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December 2015

2015/2016

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

Gifts of Travel

Effective January 1, 2016, if an individual receives a travel

payment that is a reportable gift, he or she must disclose

the travel destination. (See the Schedule E instructions

for information about other details that must be disclosed.)

This applies to travel taken on or after January 1, 2016.

An individual who is ling a 2015 annual statement is not

required to disclose the travel destination, but may do so.

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

• Candidates 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.

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 1, 2016

- Elected State Ofcers

- Judges and Court Commissioners

- State Board and Commission Members listed in

Government Code Section 87200

 April 1, 2016

- 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, 2015, and

December 31, 2015, and led an assuming ofce statement,

you are not required to le an annual statement until March

1, 2017, or April 3, 2017, whichever is applicable. The

annual statement will cover the day after you assumed ofce

through December 31, 2016. 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.

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. For years 2015-2016,

the limit is $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

publicly identify the economic interest that creates a

conict of interest and leave the room before a discussion

or vote takes place at a public meeting. For more

information, consult Government Code Section 87105,

Regulation 18707, and the Guide to Recognizing Conicts

of Interest 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 (2015/2016)

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, 2015,

through December 31, 2015. If the period covered by

the statement is different than January 1, 2015, through

December 31, 2015, (for example, you assumed ofce

between October 1, 2014, and December 31, 2014 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 2015.

• 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, 2015,

through the date you stopped performing the duties of

your position. If the period covered differs from January

1, 2015, through the date you stopped performing the

duties of your position (for example, you assumed ofce

between October 1, 2014, and December 31, 2014, 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 2015.

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, 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.

FPPC Form 700 (2015/2016)

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 2015 annual statement, do not change the

pre-printed dates to reect 2016. Your annual statement is

used for reporting the previous year’s economic interests.

Economic interests for your annual ling covering January 1,

2016, through December 31, 2016, will be disclosed on your

statement led in 2017. 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

• 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 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 (2015/2016)

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:

Yuba & Sutter Counties

Board MemberN/A

N/A

Feather River Irrigation District

LeavingOfce: Date Left / /

(Check one)

The period covered is January 1, 2015, 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, 2015, through

December 31, 2015.

The period covered is / / , through

December 31, 2015.

STATEMENTOFECONOMICINTERESTS

COVERPAGE

FPPC Form 700 (2015/2016)

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

NAMEOFFILER(LAST)  (FIRST) (MIDDLE)

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

A PUBLIC DOCUMENT

► If ling for multiple positions, list below or on an attachment. (Do not use acronyms)

Agency: Position:

-or-

None - No reportable interests on any schedule

4. ScheduleSummary(mustcomplete)

Schedules attached

ScheduleA-1- Investments – schedule attached

ScheduleA-2- Investments – schedule attached

ScheduleB- Real Property – schedule attached

► Total number of pages including this cover page:

-or-

ScheduleC- Income, Loans, & Business Positions – schedule attached

ScheduleD- Income – Gifts – schedule attached

ScheduleE- Income – Gifts – Travel Payments – schedule attached

Clear Page

Print Form

Which Schedule Do I Use?

FPPC Form 700 (2015/2016)

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.

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.

Q. My spouse and I are currently separated and in the

process of obtaining a divorce. Must I still report my

spouse’s income, investments, and interests in real

property?

A. Yes. A public ofcial must continue to report a spouse’s

economic interests until such time as dissolution of

marriage proceedings is nal. However, if a separate

property agreement has been reached prior to that

time, your estranged spouse’s income may not have to

be reported. Contact the FPPC for more information.

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.

FPPC Form 700 (2015/2016)

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. I am the sole owner of my business, an S-Corporation.

I believe that the nature of the business is such that it

cannot be said to have any “fair market value” because

it has no assets. I operate the corporation under

an agreement with a large insurance company. My

contract does not have resale value because of its

nature as a personal services contract. Must I report

the fair market value for my business on Schedule A-2

of the Form 700?

A. Yes. Even if there are no tangible assets, intangible

assets, such as relationships with companies and

clients are commonly sold to qualied professionals.

The “fair market value” is often quantied for other

purposes, such as marital dissolutions or estate

planning. In addition, the IRS presumes that “personal

services corporations” have a fair market value. A

professional “book of business” and the associated

goodwill that generates income are not without a

determinable value. The Form 700 does not require a

precise fair market value; it is only necessary to check

a box indicating the broad range within which the value

falls.

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.

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 located in or 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 or Federal

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.

FPPC Form 700 (2015/2016)

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 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 the client’s 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.

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.

FPPC Form 700 (2015/2016)

FPPC Advice Email: advice@fppc.ca.gov

FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov

Instrucons – 6

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?

A. Yes, each spouse may make a gift valued at the gift

limit during a calendar year. For example, during 2015

the gift limit was $460, so the Bensons may have given

the supervisor artwork valued at no more than $920.

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.

Questions and Answers

Continued

FPPC Form 700 (2015/2016)

FPPC Advice Email: advice@fppc.ca.gov

FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov

Instrucons – 7

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

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 is located in or 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 (2015/2016)

FPPC Advice Email: advice@fppc.ca.gov

FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov

Instrucons – 8

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

15 15

1515

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 (2015/2016) 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

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)

Clear Page

Print Form

Instructions – Schedule A-2

Investments, Income, and Assets of Business Entities/Trusts

FPPC Form 700 (2015/2016)

FPPC Advice Email: advice@fppc.ca.gov

FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov

Instrucons – 10

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, 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

15 15

15 1515 15

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

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

FPPC Form 700 (2015/2016) 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

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

15 15

Other

NATURE OF INVESTMENT

Partnership Sole Proprietorship

Other

NATURE OF INVESTMENT

Partnership Sole Proprietorship

None

Names listed below

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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

is not also required to be reported on Schedule B.

• Code lers – do your disclosure categories require

disclosure of real property?

FPPC Form 700 (2015/2016)

FPPC Advice Email: advice@fppc.ca.gov

FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov

Instrucons – 12

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

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

15 1515 15

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 (2015/2016) 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

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Instructions – Schedule C

Income, Loans, & Business Positions

(Income Other Than Gifts and Travel Payments)

FPPC Form 700 (2015/2016)

FPPC Advice Email: advice@fppc.ca.gov

FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov

Instrucons – 14

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

• 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 (2015/2016) 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)

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

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Instructions – Schedule D

Income – Gifts

Reminders

• Gifts from a single source are subject to a $460 limit.

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 (2015/2016)

FPPC Advice Email: advice@fppc.ca.gov

FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov

Instrucons – 16

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 (2015/2016) 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

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FPPC Form 700 (2015/2016)

FPPC Advice Email: advice@fppc.ca.gov

FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov

Instrucons - 18

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: 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. If the travel occurred on or after January 1,

2016, you must also disclose the travel destination.

- 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 he is not providing

services are likely

considered gifts.

Instructions – Schedule E

Travel Payments, Advances,

and Reimbursements

SCHEDULE E

Income – Gifts

Travel Payments, Advances,

and Reimbursements

Name

Comments:

FPPC Form 700 (2015/2016) Sch. E

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

• 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 $460 gift limit, but may result in a disqualifying conict of interest.

• For gifts of travel that occurred on or after January 1, 2016, provide the travel destination.

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 -or- Income

► If Gift, Provide Travel Destination

► MUST CHECK ONE:

Made a Speech/Participated in a Panel

Other - Provide Description

Gift -or- Income

► If Gift, Provide Travel Destination

► MUST CHECK ONE:

Made a Speech/Participated in a Panel

Other - Provide Description

Gift -or- Income

► If Gift, Provide Travel Destination

► MUST CHECK ONE:

Made a Speech/Participated in a Panel

Other - Provide Description

Gift -or- Income

► If Gift, Provide Travel Destination

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Form 700 Statement Of Economic Interests 2015 16 Form-700-2015-16

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Completed 19 April 2020

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