Statement of Economic Interests - California State … · 2017-11-19 · issuing the attached Statement of Economic Interests, Form 700 ... arerohibited p from accepting an honorarium

Form 700Statement of Economic Interests

Also available on the FPPC website:Form 700 Reference Pamphlet

a public document

Fair Political Practices Commission428 J Street, Suite 620 • Sacramento, CA 95814Toll-Free Advice Line: 866-ASK-FPPC • (866) 275-3772Telephone: (916) 322-5660www.fppc.ca.gov

2008/2009

What’s New• Giftlimitincreasedto$420.• Newrestrictionsonreceivingticketstononprofitand

politicalfundraisers.MoreinformationisintheReferencePamphlet.

Who must file:• Electedandappointedofficialsandcandidateslistedin

GovernmentCodeSection87200.• Employeesandappointedofficialsfilingpursuantto

aconflict-of-interestcode.Obtainyourdisclosurecategories,whichdescribetheinterestsyoumustreport,fromyouragency.TheyarenotpartoftheForm700.

• Candidatesrunningforlocalelectiveofficesthataredesignatedinaconflict-of-interestcode(forexample,countysheriffs,cityclerks,schoolboardtrustees,andwaterboardmembers).

• Membersofnewlycreatedboardsandcommissionsnotyetcoveredunderaconflict-of-interestcode.

(SeeForm700ReferencePamphlet,page2,atwww.fppc.ca.govorobtainfromyourfilingofficer.)

Where to file:87200 FilersStateoffices YouragencyJudicialoffices TheclerkofyourcourtRetiredJudges DirectlywithFPPCLegislativeStaff DirectlywithFPPCCountyoffices YourcountyfilingofficialCityoffices YourcityclerkMulti-Countyoffices Youragency

Members of Boards/Commissions of Newly Created Agencies:Filewithyournewlycreatedagencyorwithyouragency’scodereviewingbodyasprovidedbythecodereviewingbody.

Code Filers — State and Local Officials and Employees Designated in a Conflict-of-Interest Code:Filewithyouragency,board,orcommissionunlessotherwisespecifiedinyouragency’sconflict-of-interestcode.Inmostcases,theagency,board,orcommissionwillretainthestatements.

Candidatesfilewiththeirlocalelectionsoffice.

How to file:AForm700shouldbeprovidedtoyoubyyourfilingofficial.AninteractiveversionoftheForm700isavailableonourwebsiteatwww.fppc.ca.gov.

Youonlyhavetoreportinvestmentsandbusinesspositionsinbusinessentities,realproperty,andincomefromsourcesthatarelocatedinordoingbusinessinyouragency’sjurisdiction.However,reportablegiftsmustbedisclosedregardlessofthejurisdiction.SeeForm700Ref.Pamphlet,page12,formoreinformation.

When to file:Annual StatementsMarch 2, 2009*

- ElectedStateOfficers- JudgesandCourtCommissioners- StateBoard/CommissionMemberslistedin

GovernmentCodeSection87200

April 1, 2009- Mostotherfilers

Individualsfilingunderconflict-of-interestcodesincityandcountyjurisdictionsshouldverifytheannualfilingdatewiththeirlocalfilingofficer.*BecauseMarch1isaSunday,thedeadlineisextended.Statementspostmarkedbythefilingdeadlineareconsideredtimelyfiled.

Assuming, Leaving, and Initial StatementsMostfilersfilewithin30daysofassumingorleavingofficeorwithin30daysoftheeffectivedateofanewlyadoptedoramendedconflict-of-interestcode.

Candidate StatementsFilenolaterthanthefinalfilingdateforthedeclarationofcandidacyornominationdocuments.

AmendmentsStatementsmaybeamendedatanytime.Youareonlyrequiredtoamendtheschedulethatneedstoberevised.Itisnotnecessarytoamendtheentirefiledform.Obtainamendmentschedulesfromyourfilingofficialorinteractivelyatwww.fppc.ca.gov.

Statements that are mailed are considered filed on the postmark date. There is no provision for filing deadline extensions. Statementsof30pagesorlessmaybefaxedbythedeadlineaslongastheoriginallysignedpaperversionissentbyfirstclassmailtothefilingofficerwithin24hours.

ThePoliticalReformAct(Gov.CodeSections81000-91014)requiresmoststateandlocalgovernmentofficialsandemployeestopubliclydisclosetheirpersonalassetsandincome.Theyalsomustdisqualifythemselvesfromparticipatingindecisionswhichmayaffecttheirpersonaleconomicinterests.TheFairPoliticalPracticesCommission(FPPC)isthestateagencyresponsibleforissuingtheattachedStatementofEconomicInterests,Form700,andforinterpretingthelaw’sprovisions.

Gift ProhibitionGiftsreceivedbymoststateandlocalofficials,employees,andcandidatesaresubjecttolimit.For2007-2008,thegiftlimitwas$390fromasinglesourceduringacalendaryear.For2009-2010,thelimitincreasedto$420fromasinglesourceduringacalendaryear.Inaddition,stateofficials,statecandidates,andcertainstateemployeesaresubjecttoa$10limitpercalendarmonthongiftsfromlobbyistsandlobbyingfirmsregisteredwiththeSecretaryofState.(SeeRef.Pamphlet,page9,fordetailedinformation.)

Stateandlocalofficialsandemployeesalsoshouldcheckwiththeiragencytodetermineifanyotherrestrictionsapply.

Honorarium BanMoststateandlocalofficials,employees,andcandidatesareprohibitedfromacceptinganhonorariumforanyspeechgiven,articlepublished,orattendanceataconference,convention,meeting,orlikegathering.(SeeRef.Pamphlet,page9,fordetailedinformation.)

Loan RestrictionsCertainstateandlocalpublicofficialsaresubjecttorestrictionsonloans.(SeeRef.Pamphlet,page13,fordetailedinformation.)

DisqualificationPublicofficialsare,undercertaincircumstances,requiredtodisqualifythemselvesfrommaking,participatingin,orattemptingtoinfluencegovernmentaldecisionsthatwillaffecttheireconomicinterests.Thismayincludeintereststheyarenotrequiredtodisclose(forexample,apersonalresidenceisoftennotreportable,butmaybedisqualifying).Specificdisqualificationrequirementsapplyto87200filers(forexample,citycouncilmembers,membersofboardsofsupervisorsandplanningcommissioners).Theseofficialsmustorallyidentifytheeconomicinterestthatcreatesaconflictofinterestandleavetheroombeforeadiscussionorvotetakesplaceatapublicmeeting.Formoreinformation,consultGovernmentCodeSection87105andRegulation18702.5,orrefertothebookletentitled“CanIVote?ConflictsofInterestOverview,”allofwhichareavailableontheFPPCwebsite.Visitwww.fppc.ca.govandclickontheLibrary&Publicationsicon.

Post-Governmental EmploymentTherearerestrictionsonrepresentingclientsoremployersbeforeformeragencies.Theprovisionsapplytoelectedstateofficials,moststateemployees,localelectedofficials,countychiefadministrativeofficers,citymanagers,includingthechiefadministratorofacity,andgeneralmanagersorchiefadministratorsoflocalspecialdistricts.TheFPPCwebsitehasfactsheetsexplainingtheprovisions.

Late FilingThefilingofficerwhoretainsoriginallysignedstatementsofeconomicinterestsmayimposeonanindividualafineforanystatementthatisfiledlate.Thefineis$10perdayuptoamaximumof$100.Latefilingpenaltiescanbereducedorwaivedundercertaincircumstances.

PersonswhofailtotimelyfiletheirForm700maybereferredtotheFPPC’sEnforcementDivision(and,insomecases,totheAttorneyGeneralordistrictattorney)forinvestigationandpossibleprosecution.Inadditiontothelatefilingpenalties,afineofupto$5,000perviolationmaybeimposed.

For assistanceconcerningreporting,prohibitions,andrestrictionsundertheAct:

• CalltheFPPCtoll-freeat(866)ASK-FPPC.

• Seethebookletentitled“YourDutytoFile:ABasicOverviewofStateEconomicDisclosureLawandReportingRequirementsforPublicOfficials.”

Form 700 Public AccessStatementsofEconomicInterestsarepublicdocuments.Thefilingofficermustpermitanymemberofthepublictoinspectandcopyanystatement.• Formsmustbeavailableassoonaspossibleduringtheagency'sregularbusinesshours,butinanyeventnotlaterthanthesecondbusinessdayafterthestatementisreceived.

•Noconditionsmaybeplacedonpersonsseekingaccesstotheforms.

•Noinformationoridentificationmayberequiredfrompersonsseekingaccess.

Reproductionfeesofnomorethan10centsperpagemaybecharged.

INTRODUCTION

FPPCForm700(2008/2009)FPPCToll-FreeHelpline:866/ASK-FPPCwww.fppc.ca.gov

Instructions-1

Enteryourname,mailingaddress,anddaytimetelephonenumberinthespacesprovided.BecausetheForm700isadocumentavailableforpublicreview,youmaylistyourbusiness/officeaddressinsteadofyourhomeaddress.

Part 1. Office, Agency, or Court• Enterthenameoftheofficesoughtorheld,orthe

agencyorcourt.Consultantsmustenterthepublicagencynameratherthantheirprivatefirmname.(Examples:StateAssembly;BoardofSupervisors;OfficeoftheMayor;DepartmentofFinance;HopeCountySuperiorCourt.)

• Indicatethenameofyourdivision,board,ordistrict,ifapplicable.(Examples:DivisionofWasteManagement;BoardofAccountancy;District45.)

• Enteryourpositiontitle.(Examples:Director;ChiefCounsel;CityCouncilMember;StaffServicesAnalyst.)

• Ifyouholdmultiplepositions(forexample,acitycouncilmemberwhoalsoisamemberofacountyboardorcommission),youmayberequiredtofilestatementswitheachagency.

Tosimplifyyourfilingobligations,youmaycompleteanexpandedstatement.

Todothis,enterthenameoftheotheragency(ies)withwhichyouarerequiredtofileandyourpositiontitle(s)inthespaceprovided.Attachanadditionalsheetifnecessary.Completeonestatementcoveringthedisclosurerequirementsforallpositions.Eachcopymustcontainanoriginalsignature.Therefore,beforesigningastatement,makeacopyforeachagency.Signeachcopywithanoriginalsignatureandfilewitheachagency.

Rememberthatifyouassumeorleaveapositionafterafilingdeadline,youmustcompleteaseparatestatement.Forexample,acitycouncilmemberwhoassumesapositionwithacountyspecialdistrictaftertheApril1annualfilingdeadlinemustfileaseparateassumingofficestatement.Insubsequentyears,thecitycouncilmembermayexpandhisorherannualfilingtoincludebothpositions.

Part 2. Jurisdiction of Office• Checktheboxindicatingthejurisdictionofyouragency

and,ifapplicable,identifythejurisdiction.Judges,judicialcandidates,andcourtcommissionershavestatewidejurisdiction.AllotherfilersshouldreviewRef.Pamphlet,page12,todeterminetheirjurisdiction.

• Ifyouragencyisamulti-countyoffice,listeachcountyinwhichyouragencyhasjurisdiction.

• Ifyouragencyisnotastateoffice,court,countyoffice,cityoffice,ormulti-countyoffice(forexample,schooldistrictsandspecialdistricts),checkthe“other”boxandenterthecountyorcityinwhichtheagencyhasjurisdiction.

Example: ThisfilerisamemberofawaterdistrictboardwithjurisdictioninportionsofYubaandSutterCounty.

Part 3. Type of StatementCheckatleastonebox.Theperiodcoveredbyastatementisdeterminedbythetypeofstatementyouarefiling.Ifyouarecompletinga2008AnnualStatement,do notchangethepre-printeddatestoreflect2009.Yourannualstatementisusedforreportingthepreviousyear’seconomicinterests.EconomicinterestsforyourannualfilingcoveringJanuary1,2008,throughDecember31,2008,willbedisclosedonyourstatementfiledin2009.(SeeRef.Pamphlet,page3,fordetailedinformationabouttypesofstatements.)

CombiningStatements:Certaintypesofstatementsmaybecombined.Forexample,ifyouleaveofficeafterJanuary1butbeforethedeadlineforfilingyourannualstatement,youmaycombineyourannualandleavingofficestatements.Filebytheearliestdeadline.ConsultyourfilingofficerortheFPPC.

Part 4. Schedule Summary• Enterthetotalnumberofcompletedpagesincluding

thecoverpageand,either:Checkthe“Yes”boxforeachscheduleyouusetodiscloseinterests.

- or -Ifyouhavenothingtodiscloseonanyschedules,checkthe“Noreportableinterests”box.Pleasedonotattachanyblankschedules.

Part 5. VerificationCompletetheverificationbysigningthestatementandenteringthedatesigned.Whenyousignyourstatement,youarestating,underpenaltyofperjury,thatitistrueandcorrect.Onlythefilerhasauthoritytosignthestatement.An unsigned statement is not considered filed and you may be subject to late filing 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 Office Date Left: / / (Check one)

The period covered is January 1, 2008, through the date of leaving office.

The period covered is / / , through the date of leaving office.

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.VerificationI 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. JurisdictionofOffice (Check at least one box)

Candidate

No reportable interests on any schedule

A Public Document

Assuming Office/Initial Date: / /

OPTIONAL: FAX / E-MAIL ADDRESS(May use business address)

Date ReceivedOfficial Use Only

(File the originally signed statement with your filing official.)

Please type or print in ink.

-or-

-or-

700FAIR POLITICAL PRACTICES COMMISSION

CALIFORNIA FORM

Name of Office, Agency, or Court:

Division, Board, District, if applicable:

Your Position:

► If filing for multiple positions, list additional agency(ies)/ position(s): (Attach a separate sheet if necessary.)

Agency:

Position:

1.Office,Agency,orCourt► Total number of pages

including this cover page:


Instructions-2

ScheduleA-1: Stocks

ScheduleA-2: Businessentities,partnerships,LLCs,corporations,trusts

ScheduleB: Rentalpropertyinthejurisdiction

ScheduleC: Non-governmentsalariesofpublicofficialandspouse/registereddomesticpartner

ScheduleD: Giftsfromnon-familymembers(suchasticketstosportingorentertainmentevents)

ScheduleE: Travelpaymentsfromthirdparties(notyouremployer)

ScheduleA-1/A-2: DiversifiedmutualfundsregisteredwiththeSECundertheInvestmentCompanyActof 1940andcertainretirementaccountsinvestedininsurancepoliciesorgovernmentalbonds

ScheduleA-1/A/2: Savingsandcheckingaccounts

ScheduleB: Aresidenceusedexclusivelyasapersonalresidence(suchasahome,vacationcabin)

ScheduleC: Governmentsalary(suchasaschooldistrict)

ScheduleD: Giftsfromfamilymembers

ScheduleE: Travelpaidbyyourgovernmentagency

Remember: Markthe“noreportableinterests”boxonPart4oftheschedulesummaryifyoudetermineyouhavenothingtodiscloseandfilethecoverpageonly. Make sure you carefully read all instructions to ensure proper reporting.

TheForm700isapublicdocument.

Mostindividualsmustconsulttheagency’sconflict-of-interestcodeforreportableinterests.

MostindividualsfiletheForm700withtheiragency.

COMMON REPORTABLE INTERESTS

WHAT SCHEDULE DO I USE?

COMMON NON-REPORTABLE INTERESTS

Instructions-2


Instructions-3

Q. Whatisthereportingperiodfordisclosinginterestsonanassumingofficestatementoracandidatestatement?

A. Onanassumingofficestatement,discloseallreportableinvestments,interestsinrealproperty,andbusinesspositionsheldonthedateyouassumedoffice.Inaddition,youmustdiscloseincome(includingloans,giftsandtravelpayments)receivedduringthe12monthspriortothedateyouassumedoffice.

Onacandidatestatement,discloseallreportableinvestments,interestsinrealproperty,andbusinesspositionsheldonthedateyoufileyourdeclarationofcandidacy.Inaddition,youmustdiscloseincome(includingloans,giftsandtravelpayments)receivedduringthe12monthspriortothedateyoufileyourdeclarationofcandidacy.

Q. Iholdtwootherboardpositionsinadditiontomypositionwiththecounty.MustIfilethreestatementsofeconomicinterests?

A. Yes.However,youmaycompleteonestatementlistingthecountyandthetwoboardsonthecoverpageoftheForm700astheagenciesforwhichyouwillbefiling.Reportyoureconomicinterestsusingthebroadestjurisdictionanddisclosurerequirementsassignedtoyoubythethreeagencies.Maketwocopiesoftheentirestatementbefore signing it,signeachcopywithanoriginalsignature,anddistributeoneoriginaltothecountyandtoeachofthetwoboards.Remembertocompleteseparatestatementsforpositionsthatyouleaveorassumeduringtheyear.

Q. Iamclassifiedasadepartmentheadbutrecentlybeganactingascitymanager.ShouldIfileasthecitymanager?

A. Yes.Fileanassumingofficestatementascitymanager.Personsservingas“acting”,“interim”,or“alternate”mustfileasiftheyholdtheposition.

Q. Ileftonestateagencytoworkforanotherstateagency.MustIfilealeavingofficestatement?

A. Yes.

Investment Disclosure

Q. Ihaveaninvestmentinterestinsharesofstockinacompanythatdoesnothaveanofficeinmyjurisdiction.MustIstilldisclosemyinvestmentinterestinthiscompany?

A. Probably.Thedefinitionof“doingbusinessinthejurisdiction”isnotlimitedtowhetherthebusinesshasanofficeinyourjurisdiction.SeeRef.Pamphlet,

page12,forguidance.

Q. MyspouseandIhavealivingtrust.Thetrustholdsrentalpropertyinmyjurisdiction,ourprimaryresidence,andinvestmentsindiversifiedmutualfunds.Ihavefulldisclosure.Howisthistrustdisclosed?

A. Disclosethenameofthetrust,therentalpropertyanditsincomeonScheduleA-2.YourprimaryresidenceandinvestmentsindiversifiedmutualfundsregisteredwiththeSECarenotreportable.

Q. Iamrequiredtoreportallinvestments.Iholdmanystocksthroughanaccountmanagedbyabrokeragefirm.MustIdisclosethesestockseventhoughIdidnotdecidewhichstockstopurchase?

A. Yes,youmustdiscloseonScheduleA-1orA-2anystockworth$2,000ormoreinabusinessentitylocatedinordoingbusinessinyourjurisdiction.

Income Disclosure

Q. IreportedabusinessentityonScheduleA-2.Clientsofmybusinessarelocatedinseveralstates.MustIreportallclientsfromwhommyproratashareofincomeis$10,000ormoreonScheduleA-2,Part3?

A. No,onlytheclientsdoingbusinessonaregularbasisinyourjurisdictionmustbedisclosed.

Q. IbelieveIamnotrequiredtodisclosethenamesofclientsfromwhommyproratashareofincomeis$10,000ormoreonScheduleA-2becauseoftheirrighttoprivacy.Isthereanexceptionforreportingclients’names?

A. Regulation18740providesaprocedureinwhichaclient’snamemaynotbedisclosedifdisclosureofthenamewouldviolatealegallyrecognizedprivilegeunderCalifornialaw.Thisregulationmaybeobtainedfromourwebsiteatwww.fppc.ca.gov.

QUESTIONS AND ANSWERS


Instructions-4

Q. Iamthesoleownerofmybusiness.WheredoIdisclosemyincome-onScheduleA-2orScheduleC?

A. Sourcesofincometoabusinessinwhichyouhaveanownershipinterestof10%orgreateraredisclosedonScheduleA-2.(SeeRef.Pamphlet,page7,whichdefines“businessentity,”formoreinformation.)

Q. HowdoIdisclosemyspouse’sorregistereddomesticpartner’sincomefromanemployer?

A. ReportthenameoftheemployerasasourceofincomeonScheduleC.

Q. Iamadoctor.Forpurposesofreporting$10,000sourcesofincomeonScheduleA-2,Part3,arethepatientsortheirinsurancecarriersconsideredsourcesofincome?

A. Ifyourpatientsexercisesufficientcontrolbyselectingyouinsteadofotherdoctors,yourpatients,ratherthantheirinsurancecarriers,aresourcesofincometoyou.

Gift DisclosureQ. IfIreceivedagiftoftwoticketstoaconcertvaluedat

$100each,butgavetheticketstoafriendbecauseIcouldnotattendtheconcert,doIhaveanyreportingobligations?

A. Yes.Sinceyouacceptedthegiftandexerciseddiscretionandcontroloftheuseofthetickets,youmustdisclosethegiftonScheduleD.

Q. Co-workersarehostingaretirementpartyforapublicofficialbeforetheofficialleavesoffice.Attendeeswillpay$45;$35coverstheevent’scosts(food,decorations,etc.)and$10goestowardagift.Oneco-workeriscollectingthefundsandmakingtheexpenditures.WhatdoestheofficialreportonhisForm700?

A. Theofficialdisclosestheamountthatincludesthevalueofthegift,plus$35(hisproratashareoftheevent’scost).Thesourcecanbeidentifiedas“officestaff”or“co-workers.”Thenamesofindividualdonorsarenotrequiredtobereportedaslongasnoindividualcontributed$50ormore.

Q. MaryandJoeBenson,amarriedcouple,wanttogiveapieceofartworktoaclosefriendwhoisacountysupervisor.Iseachspouseconsideredaseparatesourceforpurposesofthegiftlimitanddisclosure?

A. Yes,eachspousemaymakeagiftvaluedat$420during2009-2010.Therefore,theBensonsmaygivethesupervisorartworkvaluedatnomorethan$840.(During2007-2008,thegiftlimitwas$390fromasinglesourceduringacalendaryear.)ThesupervisormustidentifyJoeandMaryBensonasthesourceofthegift.

QUESTIONS AND ANSWERSContinued


Instructions-5

“Investment”meansafinancialinterestinanybusinessentitywhichislocatedin,doingbusinessin,planningtodobusinessin,orwhichhasdonebusinessduringtheprevioustwoyearsinyouragency’sjurisdictioninwhichyou,yourspouseorregistereddomesticpartner,oryourdependentchildrenhadadirect,indirect,orbeneficialinteresttotaling$2,000ormoreatanytimeduringthereportingperiod.(SeeRef.Pamphlet,page12.)

Reportable investments include:• Stocks,bonds,warrants,andoptions,includingthose

heldinmarginorbrokerageaccountsandmanagedinvestmentfunds(SeeRef.Pamphlet,page12.)

• Soleproprietorships• Yourownbusinessoryourspouse’sorregistered

domesticpartner’sbusiness(SeeRef.Pamphlet, page7,forthedefinitionof“businessentity.”)• Yourspouse’sorregistereddomesticpartner’s

investmentsthatarelegallyseparateproperty• Partnerships(forexample,alawfirmorfamilyfarm)• Investmentsinreportablebusinessentitiesheldina

retirementaccount(SeeRef.Pamphlet,page14.)• Ifyou,yourspouseorregistereddomesticpartner,or

dependentchildrenhada10%orgreaterownershipinterestinabusinessentityortrust(includingalivingtrust),youmustdiscloseinvestmentsheldbythebusinessentityortrust.(SeeRef.Pamphlet,page14,formoreinformationondisclosingtrusts.)

• Businesstrusts

You are not required to disclose:• DiversifiedmutualfundsregisteredwiththeSecurities

andExchangeCommission(SEC)undertheInvestmentCompanyActof1940

• Bankaccounts,savingsaccounts,andmoneymarketaccounts

• Insurancepolicies• Annuities• Sharesinacreditunion• Governmentbonds(includingmunicipalbonds)• Retirementaccountsinvestedinnon-reportableinterests

(forexample,insurancepolicies,diversifiedmutualfunds,orgovernmentbonds)(SeeRef.Pamphlet,

page14.)

● Governmentdefined-benefitpensionplans• Interestsheldinablindtrust(SeeRef.Pamphlet, page15.)

Use Schedule A-1toreportownershipoflessthan10%(forexample,stock).ScheduleC(Income)mayalsoberequirediftheinvestmentisnotastockorcorporatebond.(Seesecondexamplebelow.)

Use Schedule A-2toreportownershipof10%orgreater(forexample,asoleproprietorship).

TO COMPLETE SCHEDULE A-1:Do not attach brokerage or financial statements.• Disclosethenameofthebusinessentity.• Provideageneraldescriptionofthebusinessactivity

oftheentity(forexample,pharmaceuticals,computers,automobilemanufacturing,orcommunications).

• Checktheboxindicatingthehighestfairmarketvalueofyourinvestmentduringthereportingperiod.Ifyouarefilingacandidateoranassumingofficestatement,indicatethefairmarketvalueonthefilingdateorthedateyoutookoffice,respectively.

• Identifythenatureofyourinvestment(forexample,stocks,warrants,options,orbonds).

• Ifyouinitiallyacquiredordisposedofyourentireinvestmentinterestduringthereportingperiod,enterthedateacquiredordisposed.

Examples:JohnSmithholdsastateagencyposition.Hisconflict-of-interestcoderequiresfulldisclosureofinvestments.Johnmustdisclosehisstockholdingsof$2,000ormoreinanycompanythatdoesbusinessinCalifornia,aswellasthosestocksheldbyhisspouseorregistereddomesticpartneranddependentchildren.

SusanJonesisacitycouncilmember.Shehasa4%interest,worth$5,000,inalimitedpartnershiplocatedinthecity.SusanmustdisclosethepartnershiponScheduleA-1andincomeof$500ormorereceivedfromthepartnershiponScheduleC.

INSTRUCTIONS ─ SCHEDULES A-1 AND A-2INVESTMENTS

REMINDERS•Doyouknowyouragency’sjurisdiction?•Didyouholdinvestmentsatanytimeduringtheperiodcoveredbythisstatement?

•Codefilers–Yourdisclosurecategoriesmayonlyrequiredisclosureofspecificinvestments.

IF APPLICABLE, LIST DATE:

/ / / / ACQUIRED DISPOSED











08 08 08 08

0808

080808

0808

Name

► NAME OF BUSINESS ENTITY

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

NATURE OF INVESTMENT Stock

Other (Describe)


Other (Describe)


Other (Describe)


Other (Describe)


Other (Describe)


Other (Describe)











Comments:

SCHEDULE A-1Investments

Stocks, Bonds, and Other Interests(Ownership Interest is Less Than 10%)

Do not attach brokerage or financial statements.


CALIFORNIA FORM

FPPC Form 700 (2008/2009) Sch. A-1FPPC 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






08


Instructions-6

UseScheduleA-2toreportinvestmentsinabusinessentityortrust(includingalivingtrust)inwhichyou,yourspouseorregistereddomesticpartner,oryourdependentchildrenhada10%orgreaterinterest,totaling$2,000ormore,duringthereportingperiodandwhichislocatedin,doingbusinessin,planningtodobusinessin,orwhichhasdonebusinessduringtheprevioustwoyearsinyouragency’sjurisdiction.(SeeRef.Pamphlet,page12.)Atrustlocatedoutsideyouragency’sjurisdictionisreportableifitholdsassetsthatarelocatedinordoingbusinessinthejurisdiction.Youarenotrequiredtoreportatrustthatcontainsnoreportableinterests.Forexample,ifyouhaveatrustcontainingonlyyourpersonalresidence,yoursavingsaccount,andsomemunicipalbonds,youwouldnotreportthistrustbecausetheseinterestsarenotreportable.

AlsoreportonScheduleA-2investmentsandrealpropertyheldbythatentityortrustifyourproratashareoftheinterestwas$2,000ormoreduringthereportingperiod.

TO COMPLETE SCHEDULE A-2:Part 1.Disclosethenameandaddressofthebusinessentityortrust.Ifyouarereportinganinterestinabusinessentity,check“BusinessEntity”andcompletetheboxasfollows:• Provideageneraldescriptionofthebusinessactivityof

theentity.• Checktheboxindicatingthefairmarketvalueofyour

investment.• Ifyouinitiallyacquiredorentirelydisposedofthis

interestduringthereportingperiod,enterthedateacquiredordisposed.

• Identifythenatureofyourinvestment.• Disclosethejobtitleorbusinesspositionyouheldwith

theentity,ifany(forexample,ifyouwereadirector,officer,partner,trustee,employee,orheldanypositionofmanagement).

Part 2.Checktheboxindicatingyourgrossincome.Grossincomeisthetotalamountofincomebeforedeductingexpenses,losses,ortaxes.(Thisincludesyourproratashareofthegrossincometo the business entity or trust,aswellasyourcommunitypropertyinterestinyourspouse’sorregistereddomesticpartner’sshare.)

Part 3.Disclosethenameofeachsourceofincomewhichislocatedin,doingbusinessin,planningtodobusinessin,orwhichhasdonebusinessduringtheprevioustwoyearsinyouragency’sjurisdiction,asfollows:• Discloseeachsourceofincomeandoutstandingloan to the business entity or trustidentifiedinPart1if

yourproratashareofthegrossincome(includingyourcommunitypropertyinterestinyourspouse’sorregistereddomesticpartner’sshare)tothebusinessentityortrustfromthatsourcewas$10,000ormoreduringthereportingperiod.(SeeRef.Pamphlet,page10,forexamples.)Incomefromgovernmentalsourcesmaybereportableifnotconsideredsalary.(SeeRegulation18232.)Loansfromcommerciallendinginstitutionsmadeinthelender’sregularcourseofbusinessontermsavailabletomembersofthepublicwithoutregardtoyourofficialstatusarenot reportable.

• Discloseeachindividualorentitythatwasasourceofcommissionincomeof$10,000ormoreduringthereportingperiodthroughthebusinessentityidentifiedinPart1.(SeeRef.Pamphlet,page7,foranexplanationofcommissionincome.)Youmayberequiredtodisclosesourcesofincomelocatedoutsideyourjurisdiction.Forexample,youmayhaveaclientwhoresidesoutsideyourjurisdictionwhodoesbusinessonaregularbasiswithyou.Suchaclient,ifareportablesourceof$10,000ormore,mustbedisclosed.

LeavePart3blankifyoudonothaveanyreportable$10,000sourcesofincometodisclose.Addingphrasessuchas“variousclients”or“notdisclosingsourcespursuanttoattorney-clientprivilege”maytriggerarequestforanamendmenttoyourstatement.(SeeRef.Pamphlet,page13,fordetailsaboutprivilegedinformation.)

Part 4.Reportanyinvestmentsorinterestsinrealpropertyheldby the entity or trustidentifiedinpart1ifyourproratashareoftheinterestheldwas$2,000ormoreduringthereportingperiod.• Checktheapplicableboxidentifyingtheinterestheldas

realpropertyoraninvestment.• Ifinvestment,providethenameanddescriptionofthe

businessentity.• Ifrealproperty,reporttheaddressorotherprecise

location(forexample,anassessor’sparcelnumber).• Checktheboxindicatingthefairmarketvalueofyour

interestintherealpropertyorinvestment.(Reportthefairmarketvalueoftheportionofyourresidenceclaimedasataxdeductionifyouareutilizingyourresidenceforbusinesspurposes.)

• Identifythenatureofyourinterest.• Enterthedateacquiredordisposedonlyifyouinitially

acquiredorentirelydisposedofyourinterestinthepropertyorinvestmentduringthereportingperiod.

INSTRUCTIONS ─ SCHEDULE A-2INVESTMENTS, INCOME, AND ASSETS OF BUSINESS ENTITIES/TRUSTS







08080808

08 08



08 08

SCHEDULE A-2Investments, Income,andAssets

of Business Entities/Trusts(Ownership Interest is 10% or Greater)

Comments:

Name

Address

Name

Address



INVESTMENT REAL PROPERTY

Name of Business Entity or Street Address or Assessor’s Parcel Number of Real Property

Description of Business Activity orCity 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 INCOMEOF$10,000ORMORE (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-2FPPC Toll-Free Helpline: 866/ASK-FPPC www.fppc.ca.gov


$0 - $499 $500 - $1,000 $1,001 - $10,000

$10,001 - $100,000 OVER $100,000



INVESTMENT REAL PROPERTY

Name of Business Entity or Street Address or Assessor’s Parcel Number of Real Property

Description of Business Activity orCity 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 INCOMEOF$10,000ORMORE (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:



$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


Instructions-7

Reportinterestsinrealpropertylocatedinyouragency’sjurisdictioninwhichyou,yourspouseorregistereddomesticpartner,oryourdependentchildrenhadadirect,indirect,orbeneficialinteresttotaling$2,000ormoreanytimeduringthereportingperiod.(SeeRef.Pamphlet,page12.)

Interests in real property include:• Anownershipinterest(includingabeneficialownership

interest)• Adeedoftrust,easement,oroptiontoacquireproperty• Aleaseholdinterest(SeeRef.Pamphlet,page13.)• Amininglease• Aninterestinrealpropertyheldinaretirementaccount

(SeeRef.Pamphlet,page14.)• Aninterestinrealpropertyheldbyabusinessentityor

trustinwhichyou,yourspouseorregistereddomesticpartner,oryourdependentchildrenhada10%orgreaterownershipinterest(reportonScheduleA-2)

• Yourspouse’sorregistereddomesticpartner’sinterestsinrealpropertythatarelegallyheldseparatelybyhimorher

You are not required to report:• Aresidence,suchasahomeorvacationcabin,used

exclusivelyasapersonalresidence(However,aresidenceforwhichyouclaimabusinessdeductionmaybereportable.Ifreportable,reportthefairmarketvalueoftheportionclaimedasataxdeduction.)

• Interestsinrealpropertyheldthroughablindtrust(SeeRef.Pamphlet,page15,forexceptions.)

TO COMPLETE SCHEDULE B:• Reporttheaddressorotherpreciselocation(for

example,anassessor’sparcelnumber)oftherealproperty.

• Checktheboxindicatingthefairmarketvalueofyourinterestintheproperty(regardlessofwhatyouoweontheproperty).

• Enterthedateacquiredordisposedonlyifyouinitiallyacquiredorentirelydisposedofyourinterestinthepropertyduringthereportingperiod.

• Identifythenatureofyourinterest.Ifitisaleasehold,disclosethenumberofyearsremainingonthelease.

• Ifyoureceivedrentalincome,checktheboxindicatingthegrossamountyoureceived.

• Ifyouhada10%orgreaterinterestinrealpropertyandreceivedrentalincome,listthenameofthesource(s)ifyourproratashareofthegrossincomefromanysingletenantwas$10,000ormoreduringthereportingperiod.Ifyoureceivedatotalof$10,000ormorefromtwoormoretenantsactinginconcert(e.g.,inmostcases,thiswillapplytomarriedcouples),disclosethenameofeachtenant.Otherwise,leavethissectionblank.

• Loansfromaprivatelenderthattotal$500ormoreandaresecuredbyrealpropertymaybereportable.ReportableloansmaybedisclosedonScheduleBorScheduleC.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 official status are not reportable.-- Providethenameandaddressofthelender.-- Describethelender’sbusinessactivity.-- Disclosetheinterestrateandtermoftheloan.The

termofaloanisthetotalnumberofmonthsoryearsgivenforrepaymentoftheloanatthetimetheloanwasenteredinto.Forvariableinterestrateloans,disclosetheconditionsoftheloan(forexample,Prime+2)ortheaverageinterestratepaidduringthereportingperiod.

-- Checktheboxindicatingthehighestbalanceoftheloanduringthereportingperiod.

-- Identifyaguarantor,ifapplicable.

Ifyouhavemorethanonereportableloanonasinglepieceofrealproperty,reporttheadditionalloan(s)onScheduleC.

Example: JoeNelsonisacityplanningcommissioner.Joereceivedrentalincomeof$12,000duringthereportingperiodfromasingletenantwhorentedpropertyJoeownedinthecity’sjurisdiction.IfJoehadreceivedthe$12,000fromtwoormoretenants,thetenants’nameswouldnotberequiredaslongasnosingletenantpaid$10,000ormore.

REMINDERS• IncomeandloansalreadyreportedonScheduleBarenotalsorequiredtobereportedonScheduleC.

•Codefilers–Doyourdisclosurecategoriesrequiredisclosureofrealproperty?

INSTRUCTIONS ─ SCHEDULE BINTERESTS IN REAL PROPERTY



NAME OF LENDER*

ADDRESS

BUSINESS ACTIVITY OF LENDER



08 0808 08

SCHEDULE BInterests 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:


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. BFPPC Toll-Free Helpline: 866/ASK-FPPC www.fppc.ca.gov


CALIFORNIA FORM

NAME OF LENDER*

ADDRESS

BUSINESS ACTIVITY OF LENDER

► STREET ADDRESS OR PRECISE LOCATION

CITY


% 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


IF RENTAL PROPERTY, GROSS INCOME RECEIVED

OVER $100,000

$500 - $1,000 $0 - $499 $1,001 - $10,000

$10,001 - $100,000


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 official status. Personal loans and loans received not in a lender’s regular course of business must be disclosed as follows:


Instructions-8

Reportthesourceandamountofgrossincomeof$500ormoreyoureceivedduringthereportingperiod.Grossincomeisthetotalamountofincomebeforedeductingexpenses,losses,ortaxesandincludesloansotherthanloansfromacommerciallendinginstitution.(SeeRef.Pamphlet,page10.)Alsoreportyourjobtitlewitheachreportablebusinessentity,evenifyoureceivednoincomeduringthereportingperiod.Youmustalsoreportthesourceofincometoyourspouseorregistereddomesticpartnerifyourcommunitypropertyshareis$500ormoreduringthereportingperiod.

Asourceofincomemustbereportedonlyifthesourceislocatedin,doingbusinessin,planningtodobusinessin,orhasdonebusinessduringtheprevioustwoyearsinyouragency’sjurisdiction.(SeeRef.Pamphlet,page12,formoreinformationaboutdoingbusinessinthejurisdiction.)Reportablesourcesofincomemaybefurtherlimitedbyyouragency’sconflict-of-interestcode.

Commonly reportable income and loans include:• Salary/wages,perdiem,reimbursementforexpensesincludingtravelpaymentsprovidedbyyouremployer

• Communitypropertyinterest(50%)inyourspouse’sorregistereddomesticpartner’sincome-report the employer’s name and all other required information

• Incomefrominvestmentinterests,suchaspartnerships,reportedonScheduleA-1

• CommissionincomenotrequiredtobereportedonScheduleA-2(SeeRef.Pamphlet,page7.)

• Grossincomefromanysale,includingthesaleofahouseorcar(reportyourproratashareofthetotalsaleprice)

• RentalincomenotrequiredtobereportedonScheduleB• Prizesorawardsnotdisclosedasgifts• Paymentsreceivedonloansyoumadetoothers,includingloanrepaymentsfromacampaigncommittee

• Anhonorariumreceivedpriortobecomingapublicofficial(SeeRef.Pamphlet,page9,concerningyourabilitytoreceivefuturehonoraria.)

• Incentivecompensation(SeeRef.Pamphlet,page11.)

You are not required to report:• Salary,reimbursementforexpensesorperdiem,socialsecurity,disability,orothersimilarbenefitpaymentsreceivedbyyouoryourspouseorregistereddomesticpartnerfromafederal,state,orlocalgovernmentagency

See Ref. Pamphlet, page 11, for more exceptions to income reporting.

TO COMPLETE SCHEDULE C:1. Income Received/Business Position Disclosure• Disclosethenameandaddressofeachsourceofincomeoreachbusinessentitywithwhichyouheldabusinessposition.

• Provideageneraldescriptionofthebusinessactivityifthesourceisabusinessentity.

• Disclosethejobtitleorbusinessposition,ifany,thatyouheldwiththebusinessentity,evenifyoudidnotreceiveincomeduringthereportingperiod.

• Checktheboxindicatingtheamountofgrossincomereceived.

• Identifytheconsiderationforwhichtheincomewasreceived.

• Forincomefromcommissionsales,checktheboxindicatingthegrossincomereceivedandlistthenameofeachsourceofcommissionincomeof$10,000ormore.(SeeRef.Pamphlet,page7.)

• ForincomefromrentalpropertythatisnotrequiredtobelistedonScheduleB,enter“RentalIncome”under“NameofSource,”checktheboxindicatingthegrossincomereceived,and,ifyouhada10%orgreaterinterestintherentalproperty,listthenameofeachtenantifyourproratashareofthegrossincomefromthattenantwas$10,000ormoreduringthereportingperiod.

2. Loans Received or Outstanding During Reporting Period•Disclosethenameandaddressofeachlender.•Provideageneraldescriptionofthebusinessactivityifthelenderisabusinessentity.

•Checktheboxindicatingthehighestbalanceoftheloanduringthereportingperiod.

• Disclosetheinterestrateandthetermoftheloan.-- Thetermoftheloanisthetotalnumberofmonthsor

yearsgivenforrepaymentoftheloanatthetimetheloanwasenteredinto.

-- Forvariableinterestrateloans,disclosetheconditionsoftheloan(forexample,Prime+2)ortheaverageinterestratepaidduringthereportingperiod.

• Identifythesecurity,ifany,fortheloan.

REMINDERS• Codefilers–Yourdisclosurecategoriesmaynotrequiredisclosureofallsourcesofincome.

• Ifyouoryourspouseorregistereddomesticpartnerareself-employed,reportthebusinessentityonScheduleA-2.

• DonotdiscloseonScheduleCincome,loans,orbusinesspositionsalreadyreportedonSchedulesA-2orB.

INSTRUCTIONS ─ SCHEDULE CINCOME, LOANS, & BUSINESS POSITIONS

(Income Other Than Gifts and Travel Payments)

SCHEDULE CIncome,Loans,&Business

Positions(Other than Gifts and Travel Payments)

GROSS INCOME RECEIVED

Name

FPPC Form 700 (2008/2009) Sch. CFPPC Toll-Free Helpline: 866/ASK-FPPC www.fppc.ca.gov

OVER $100,000

$500 - $1,000 $1,001 - $10,000

$10,001 - $100,000


CALIFORNIA FORM

► 1. INCOME RECEIVED NAME OF SOURCE OF INCOME

ADDRESS

BUSINESS ACTIVITY, IF ANY, OF SOURCE


► 1. INCOME RECEIVED NAME OF SOURCE OF INCOME

ADDRESS



NAME OF LENDER*

ADDRESS

BUSINESS ACTIVITY, IF ANY, OF LENDER


% None


$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 official 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.)


Instructions-9

Agiftisanythingofvalueforwhichyouhavenotprovidedequalorgreaterconsiderationtothedonor.Agiftisreportableifitsfairmarketvalueis$50ormore.Inaddition,multiplegiftstotaling$50ormorereceivedduringthereportingperiodfromasinglesourcemustbereported.Gifts are reportable regardless of where the donor is located.Itistheacceptanceofagift,nottheultimateusetowhichitisput,thatimposesyourreportingobligation.Exceptasnotedbelow,youmustreportagiftevenifyouneveruseditorifyougaveitawaytoanotherperson.Iftheexactamountofagiftisunknown,youmustmakeagoodfaithestimateoftheitem’sfairmarketvalue.Listingthevalueofagiftas“over$50”or“valueunknown”isnotadequatedisclosure.Inaddition,ifyoureceivedagiftthroughanintermediary,youmustdisclosethename,address,andbusinessactivityofboththedonorandtheintermediary.Commonly reportable gifts include:• Tickets/passestosportingorentertainmentevents• Tickets/passestoamusementparks•Parkingpasses• Food,beverages,andaccommodations,includingthoseprovidedindirectconnectionwithyourattendanceataconvention,conference,meeting,socialevent,meal,orlikegathering,whereyoudidnotgiveaspeech,participateinapanelorseminar,orprovideasimilarservice

•Rebates/discountsnotmadeintheregularcourseofbusinesstomembersofthepublicwithoutregardtoofficialstatus

•Weddinggifts(SeeRef.Pamphlet,page15,todeterminevalue.)

•Anhonorarium(YoumayreportanhonorariumasincomeonScheduleC,ratherthanasagiftonScheduleD,ifyouprovidedservicesofequalorgreatervaluethanthepaymentreceived.SeeRef.Pamphlet,page9,regardingyourabilitytoreceivefuturehonoraria.)

• Transportationandlodging(seeScheduleE)• Forgivenessofaloanreceivedbyyou

You are not required to disclose:•Giftsthatwerenotusedandwhich,within30daysafterreceipt,werereturnedtothedonorordeliveredtoacharitableorganizationwithoutbeingclaimedbyyouasacharitablecontributionfortaxpurposes

•Giftsfromyourspouseorregistereddomesticpartner,child,parent,grandparent,grandchild,brother,sister,aunt,uncle,niece,nephew,orfirstcousin(Includedinthisexceptionaregiftsfromyourspouseordomesticpartner’schildren,parents,brothers,sisters,andthespouseorregistereddomesticpartneroftheindividualslistedabove.Theexceptiondoesnotapplyifthedonorwasactingasanagentorintermediaryforareportablesourcewhowasthetruedonor.)

•Giftsofhospitalityinvolvingfood,drink,oroccasionallodgingprovidedinanindividual’shomewhentheindividualoramemberoftheindividual’sfamilywaspresent

•Giftsofsimilarvalueexchangedbetweenyouandanindividual,otherthanalobbyist,onholidays,birthdays,orsimilaroccasions

•Giftsofinformationalmaterialprovidedtoassistyouintheperformanceofyourofficialduties(forexample,books,pamphlets,reports,calendars,periodicals,oreducationalseminars)

• Abequestorinheritance(However,inheritedinvestmentsorrealpropertymaybereportableonotherschedules.)

•Personalizedplaquesandtrophieswithanindividualvalueoflessthan$250

•Campaigncontributions• Asingletickettoa501(c)(3)orpoliticalfundraisingeventreceivedforyourownusefromtheorganizationorthecommitteeholdingthefundraiser(thegiftlimitappliestononprofittickets)

•Giftsgiventomembersofyourimmediatefamilyunlessyouenjoydirectbenefitofthegift,usethegift,orexercisediscretionorcontrolovertheuseordispositionofthegift(SeeCommissionRegulation18944.)

•Apassorticketthatprovidedaone-timeadmissiontoanevent(theaterperformance,sportingevent)thatwasnotusedandwasnottransferredtoanotherperson(CommissionRegulation18946.1providesamethodfordeterminingthevalueofaticketorpassthatwasusedortransferredtoanotherpersonandfordeterminingthevalueofpassesorticketswhichproviderepeatedadmissiontofacilitiesorservices.)

• Food,beverages,andnecessaryaccommodationsprovideddirectlyinconnectionwithaneventatwhichyougaveaspeech,participatedinapanelorseminar,orprovidedasimilarservice

TO COMPLETE SCHEDULE D:•Disclosethefullname(notanacronym),address,and,ifabusinessentity,thebusinessactivityofthesource.

•Providethedate(month,day,andyear)ofreceipt,anddisclosethefairmarketvalueanddescriptionofthegift.

REMINDERS•Giftsfromasinglesourcearesubjecttolimit.SeeRef.Pamphlet,page9.

•SeeRef.Pamphlet,page1,fornewrulesontickets.•Codefilers–Youonlyneedtoreportgiftsfromreportablesources.

INSTRUCTIONS ─ SCHEDULE DINCOME ─ GIFTS

SCHEDULE DIncome – Gifts

Comments:

Name

FPPC Form 700 (2008/2009) Sch. DFPPC Toll-Free Helpline: 866/ASK-FPPC www.fppc.ca.gov


CALIFORNIA FORM

► NAME OF SOURCE

ADDRESS


DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)

/ / $

/ / $

/ / $

► NAME OF SOURCE

ADDRESS



/ / $

/ / $

/ / $

► NAME OF SOURCE

ADDRESS



/ / $

/ / $

/ / $

► NAME OF SOURCE

ADDRESS



/ / $

/ / $

/ / $

► NAME OF SOURCE

ADDRESS



/ / $

/ / $

/ / $

► NAME OF SOURCE

ADDRESS



/ / $

/ / $

/ / $


Instructions-10

TravelpaymentsreportableonScheduleEincludeadvancesandreimbursementsfortravelandrelatedexpenses,includinglodgingandmeals.

Giftsoftravelmaybesubjecttothegiftlimit.Inaddition,certaintravelpaymentsarereportablegifts,butarenotsubjecttothegiftlimit.Toavoidpossiblemisinterpretationortheperceptionthatyoumayhavereceivedagiftinexcessofthegiftlimit,youmaywishtoprovideaspecificdescriptionofthepurposeofyourtravel.SeetheFPPCfactsheetentitled“LimitationsandRestrictionsonGifts,Honoraria,Travel,andLoans,”whichcanbeobtainedfromyourfilingofficerortheFPPCwebsiteatwww.fppc.ca.gov.EffectiveAugust15,2008,Regulation18946.6providesnewvaluationmethodsforgiftsofairtransportation.

You are not required to disclose:• Travelpaymentsreceivedfromanystate,local,or

federalgovernmentagencyforwhichyouprovidedservicesequalorgreaterinvaluethanthepaymentsreceived

• TravelpaymentsreceivedfromyouremployerinthenormalcourseofyouremploymentthatareincludedintheincomereportedonScheduleC

• PaymentsorreimbursementsfortransportationwithinCaliforniainconnectionwithaneventatwhichyougaveaspeech,participatedinapanelorseminar,orperformedasimilarservice

• Food,beverages,andnecessaryaccommodationsreceiveddirectlyinconnectionwithaneventheldinsideoroutsideCaliforniaatwhichyougaveaspeech,participatedinapanel,orprovidedasimilarservice(NotethatpaymentsfortransportationoutsideofCaliforniaarereportable.)

• Atravelpaymentthatwasreceivedfromanon-profitentityexemptfromtaxationunderInternalRevenueCodeSection501(c)(3)forwhichyouprovidedequalorgreaterconsideration

TO COMPLETE SCHEDULE E:

• Disclosethefullname(notanacronym)andaddressofthesourceofthetravelpayment.

• Identifythebusinessactivity,ifany,ofthesource.

• Checktheboxtoidentifythepaymentasagiftorincome,reporttheamount,anddisclosethedate(s)ifapplicable.

-- Travelpaymentsaregiftsifyoudidnotprovideservicesthatwereequaltoorgreaterinvaluethanthepaymentsreceived.Youmustdisclosegiftstotaling$50ormorefromasinglesourceduringtheperiodcoveredbythestatement.Giftsoftravelarereportablewithoutregardtowherethedonorislocated.

Whenreportingtravelpaymentsthataregifts,youmustprovideadescriptionofthegiftandthedate(s)received.

-- Travelpaymentsareincomeifyouprovidedservicesthatwereequaltoorgreaterinvaluethanthepaymentsreceived.Youmustdiscloseincometotaling$500ormorefromasinglesourceduringtheperiodcoveredbythestatement.Youhavetheburdenofprovingthepaymentsareincomeratherthangifts.

Whenreportingtravelpaymentsasincome,youmustdescribetheservicesyouprovidedinexchangeforthepayment.Youarenotrequiredtodisclosethedate(s)fortravelpaymentsthatareincome.

Example:CitycouncilmemberRickChandlerisaboardmemberoftheLeagueofCaliforniaCities.TheLeaguereimbursesitsboardmembersfortravelandlodging,aswellasmealsandotherexpensesassociatedwithboardmeetings.IfRickprovidesequalorgreaterconsiderationforthetravelandlodgingwhenheparticipatesinthemeeting,thereimbursementsarereportedasincome.Notethattheburdenisontheofficialtodeterminewhetherheorshehasprovidedequalorgreatervalueforthepayment.

INSTRUCTIONS ─ SCHEDULE ETRAVEL PAYMENTS, ADVANCES,

AND REIMBURSEMENTS

SCHEDULE EIncome – Gifts

TravelPayments,Advances,and Reimbursements

Name

► NAME OF SOURCE

ADDRESS

CITY AND STATE


DESCRIPTION:

► NAME OF SOURCE

ADDRESS

CITY AND STATE


DESCRIPTION:

Comments:

FPPC Form 700 (2008/2009) Sch. EFPPC 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


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


DESCRIPTION:

► NAME OF SOURCE

ADDRESS

CITY AND STATE


DESCRIPTION:

DATE(S): / / - / / AMT: $ (If applicable)


TYPE OF PAYMENT: (must check one) Gift Income TYPE OF PAYMENT: (must check one) Gift Income



Statement of Economic Interests - California State … · 2017-11-19 · issuing the attached Statement of Economic Interests, Form 700 ... arerohibited p from accepting an honorarium

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