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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
2009/2010
What’s New
• Effective January 1, 2010, an individual hired for a
position not yet covered under an agency’s conict-
of-interest code must le Form 700 if the individual
serves in a position that makes or participates in
making governmental decisions. These individuals
must le under the broadest disclosure category until
the code is amended to include the new position
unless the agency has provided in writing a limited
disclosure requirement. Such individuals are referred
to as “code lers.” See Regulation 18734.
• New restrictions on receiving tickets to nonprot and
political fundraisers and other events.
More information is contained 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 (“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 (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
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.
Members of Boards and Commissions of Newly
Created Agencies:
File with your newly created agency or with your agency’s
code reviewing body.
Candidates: File with your local elections ofce.
How to le:
The Form 700 is available at www.fppc.ca.gov. Effective
January 1, 2010, Form 700 schedules are also available
in Excel format. All statements must have an original
“wet” signature. Instructions, examples, and a reference
pamphlet are available.
When to le:
Annual Statements
March 1, 2010
- Elected State Ofcers
- Judges and Court Commissioners
- State Board and Commission Members listed in
Government Code Section 87200
April 1, 2010
- 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.
Statements postmarked by the ling deadline are
considered led on time.
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 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cial 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 a limit. For 2009-2010, the
gift limit is $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 Reference Pamphlet,
page 9.)
State and local ofcials and employees should also check
with their agency to determine if any other restrictions
apply.
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 9.)
Loan Restrictions
Certain state and local ofcials are subject to restrictions on
loans. (See Reference Pamphlet, page 13.)
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 at, www.fppc.ca.gov.
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.
• 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.
• 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 (2009/2010)
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. Since 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 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 the Reference
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 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 2009 Annual Statement, do
not change the pre-printed dates to reect 2010. Your
annual statement is used for reporting the previous year’s
economic interests. Economic interests for your annual
ling covering January 1, 2009, through December 31,
2009, will be disclosed on your statement led in 2010.
(See Reference Pamphlet, page 3.)
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 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. 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, 2009, 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, 2009,
through December 31, 2009.
The period covered is / / , through
December 31, 2009.
-or-
STATEMENT OF ECONOMIC INTERESTS
COVER PAGE
NAME (LAST) (FIRST) (MIDDLE)
MAILING ADDRESS STREET CITY STATE ZIP CODE
( )
DAYTIME TELEPHONE NUMBER
FPPC Form 700 (2009/2010)
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: E-MAIL ADDRESS
(Business Address Acceptable)
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 Page
Print Form
specify pages to print
FPPC Form 700 (2009/2010)
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 or 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 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.
•
The Form 700 is a public document.
•
Most individuals must consult their agency’s conict-of-interest code for reportable interests.
•
Most individuals le the Form 700 with their agency.
COMMON REPORTABLE INTERESTS
WHICH SCHEDULE DO I USE?
COMMON NON-REPORTABLE INTERESTS
Instructions - 2
FPPC Form 700 (2009/2010)
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, three are required. However, you may complete
one statement listing the county and the two boards
on the cover page 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 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 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. You may also need to le an assuming ofce
statement for the new agency.
Investment Disclosure
Q. I have an investment interest in shares of stock
in a company that does not have an ofce in my
jurisdiction. Must I still disclose my investment interest
in this company?
A. Probably. The denition of “doing business in the
jurisdiction” is not limited to whether the business
has an ofce in your jurisdiction. (See Reference
Pamphlet, page 12.)
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.
Q. I own stock in IBM and must report this investment on
Schedule A-1. I initially purchased this stock in the
early 90’s; 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, if 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. Note: If a previously
reported investment falls below the $2,000 reporting
threshold, you may note this in the comment section of
the schedule.
QUESTIONS AND ANSWERS
FPPC Form 700 (2009/2010)
FPPC Toll-Free Helpline: 866/ASK-FPPC www.fppc.ca.gov
Instructions - 4
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.
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 7, for
the denition of “business entity.”)
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.
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 total
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.
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.
QUESTIONS AND ANSWERS
Continued
FPPC Form 700 (2009/2010)
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 Reference Pamphlet, page 12.)
Reportable investments include:
• Stocks, bonds, warrants, and options, including those
held in margin or brokerage accounts and managed
investment funds (See Reference Pamphlet, page 12.)
• Sole proprietorships
• Your own business or your spouse’s or registered
domestic partner’s business (See Reference 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 Reference 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 Reference 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 Reference Pamphlet,
page 14.)
● Government dened-benet pension plans
• Interests held in a blind trust (See Reference Pamphlet,
page 15.)
Use Schedule A-1 to report ownership of less than 10% (for
example, 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
(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).
• An acquired or disposed of date is only required if you
initially acquired or entirely disposed of the investment
interest during the reporting period. The date of a stock
dividend reinvestment or partial disposal is not required.
Generally, these dates will not apply if you are ling a
candidate or an assuming ofce statement.
Examples:
John Smith holds a state agency position. His conict-of-
interest code requires full disclosure of investments. John
must disclose his stock holdings of $2,000 or more in any
company that does business in California, as well as those
stocks held by his spouse or registered domestic partner
and dependent children.
Susan Jones is a city council member. She has a 4%
interest, worth $5,000, in a limited partnership located in
the city. Susan must disclose the partnership on Schedule
A-1 and income of $500 or more received from the
partnership on Schedule C.
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
09 09
09
09
0909
09
0909
09
09
Name
► 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
► 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 (2009/2010) 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
09
NATURE OF INVESTMENT
Stock Other
(Describe)
Partnership
Income of $0 - $500
Income Received of $500 or More (Report on Schedule C)
NATURE OF INVESTMENT
Stock Other
(Describe)
Partnership
Income of $0 - $500
Income Received of $500 or More (Report on Schedule C)
NATURE OF INVESTMENT
Stock Other
(Describe)
Partnership
Income of $0 - $500
Income Received of $500 or More (Report on Schedule C)
NATURE OF INVESTMENT
Stock Other
(Describe)
Partnership
Income of $0 - $500
Income Received of $500 or More (Report on Schedule C)
NATURE OF INVESTMENT
Stock Other
(Describe)
Partnership
Income of $0 - $500
Income Received of $500 or More (Report on Schedule C)
NATURE OF INVESTMENT
Stock Other
(Describe)
Partnership
Income of $0 - $500
Income Received of $500 or More (Report on Schedule C)
Clear Sch. A-1
Print Form
specify pages to print
FPPC Form 700 (2009/2010)
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 Reference 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
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 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 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 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 Reference 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 Reference 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
Reference 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
09
09
0909
09 09
IF APPLICABLE, LIST DATE:
/ / / /
ACQUIRED DISPOSED
09 09
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
$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 (2009/2010) 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
Clear Sch. A-2
specify pages to print
FPPC Form 700 (2009/2010)
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 Reference
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 Reference Pamphlet, page 13.)
• A mining lease
• An interest in real property held in a retirement account
(See Reference 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
Reference 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.
• 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
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, leave this section blank.
• 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 (for example, 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.
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 Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF LENDER
IF APPLICABLE, LIST DATE:
/ / / /
ACQUIRED DISPOSED
09 09
09 09
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 (2009/2010) 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 Address Acceptable)
BUSINESS ACTIVITY, IF ANY, 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 (2009/2010)
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 Reference
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 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 12, 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.
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 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 Reference Pamphlet, page 9, concerning your ability to
receive future honoraria.)
• Incentive compensation (See Reference Pamphlet, page 11.)
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
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.
• 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 Reference 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.
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 (for example, 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.
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 (2009/2010) 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 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
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.)
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FPPC Form 700 (2009/2010)
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, and accommodations, including those
provided in direct connection with your attendance at a
convention, conference, meeting, social event, meal, or like
gathering, where you did not give a speech, participate in a
panel or seminar, or provide a similar 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 Reference Pamphlet, page 15)
• 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 Reference 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’s 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 (e.g.,
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 or 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 (e.g., theater performance or 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 a $420
limit. See Reference Pamphlet, page 9.
• See Reference Pamphlet, page 1, for 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 (2009/2010) 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 Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
/ / $
/ / $
/ / $
► NAME OF SOURCE
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
/ / $
/ / $
/ / $
► NAME OF SOURCE
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
/ / $
/ / $
/ / $
► NAME OF SOURCE
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
/ / $
/ / $
/ / $
► NAME OF SOURCE
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
/ / $
/ / $
/ / $
► NAME OF SOURCE
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
/ / $
/ / $
/ / $
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FPPC Form 700 (2009/2010)
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 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
• 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).
-- 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 (Business Address Acceptable)
CITY AND STATE
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DESCRIPTION:
► NAME OF SOURCE
ADDRESS (Business Address Acceptable)
CITY AND STATE
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DESCRIPTION:
Comments:
FPPC Form 700 (2009/2010) 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 (Business Address Acceptable)
CITY AND STATE
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DESCRIPTION:
► NAME OF SOURCE
ADDRESS (Business Address Acceptable)
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)
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Form700-09-10 Statement Of Econ Intrst%5B1%5D

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Completed 17 February 2020

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