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:
FPPCForm700(2008/2009)FPPCToll-FreeHelpline:866/ASK-FPPCwww.fppc.ca.gov
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
FPPCForm700(2008/2009)FPPCToll-FreeHelpline:866/ASK-FPPCwww.fppc.ca.gov
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
FPPCForm700(2008/2009)FPPCToll-FreeHelpline:866/ASK-FPPCwww.fppc.ca.gov
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
FPPCForm700(2008/2009)FPPCToll-FreeHelpline:866/ASK-FPPCwww.fppc.ca.gov
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
IF APPLICABLE, LIST DATE:
/ / / / ACQUIRED DISPOSED
IF APPLICABLE, LIST DATE:
/ / / / ACQUIRED DISPOSED
IF APPLICABLE, LIST DATE:
/ / / / ACQUIRED DISPOSED
IF APPLICABLE, LIST DATE:
/ / / / ACQUIRED DISPOSED
IF APPLICABLE, LIST DATE:
/ / / / ACQUIRED DISPOSED
08 08 08 08
0808
080808
0808
Name
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
NATURE OF INVESTMENT Stock
Other (Describe)
NATURE OF INVESTMENT Stock
Other (Describe)
NATURE OF INVESTMENT Stock
Other (Describe)
NATURE OF INVESTMENT Stock
Other (Describe)
NATURE OF INVESTMENT Stock
Other (Describe)
NATURE OF INVESTMENT Stock
Other (Describe)
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
Comments:
SCHEDULE A-1Investments
Stocks, Bonds, and Other Interests(Ownership Interest is Less Than 10%)
Do not attach brokerage or financial statements.
700FAIR POLITICAL PRACTICES COMMISSION
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
FAIR MARKET VALUE $2,000 - $10,000 $10,001 - $100,000 $100,001 - $1,000,000 Over $1,000,000
FAIR MARKET VALUE $2,000 - $10,000 $10,001 - $100,000 $100,001 - $1,000,000 Over $1,000,000
FAIR MARKET VALUE $2,000 - $10,000 $10,001 - $100,000 $100,001 - $1,000,000 Over $1,000,000
FAIR MARKET VALUE $2,000 - $10,000 $10,001 - $100,000 $100,001 - $1,000,000 Over $1,000,000
FAIR MARKET VALUE $2,000 - $10,000 $10,001 - $100,000 $100,001 - $1,000,000 Over $1,000,000
08
FPPCForm700(2008/2009)FPPCToll-FreeHelpline:866/ASK-FPPCwww.fppc.ca.gov
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
IF APPLICABLE, LIST DATE:
/ / / / ACQUIRED DISPOSED
IF APPLICABLE, LIST DATE:
/ / / / ACQUIRED DISPOSED
IF APPLICABLE, LIST DATE:
/ / / / ACQUIRED DISPOSED
08080808
08 08
IF APPLICABLE, LIST DATE:
/ / / / ACQUIRED DISPOSED
08 08
SCHEDULE A-2Investments, Income,andAssets
of Business Entities/Trusts(Ownership Interest is 10% or Greater)
Comments:
Name
Address
Name
Address
FAIR MARKET VALUE $2,000 - $10,000 $10,001 - $100,000 $100,001 - $1,000,000 Over $1,000,000
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
INVESTMENT REAL PROPERTY
Name of Business Entity or Street Address or Assessor’s Parcel Number of Real Property
Description of Business Activity 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
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 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:
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
FPPCForm700(2008/2009)FPPCToll-FreeHelpline:866/ASK-FPPCwww.fppc.ca.gov
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
IF APPLICABLE, LIST DATE:
/ / / / ACQUIRED DISPOSED
NAME OF LENDER*
ADDRESS
BUSINESS ACTIVITY OF LENDER
IF APPLICABLE, LIST DATE:
/ / / / ACQUIRED DISPOSED
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:
FAIR MARKET VALUE $2,000 - $10,000 $10,001 - $100,000 $100,001 - $1,000,000 Over $1,000,000
IF RENTAL PROPERTY, GROSS INCOME RECEIVED
OVER $100,000
$500 - $1,000 $0 - $499 $1,001 - $10,000
$10,001 - $100,000
HIGHEST BALANCE DURING REPORTING PERIOD
Guarantor, if applicable
OVER $100,000
$500 - $1,000 $1,001 - $10,000
$10,001 - $100,000
FPPC Form 700 (2008/2009) Sch. BFPPC Toll-Free Helpline: 866/ASK-FPPC www.fppc.ca.gov
700FAIR POLITICAL PRACTICES COMMISSION
CALIFORNIA FORM
NAME OF LENDER*
ADDRESS
BUSINESS ACTIVITY OF LENDER
► STREET ADDRESS OR PRECISE LOCATION
CITY
INTEREST RATE TERM (Months/Years)
% None
SOURCES OF RENTAL INCOME: If you own a 10% or greater interest, list the name of each tenant that is a single source of income of $10,000 or more.
NATURE OF INTEREST
Ownership/Deed of Trust Easement
Leasehold Yrs. remaining Other
Guarantor, if applicable
FAIR MARKET VALUE $2,000 - $10,000 $10,001 - $100,000 $100,001 - $1,000,000 Over $1,000,000
IF RENTAL PROPERTY, GROSS INCOME RECEIVED
OVER $100,000
$500 - $1,000 $0 - $499 $1,001 - $10,000
$10,001 - $100,000
HIGHEST BALANCE DURING REPORTING PERIOD
OVER $100,000
$500 - $1,000 $1,001 - $10,000
$10,001 - $100,000
* You are not required to report loans from commercial lending institutions made in the lender’s regular course of business on terms available to members of the public without regard to your official status. Personal loans and loans received not in a lender’s regular course of business must be disclosed as follows:
FPPCForm700(2008/2009)FPPCToll-FreeHelpline:866/ASK-FPPCwww.fppc.ca.gov
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
700FAIR POLITICAL PRACTICES COMMISSION
CALIFORNIA FORM
► 1. INCOME RECEIVED NAME OF SOURCE OF INCOME
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOUR BUSINESS POSITION
► 1. INCOME RECEIVED NAME OF SOURCE OF INCOME
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOUR BUSINESS POSITION
NAME OF LENDER*
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF LENDER
INTEREST RATE TERM (Months/Years)
% None
HIGHEST BALANCE DURING REPORTING PERIOD
$500 - $1,000
$1,001 - $10,000
$10,001 - $100,000
OVER $100,000
GROSS INCOME RECEIVED
OVER $100,000
$500 - $1,000 $1,001 - $10,000
$10,001 - $100,000
Comments:
► 2. LOANS RECEIVED OR OUTSTANDING DURING THE REPORTING PERIOD
* You are not required to report loans from commercial lending institutions, or any indebtedness created as part of a retail installment or credit card transaction, made in the lender’s regular course of business on terms available to members of the public without regard to your 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.)
FPPCForm700(2008/2009)FPPCToll-FreeHelpline:866/ASK-FPPCwww.fppc.ca.gov
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
700FAIR POLITICAL PRACTICES COMMISSION
CALIFORNIA FORM
► NAME OF SOURCE
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
/ / $
/ / $
/ / $
► NAME OF SOURCE
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
/ / $
/ / $
/ / $
► NAME OF SOURCE
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
/ / $
/ / $
/ / $
► NAME OF SOURCE
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
/ / $
/ / $
/ / $
► NAME OF SOURCE
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
/ / $
/ / $
/ / $
► NAME OF SOURCE
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
/ / $
/ / $
/ / $
FPPCForm700(2008/2009)FPPCToll-FreeHelpline:866/ASK-FPPCwww.fppc.ca.gov
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
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DESCRIPTION:
► NAME OF SOURCE
ADDRESS
CITY AND STATE
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DESCRIPTION:
Comments:
FPPC Form 700 (2008/2009) Sch. 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
700FAIR POLITICAL PRACTICES COMMISSION
CALIFORNIA FORM
• Reminder – you must mark the gift or income box.• You are not required to report “income” from government agencies.
► NAME OF SOURCE
ADDRESS
CITY AND STATE
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DESCRIPTION:
► NAME OF SOURCE
ADDRESS
CITY AND STATE
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DESCRIPTION:
DATE(S): / / - / / AMT: $ (If applicable)
DATE(S): / / - / / AMT: $ (If applicable)
TYPE OF PAYMENT: (must check one) Gift Income TYPE OF PAYMENT: (must check one) Gift Income
DATE(S): / / - / / AMT: $ (If applicable)
DATE(S): / / - / / AMT: $ (If applicable)