Fillable Form700 08 09%5B1%5D (California State University Channel Islands)

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Form700 08 09%5B1%5D (California State University Channel Islands)

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Form 700
Statement of Economic Interests
Also available on the FPPC website:
Form 700 Reference Pamphlet
a public document
Fair Political Practices Commission
428 J Street, Suite 620 • Sacramento, CA 95814
Toll-Free Advice Line: 866-ASK-FPPC • (866) 275-3772
Telephone: (916) 322-5660
www.fppc.ca.gov
2008/2009
What’s New
• Giftlimitincreasedto$420.
• Newrestrictionsonreceivingticketstononprotand
politicalfundraisers.
MoreinformationisintheReferencePamphlet.
Who must le:
• Electedandappointedofcialsandcandidateslistedin
GovernmentCodeSection87200.
• Employeesandappointedofcialslingpursuantto
aconict-of-interestcode.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(forexample,
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.
(SeeForm700ReferencePamphlet,page2,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
LegislativeStaff DirectlywithFPPC
Countyofces Yourcountylingofcial
Cityofces Yourcityclerk
Multi-Countyofces Youragency
Members of Boards/Commissions of Newly Created
Agencies:
Filewithyournewlycreatedagencyorwithyouragency’s
codereviewingbodyasprovidedbythecodereviewing
body.
Code Filers — State and Local Ofcials and
Employees 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.Inmostcases,theagency,board,orcommission
willretainthestatements.
Candidateslewiththeirlocalelectionsofce.
How to le:
AForm700shouldbeprovidedtoyoubyyourling
ofcial.AninteractiveversionoftheForm700isavailable
onourwebsiteatwww.fppc.ca.gov.
Youonlyhavetoreportinvestmentsandbusiness
positionsinbusinessentities,realproperty,andincome
fromsourcesthatarelocatedinordoingbusinessinyour
agency’sjurisdiction.However,reportablegiftsmustbe
disclosedregardlessofthejurisdiction.SeeForm700
Ref.Pamphlet,page12,formoreinformation.
When to le:
Annual Statements
March 2, 2009*
- ElectedStateOfcers
- JudgesandCourtCommissioners
- StateBoard/CommissionMemberslistedin
GovernmentCodeSection87200
April 1, 2009
- 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cer.
*BecauseMarch1isaSunday,thedeadlineisextended.
Statementspostmarkedbythelingdeadlineare
consideredtimelyled.
Assuming, Leaving, and Initial 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.
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fromyourlingofcialor
interactivelyatwww.fppc.ca.gov.
Statements that are mailed are considered led on
the postmark date. There is no provision for ling
deadline extensions. 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cerwithin24hours.
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which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limit.For2007-2008,thegift
limitwas$390fromasinglesourceduringacalendaryear.
For2009-2010,thelimitincreasedto$420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Ref.Pamphlet,page9,
fordetailedinformation.)
Stateandlocalofcialsandemployeesalsoshouldcheck
withtheiragencytodetermineifanyotherrestrictions
apply.
Honorarium Ban
Moststateandlocalofcials,employees,andcandidates
areprohibitedfromacceptinganhonorariumforanyspeech
given,articlepublished,orattendanceataconference,
convention,meeting,orlikegathering.(SeeRef.Pamphlet,
page9,fordetailedinformation.)
Loan Restrictions
Certainstateandlocalpublicofcialsaresubjectto
restrictionsonloans.(SeeRef.Pamphlet,page13,for
detailedinformation.)
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(forexample,apersonal
residenceisoftennotreportable,butmaybedisqualifying).
Specicdisqualicationrequirementsapplyto87200lers
(forexample,citycouncilmembers,membersofboardsof
supervisorsandplanningcommissioners).Theseofcials
mustorally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andRegulation
18702.5,orrefertothebookletentitled“CanIVote?
ConictsofInterestOverview,”allofwhichareavailableon
theFPPCwebsite.Visitwww.fppc.ca.govandclickonthe
Library&Publicationsicon.
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.TheFPPCwebsitehasfactsheetsexplainingthe
provisions.
Late Filing
Thelingofcerwhoretainsoriginallysigned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can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:
• CalltheFPPCtoll-freeat(866)ASK-FPPC.
• Seethebookletentitled“YourDutytoFile:ABasic
OverviewofStateEconomicDisclosureLawand
ReportingRequirementsforPublicOfcials.”
Form 700 Public Access
StatementsofEconomicInterestsarepublic
documents.Thelingofcermustpermitany
memberofthepublictoinspectandcopyany
statement.
• Forms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.
• 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.
INTRODUCTION
FPPCForm700(2008/2009)
FPPCToll-FreeHelpline:866/ASK-FPPCwww.fppc.ca.gov
Instructions-1
Enteryourname,mailingaddress,anddaytimetelephone
numberinthespacesprovided.BecausetheForm700is
adocumentavailableforpublicreview,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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.)
• Enteryourpositiontitle.(Examples:Director;Chief
Counsel;CityCouncilMember;StaffServicesAnalyst.)
• Ifyouholdmultiplepositions(forexample,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.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astatement,makeacopyforeachagency.
Signeachcopywithanoriginalsignatureandlewith
eachagency.
Rememberthat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.
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Ref.Pamphlet,
page12,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(for
example,schooldistricts
andspecialdistricts),
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County.
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2008AnnualStatement,do
notchangethepre-printeddatestoreect2009.Your
annualstatementisusedforreportingthepreviousyear’s
economicinterests.Economicinterestsforyourannual
lingcoveringJanuary1,2008,throughDecember31,
2008,willbedisclosedonyourstatementledin2009.
(SeeRef.Pamphlet,page3,fordetailedinformationabout
typesofstatements.)
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“Yes”boxforeachscheduleyouuseto
discloseinterests.
- or -
Ifyouhavenothingtodiscloseonanyschedules,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.Whenyousignyourstatement,
youarestating,underpenaltyofperjury,thatitistrueand
correct.Onlythelerhasauthoritytosignthestatement.
An unsigned statement is not considered led and you
may be subject to late ling penalties.
INSTRUCTIONS — COVER PAGE
Election Year:
► Check applicable schedules or “No reportable
interests.”
I have disclosed interests on one or more of the
attached schedules:
Schedule A-1
Yes – schedule attached
Investments (Less than 10% Ownership)
Schedule A-2
Yes – schedule attached
Investments (10% or greater Ownership)
Schedule B
Yes – schedule attached
Real Property
Schedule C
Yes – schedule attached
Income, Loans, & Business Positions (Income Other than Gifts
and Travel Payments)
Schedule D
Yes – schedule attached
Income – Gifts
Schedule E
Yes – schedule attached
Income – Gifts – Travel Payments
Leaving Ofce Date Left: / /
(Check one)
The period covered is January 1, 2008, 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, 2008,
through December 31, 2008.
The period covered is / / , through
December 31, 2008.
-or-
STATEMENT OF ECONOMIC INTERESTS
COVER PAGE
NAME (LAST) (FIRST) (MIDDLE)
MAILING ADDRESS STREET CITY STATE ZIP CODE
( )
DAYTIME TELEPHONE NUMBER
FPPC Form 700 (2008/2009)
FPPC Toll-Free Helpline: 866/ASK-FPPC www.fppc.ca.gov
4. Schedule Summary
5.Verication
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 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)
Signature
3. Type of Statement (Check at least one box)
State
County of
City of
Multi-County
Other
2. Jurisdiction ofOfce(Check at least one box)
Candidate
No reportable interests on any schedule
A Public Document
Assuming Ofce/Initial Date: / /
OPTIONAL: FAX / E-MAIL ADDRESS
(May use business address)
Date Received
Ofcial Use Only
(File the originally signed statement with your ling ofcial.)
Please type or print in ink.
-or-
-or-
700
FAIR POLITICAL PRACTICES COMMISSION
CALIFORNIA FORM
Name of Ofce, Agency, or Court:
Division, Board, District, if applicable:
Your Position:
► If ling for multiple positions, list additional agency(ies)/
position(s): (Attach a separate sheet if necessary.)
Agency:
Position:
1.Ofce,Agency,orCourt
► Total number of pages
including this cover page:
Clear Cover Pg.
Print Page
specify pages to print
FPPCForm700(2008/2009)
FPPCToll-FreeHelpline:866/ASK-FPPCwww.fppc.ca.gov
Instructions-2
ScheduleA-1: Stocks
ScheduleA-2: Businessentities,partnerships,LLCs,corporations,trusts
ScheduleB: Rentalpropertyinthejurisdiction
ScheduleC: Non-governmentsalariesofpublicofcialandspouse/registereddomesticpartner
ScheduleD: Giftsfromnon-familymembers(suchasticketstosportingorentertainmentevents)
ScheduleE: Travelpaymentsfromthirdparties(notyouremployer)
ScheduleA-1/A-2: DiversiedmutualfundsregisteredwiththeSECundertheInvestmentCompanyActof
 1940andcertainretirementaccountsinvestedininsurancepoliciesorgovernmentalbonds
ScheduleA-1/A/2: Savingsandcheckingaccounts
ScheduleB: Aresidenceusedexclusivelyasapersonalresidence(suchasahome,vacationcabin)
ScheduleC: Governmentsalary(suchasaschooldistrict)
ScheduleD: Giftsfromfamilymembers
ScheduleE: Travelpaidbyyourgovernmentagency
Remember: Markthe“noreportableinterests”boxonPart4oftheschedulesummary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.
TheForm700isapublicdocument.
Mostindividualsmustconsulttheagency’sconict-of-interestcodeforreportableinterests.
MostindividualsletheForm700withtheiragency.
COMMON REPORTABLE INTERESTS
WHAT SCHEDULE DO I USE?
COMMON NON-REPORTABLE INTERESTS
Instructions-2
FPPCForm700(2008/2009)
FPPCToll-FreeHelpline:866/ASK-FPPCwww.fppc.ca.gov
Instructions-3
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.Inaddition,youmust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.However,youmaycompleteonestatement
listingthecountyandthetwoboardsonthecover
pageoftheForm700astheagenciesforwhichyou
willbeling.Reportyoureconomicinterestsusing
thebroadestjurisdictionanddisclosurerequirements
assignedtoyoubythethreeagencies.Maketwo
copiesoftheentirestatementbefore 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classiedasadepartmentheadbut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.
Q. Ileftonestateagencytoworkforanotherstate
agency.MustIlealeavingofcestatement?
A. Yes.
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inyourjurisdiction.SeeRef.Pamphlet,
page12,forguidance.
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holdmany
stocksthroughanaccountmanagedbyabrokerage
rm.MustIdisclosethesestockseventhoughIdid
notdecidewhichstockstopurchase?
A. Yes,youmust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.
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inwhicha
client’snamemaynot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.
QUESTIONS AND ANSWERS
FPPCForm700(2008/2009)
FPPCToll-FreeHelpline:866/ASK-FPPCwww.fppc.ca.gov
Instructions-4
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Ref.Pamphlet,page7,which
denes“businessentity,”formoreinformation.)
Q. HowdoIdisclosemyspouse’sorregistereddomestic
partner’sincomefromanemployer?
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,yourpatients,ratherthan
theirinsurancecarriers,aresourcesofincometoyou.
Gift Disclosure
Q. IfIreceiveda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. Co-workersarehostingaretirementpartyforapublic
ofcialbeforetheofcialleavesofce.Attendees
willpay$45;$35coverstheevent’scosts(food,
decorations,etc.)and$10goestowardagift.One
co-workeriscollectingthefundsandmakingthe
expenditures.Whatdoestheofcialreportonhis
Form700?
A. Theofcialdisclosestheamountthatincludesthe
valueofthegift,plus$35(hisproratashareofthe
event’scost).Thesourcecanbeidentiedas“ofce
staff”or“co-workers.”Thenamesofindividualdonors
arenotrequiredtobereportedaslongasnoindividual
contributed$50ormore.
Q. MaryandJoeBenson,amarriedcouple,wanttogive
apieceofartworktoaclosefriendwhois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$420
during2009-2010.Therefore,theBensonsmaygive
thesupervisorartworkvaluedatnomorethan$840.
(During2007-2008,thegiftlimitwas$390froma
singlesourceduringacalendaryear.)Thesupervisor
mustidentifyJoeandMaryBensonasthesourceof
thegift.
QUESTIONS AND ANSWERS
Continued
FPPCForm700(2008/2009)
FPPCToll-FreeHelpline:866/ASK-FPPCwww.fppc.ca.gov
Instructions-5
“Investment”meansanancialinterestinanybusiness
entity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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Ref.Pamphlet,page12.)
Reportable investments include:
• Stocks,bonds,warrants,andoptions,includingthose
heldinmarginorbrokerageaccountsandmanaged
investmentfunds(SeeRef.Pamphlet,page12.)
• Soleproprietorships
• Yourownbusinessoryourspouse’sorregistered
domesticpartner’sbusiness(SeeRef.Pamphlet,
page7,forthedenitionof“businessentity.”)
• Yourspouse’sorregistereddomesticpartner’s
investmentsthatarelegallyseparateproperty
• Partnerships(forexample,alawrmorfamilyfarm)
• Investmentsinreportablebusinessentitiesheldina
retirementaccount(SeeRef.Pamphlet,page14.)
• Ifyou,yourspouseorregistereddomesticpartner,or
dependentchildren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Ref.Pamphlet,page14,
formoreinformationondisclosingtrusts.)
• Businesstrusts
You are not required to disclose:
• DiversiedmutualfundsregisteredwiththeSecurities
andExchangeCommission(SEC)underthe
InvestmentCompanyActof1940
• Bankaccounts,savingsaccounts,andmoneymarket
accounts
• Insurancepolicies
• Annuities
• Sharesinacreditunion
• Governmentbonds(includingmunicipalbonds)
• Retirementaccountsinvestedinnon-reportableinterests
(forexample,insurancepolicies,diversiedmutual
funds,orgovernmentbonds)(SeeRef.Pamphlet,
page14.)
● Governmentdened-benetpensionplans
• Interestsheldinablindtrust(SeeRef.Pamphlet,
page15.)
Use Schedule A-1toreportownershipoflessthan10%(for
example,stock).ScheduleC(Income)mayalsoberequired
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
(forexample,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(forexample,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(forexample,
stocks,warrants,options,orbonds).
• Ifyouinitiallyacquiredordisposedofyourentire
investmentinterestduringthereportingperiod,enter
thedateacquiredordisposed.
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.
INSTRUCTIONS ─ SCHEDULES A-1 AND A-2
INVESTMENTS
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.
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
08 08
08
08
0808
08
0808
08
08
Name
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
NATURE OF INVESTMENT
Stock
Other
(Describe)
NATURE OF INVESTMENT
Stock
Other
(Describe)
NATURE OF INVESTMENT
Stock
Other
(Describe)
NATURE OF INVESTMENT
Stock
Other
(Describe)
NATURE OF INVESTMENT
Stock
Other
(Describe)
NATURE OF INVESTMENT
Stock
Other
(Describe)
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
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 (2008/2009) Sch. A-1
FPPC Toll-Free Helpline: 866/ASK-FPPC 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
08
Clear Sch. A-1
Print Page
specify pages to print
FPPCForm700(2008/2009)
FPPCToll-FreeHelpline:866/ASK-FPPCwww.fppc.ca.gov
Instructions-6
UseScheduleA-2toreportinvestmentsinabusinessentity
ortrust(includingalivingtrust)inwhichyou,yourspouseor
registereddomesticpartner,oryourdependentchildren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Ref.Pamphlet,page12.)Atrustlocatedoutsideyour
agency’sjurisdictionisreportableifitholdsassetsthatare
locatedinordoingbusinessinthejurisdiction.Youare
notrequiredtoreportatrustthatcontainsnoreportable
interests.Forexample,ifyouhaveatrustcontainingonly
yourpersonalresidence,yoursavingsaccount,andsome
municipalbonds,youwouldnotreportthistrustbecause
theseinterestsare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
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fairmarketvalueofyour
investment.
• 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(forexample,ifyouwereadirector,
ofcer,partner,trustee,employee,orheldanyposition
ofmanagement).
Part 2.Checktheboxindicatingyourgrossincome.
Grossincomeisthetotalamountofincomebefore
deductingexpenses,losses,ortaxes.(Thisincludesyour
proratashareofthegrossincometo the business entity
or trust,aswellasyourcommunitypropertyinterestin
yourspouse’sorregistereddomesticpartner’sshare.)
Part 3.Disclosethenameofeachsourceofincome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,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Ref.Pamphlet,
page10,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Ref.Pamphlet,page7,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.
LeavePart3blankifyoudonothaveanyreportable
$10,000sourcesofincometodisclose.Adding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Ref.Pamphlet,
page13,fordetailsaboutprivilegedinformation.)
Part 4.Reportanyinvestmentsorinterestsinreal
propertyheld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.
• 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addressorotherprecise
location(forexample,anassessor’sparcelnumber).
• Checktheboxindicatingthefairmarketvalueofyour
interestintherealpropertyorinvestment.(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.
INSTRUCTIONS ─ SCHEDULE A-2
INVESTMENTS, INCOME, AND ASSETS OF BUSINESS ENTITIES/TRUSTS
IF APPLICABLE, LIST DATE:
/ / / /
ACQUIRED DISPOSED
IF APPLICABLE, LIST DATE:
/ / / /
ACQUIRED DISPOSED
IF APPLICABLE, LIST DATE:
/ / / /
ACQUIRED DISPOSED
08
08
0808
08
08
IF APPLICABLE, LIST DATE:
/ / / /
ACQUIRED DISPOSED
08 08
SCHEDULE A-2
Investments,Income,andAssets
of Business Entities/Trusts
(Ownership Interest is 10% or Greater)
Comments:
Name
Address
Name
Address
FAIR MARKET VALUE
$2,000 - $10,000
$10,001 - $100,000
$100,001 - $1,000,000
Over $1,000,000
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
INVESTMENT REAL PROPERTY
Name of Business Entity or
Street Address or Assessor’s Parcel Number of Real Property
Description of Business Activity or
City or Other Precise Location of Real Property
► 4. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD 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)
Name
700
Check one box:
YOUR BUSINESS POSITION
FPPC Form 700 (2008/2009) Sch. A-2
FPPC Toll-Free Helpline: 866/ASK-FPPC www.fppc.ca.gov
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
$10,001 - $100,000
OVER $100,000
FAIR MARKET VALUE
$2,000 - $10,000
$10,001 - $100,000
$100,001 - $1,000,000
Over $1,000,000
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
INVESTMENT REAL PROPERTY
Name of Business Entity or
Street Address or Assessor’s Parcel Number of Real Property
Description of Business Activity or
City or Other Precise Location of Real Property
► 4. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD BY THE
BUSINESS ENTITY OR TRUST
► 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)
Check one box:
YOUR BUSINESS POSITION
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
$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 INVESTMENT
Sole Proprietorship Partnership
Other
NATURE OF INVESTMENT
Sole Proprietorship Partnership
Other
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
Print Form
specify pages to print
FPPCForm700(2008/2009)
FPPCToll-FreeHelpline:866/ASK-FPPCwww.fppc.ca.gov
Instructions-7
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Ref.Pamphlet,
page12.)
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Ref.Pamphlet,page13.)
• Amininglease
• Aninterestinrealpropertyheldinaretirementaccount
(SeeRef.Pamphlet,page14.)
• Aninterestinrealpropertyheldbyabusinessentityor
trustinwhichyou,yourspouseorregistereddomestic
partner,oryourdependentchildren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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.)
• Interestsinrealpropertyheldthroughablindtrust(See
Ref.Pamphlet,page15,forexceptions.)
TO COMPLETE SCHEDULE B:
• Reporttheaddressorotherpreciselocation(for
example,anassessor’sparcelnumber)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.
• Identifythe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
yourproratashareofthegrossincomefromanysingle
tenantwas$10,000ormoreduringthereportingperiod.
Ifyoureceivedatotalof$10,000ormorefromtwoor
moretenantsactinginconcert(e.g.,inmostcases,this
willapplytomarriedcouples),disclosethenameofeach
tenant.Otherwise,leavethissectionblank.
• Loansfromaprivatelenderthattotal$500ormore
andaresecuredbyrealpropertymaybereportable.
ReportableloansmaybedisclosedonScheduleB
orScheduleC.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.
-- Providethenameandaddressofthelender.
-- Describethelender’sbusinessactivity.
-- Disclosetheinterestrateandtermoftheloan.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enteredinto.Forvariableinterestrateloans,
disclosetheconditionsoftheloan(forexample,
Prime+2)ortheaverageinterestratepaidduring
thereportingperiod.
-- 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.
REMINDERS
• IncomeandloansalreadyreportedonScheduleB
arenotalsorequiredtobereportedonScheduleC.
• Codelers–Doyourdisclosurecategoriesrequire
disclosureofrealproperty?
INSTRUCTIONS ─ SCHEDULE B
INTERESTS IN REAL PROPERTY
IF APPLICABLE, LIST DATE:
/ / / /
ACQUIRED DISPOSED
NAME OF LENDER*
ADDRESS
BUSINESS ACTIVITY OF LENDER
IF APPLICABLE, LIST DATE:
/ / / /
ACQUIRED DISPOSED
08 08
08 08
SCHEDULE B
Interests in Real Property
(Including Rental Income)
Name
► STREET ADDRESS OR PRECISE LOCATION
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.
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
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 (2008/2009) Sch. B
FPPC Toll-Free Helpline: 866/ASK-FPPC www.fppc.ca.gov
700
FAIR POLITICAL PRACTICES COMMISSION
CALIFORNIA FORM
NAME OF LENDER*
ADDRESS
BUSINESS ACTIVITY OF LENDER
► STREET ADDRESS OR PRECISE LOCATION
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.
NATURE OF INTEREST
Ownership/Deed of Trust Easement
Leasehold
Yrs. remaining
Other
Guarantor, if applicable
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
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:
Clear Sch. B
Print Form
specify pages to print
FPPCForm700(2008/2009)
FPPCToll-FreeHelpline:866/ASK-FPPCwww.fppc.ca.gov
Instructions-8
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Ref.Pamphlet,
page10.)Alsoreportyourjobtitlewitheachreportable
businessentity,evenifyoureceivednoincomeduring
thereportingperiod.Youmustalsoreportthesourceof
incometoyourspouseorregistereddomesticpartnerif
yourcommunitypropertyshareis$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Ref.Pamphlet,page12,for
moreinformationaboutdoingbusinessinthejurisdiction.)
Reportablesourcesofincomemaybefurtherlimitedbyyour
agency’sconict-of-interestcode.
Commonly reportable income and loans include:
•
Salary/wages,perdiem,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Ref.Pamphlet,page7.)
•
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
• Anhonorariumreceivedpriortobecomingapublicofcial
(SeeRef.Pamphlet,page9,concerningyourabilityto
receivefuturehonoraria.)
• Incentivecompensation(SeeRef.Pamphlet,page11.)
You are not required to report:
•
Salary,reimbursementforexpensesorperdiem,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
See Ref. Pamphlet, page 11, for more
exceptions to income reporting.
TO COMPLETE SCHEDULE C:
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.
• 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.
• 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Ref.Pamphlet,page7.)
•
Forincomefromrentalpropertythatisnotrequiredtobe
listedonScheduleB,enter“RentalIncome”under“Name
ofSource,”checktheboxindicatingthegrossincome
received,and,ifyouhada10%orgreaterinterestinthe
rentalproperty,listthenameofeachtenantifyourprorata
shareofthegrossincomefromthattenantwas$10,000or
moreduringthereportingperiod.
2. Loans Received or Outstanding During Reporting
Period
• Disclosethenameandaddressofeach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.
-- 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.
-- Forvariableinterestrateloans,disclosetheconditions
oftheloan(forexample,Prime+2)ortheaverage
interestratepaidduringthereportingperiod.
• 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.
INSTRUCTIONS ─ SCHEDULE C
INCOME, LOANS, & BUSINESS POSITIONS
(Income Other Than Gifts and Travel Payments)
SCHEDULE C
Income,Loans,&Business
Positions
(Other than Gifts and Travel Payments)
GROSS INCOME RECEIVED
Name
FPPC Form 700 (2008/2009) Sch. C
FPPC Toll-Free Helpline: 866/ASK-FPPC www.fppc.ca.gov
OVER $100,000
$500 - $1,000 $1,001 - $10,000
$10,001 - $100,000
700
FAIR POLITICAL PRACTICES COMMISSION
CALIFORNIA FORM
► 1. INCOME RECEIVED
NAME OF SOURCE OF INCOME
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOUR BUSINESS POSITION
► 1. INCOME RECEIVED
NAME OF SOURCE OF INCOME
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOUR BUSINESS POSITION
NAME OF LENDER*
ADDRESS
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
GROSS INCOME RECEIVED
OVER $100,000
$500 - $1,000 $1,001 - $10,000
$10,001 - $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
Loan repayment
Sale of
Commission or Rental Income, list each source of $10,000 or more
Other
(Describe)
(Property, car, boat, etc.)
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
Salary Spouse’s or registered domestic partner’s income
Loan repayment
Sale of
Commission or Rental Income, list each source of $10,000 or more
Other
(Describe)
(Property, car, boat, etc.)
Clear Sch. C
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FPPCForm700(2008/2009)
FPPCToll-FreeHelpline:866/ASK-FPPCwww.fppc.ca.gov
Instructions-9
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.
Gifts are reportable regardless of where the donor is
located.
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.
Commonly reportable gifts include:
• Tickets/passestosportingorentertainmentevents
• Tickets/passestoamusementparks
• Parkingpasses
• Food,beverages,andaccommodations,includingthose
providedindirectconnectionwithyourattendanceata
convention,conference,meeting,socialevent,meal,orlike
gathering,whereyoudidnotgiveaspeech,participateina
panelorseminar,orprovideasimilarservice
• Rebates/discountsnotmadeintheregularcourseof
businesstomembersofthepublicwithoutregardto
ofcialstatus
• Weddinggifts(SeeRef.Pamphlet,page15,todetermine
value.)
• Anhonorarium(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Ref.Pamphlet,page9,
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which,within30daysafter
receipt,werereturnedtothedonorordeliveredtoa
charitableorganization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,
aunt,uncle,niece,nephew,orrstcousin(Includedin
thisexceptionaregiftsfromyourspouseordomestic
partner’schildren,parents,brothers,sisters,andthe
spouseorregistereddomesticpartneroftheindividuals
listedabove.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hospitalityinvolvingfood,drink,oroccasional
lodgingprovidedinanindividual’shomewhenthe
individualoramemberoftheindividual’sfamilywas
present
• Giftsofsimilarvalueexchangedbetweenyouandan
individual,otherthanalobbyist,onholidays,birthdays,
orsimilaroccasions
• Giftsofinformationalmaterialprovidedtoassistyou
intheperformanceofyourofcialduties(forexample,
books,pamphlets,reports,calendars,periodicals,or
educationalseminars)
• Abequestorinheritance(However,inheritedinvestments
orrealpropertymaybereportableonotherschedules.)
• Personalizedplaquesandtrophieswithanindividual
valueoflessthan$250
• Campaigncontributions
• Asingletickettoa501(c)(3)orpoliticalfundraisingevent
receivedforyourownusefromtheorganizationorthe
committeeholdingthefundraiser(thegiftlimitappliesto
nonprottickets)
• Giftsgiventomembersofyourimmediatefamilyunless
youenjoydirectbenetofthegift,usethegift,or
exercisediscretionorcontrolovertheuseordisposition
ofthegift(SeeCommissionRegulation18944.)
• Apassorticketthatprovidedaone-timeadmissionto
anevent(theaterperformance,sportingevent)thatwas
notusedandwasnottransferredtoanotherperson
(CommissionRegulation18946.1providesamethodfor
determiningthevalueofaticketorpassthatwasused
ortransferredtoanotherpersonandfordetermining
thevalueofpassesorticketswhichproviderepeated
admissiontofacilitiesorservices.)
• Food,beverages,andnecessaryaccommodations
provideddirectlyinconnectionwithaneventatwhich
yougaveaspeech,participatedinapanelorseminar,or
providedasimilarservice
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.
REMINDERS
• Giftsfromasinglesourcearesubjecttolimit.See
Ref.Pamphlet,page9.
• SeeRef.Pamphlet,page1,fornewrulesontickets.
• Codelers–Youonlyneedtoreportgiftsfrom
reportablesources.
INSTRUCTIONS ─ SCHEDULE D
INCOME ─ GIFTS
SCHEDULE D
Income – Gifts
Comments:
Name
FPPC Form 700 (2008/2009) Sch. D
FPPC Toll-Free Helpline: 866/ASK-FPPC www.fppc.ca.gov
700
FAIR POLITICAL PRACTICES COMMISSION
CALIFORNIA FORM
► NAME OF SOURCE
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
/ / $
/ / $
/ / $
► NAME OF SOURCE
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
/ / $
/ / $
/ / $
► NAME OF SOURCE
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
/ / $
/ / $
/ / $
► NAME OF SOURCE
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
/ / $
/ / $
/ / $
► NAME OF SOURCE
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
/ / $
/ / $
/ / $
► NAME OF SOURCE
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
/ / $
/ / $
/ / $
Clear Sch. D
Print Form
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FPPCForm700(2008/2009)
FPPCToll-FreeHelpline:866/ASK-FPPCwww.fppc.ca.gov
Instructions-10
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may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,”whichcanbeobtainedfrom
yourlingofcerortheFPPCwebsiteatwww.fppc.ca.gov.
EffectiveAugust15,2008,Regulation18946.6provides
newvaluationmethodsforgiftsofairtransportation.
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
• Travelpaymentsreceivedfromyouremployerinthe
normalcourseofyouremploymentthatareincludedin
theincomereportedonScheduleC
• Paymentsorreimbursementsfortransportationwithin
Californiainconnectionwithaneventatwhichyou
gaveaspeech,participatedinapanelorseminar,or
performedasimilarservice
• Food,beverages,andnecessaryaccommodations
receiveddirectlyinconnectionwithaneventheldinside
oroutsideCaliforniaatwhichyougaveaspeech,
participatedinapanel,orprovidedasimilarservice
(Notethatpaymentsfortransportationoutsideof
Californiaarereportable.)
• 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
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any,ofthesource.
• Checktheboxtoidentifythepaymentasagiftor
income,reporttheamount,anddisclosethedate(s)if
applicable.
-- 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.Giftsof
travelarereportablewithoutregardtowherethe
donorislocated.
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a
boardmemberofthe
LeagueofCalifornia
Cities.TheLeague
reimbursesitsboard
membersfortravel
andlodging,aswell
asmealsandother
expensesassociated
withboardmeetings.
IfRickprovidesequalorgreaterconsiderationforthe
travelandlodgingwhenheparticipatesinthemeeting,the
reimbursementsarereportedasincome.Notethatthe
burdenisontheofcialtodeterminewhetherheorshe
hasprovidedequalorgreatervalueforthepayment.
INSTRUCTIONS ─ SCHEDULE E
TRAVEL PAYMENTS, ADVANCES,
AND REIMBURSEMENTS
SCHEDULE E
Income – Gifts
TravelPayments,Advances,
and Reimbursements
Name
► NAME OF SOURCE
ADDRESS
CITY AND STATE
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DESCRIPTION:
► NAME OF SOURCE
ADDRESS
CITY AND STATE
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DESCRIPTION:
Comments:
FPPC Form 700 (2008/2009) Sch. E
FPPC Toll-Free Helpline: 866/ASK-FPPC www.fppc.ca.gov
TYPE OF PAYMENT: (must check one) Gift Income
TYPE OF PAYMENT: (must check one) Gift Income
700
FAIR POLITICAL PRACTICES COMMISSION
CALIFORNIA FORM
• Reminder – you must mark the gift or income box.
• You are not required to report “income” from government agencies.
► NAME OF SOURCE
ADDRESS
CITY AND STATE
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DESCRIPTION:
► NAME OF SOURCE
ADDRESS
CITY AND STATE
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DESCRIPTION:
DATE(S): / / - / / AMT: $
(If applicable)
DATE(S): / / - / / AMT: $
(If applicable)
TYPE OF PAYMENT: (must check one) Gift Income
TYPE OF PAYMENT: (must check one) Gift Income
DATE(S): / / - / / AMT: $
(If applicable)
DATE(S): / / - / / AMT: $
(If applicable)
Clear Sch. E
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Form700 08 09%5B1%5D (California State University Channel Islands)

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Completed 24 July 2020

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