequiredtodisclosethedate(s)
for travel payments that are income.
Example:
City council member Rick Chandler is the chairman of a 501
(c)(6)tradeassociationandtheassociationpaysforRick’s
travel to attend its meetings. Because Rick is deemed to
be providing equal or
greater consideration for
the travel payment by
virtue of serving on the
board, this payment may
be reported as income.
Payments for Rick to
attend other events
for which Rick is not
providing services are
likely considered gifts.
Instructions – Schedule E
Travel Payments, Advances,
and Reimbursements
TYPE OF PAYMENT: (mustcheck one) Gift Income
SCHEDULE E
Income – Gifts
Travel Payments, Advances,
and Reimbursements
Name
Comments:
FPPC Form 700 (2014/2015) Sch. E
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
TYPE OF PAYMENT: (mustcheck one) Gift Income
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. These payments are not
subject to the $440 gift limit, but may result in a disqualifying conict of interest.
DATE(S): / / - / / AMT: $
(If gift)
DATE(S):
/ / - / / AMT: $
(If gift)
TYPE OF PAYMENT:
(must check one) Gift Income
TYPE OF PAYMENT: (mustcheck one) Gift Income
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
Madea Speech/Participated inaPanel
Other - Provide Description
Madea Speech/Participated inaPanel
Other - Provide Description
Madea Speech/Participated inaPanel
Other - Provide Description
Madea Speech/Participated inaPanel
Other - Provide Description
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Economic Interest 2014.2015

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Completed 19 April 2020

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