HomeMy WebLinkAboutA - FPPC FormsFor complete details of all FPPC forms:
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Forms
(All Documents on Flash Drive & Hard Copy)
Form 501, Candidate Intention Statement
Form 410, Statement of Organization Recipient Committee
Form 460, Recipient Committee Campaign Statement
Form 470, Officeholder & Candidate Campaign Statement -
Short Form and Supplement
Form 700 - Statement of Economic Interests
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Campaign Statement - Short Form
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Form 700 - Statement of Economic Interests
2017/2018
Statement of
Economic Interests
Form 700
A Public Document
Also available on the FPPC website:
• Form 700 in Excel format
• Reference Pamphlet for Form 700
California Fair Political Practices Commission
Email Advice: advice@fppc.ca.gov
Toll-free advice line: 1 (866) ASK-FPPC • 1 (866) 275-3772
Telephone: (916)322-5660 • Website: www.fppc.ca.gov
December 2017
W6a4'4 Naw
Gift Limit Increase
The gift limit increased to $470 for calendar years 2017
and 2018. The gift limit during 2016 was $460.
W a must Pile:
• Elected and appointed officials and candidates listed in
Government Code Section 87200
• Employees, appointed officials, and consultants filing
pursuant to a conflict of interest code ('code filers").
Obtain your disclosure categories, which describe
the Interests you must report, from your agency;
they are not part of the Forth 700
• Candidates running for local elective offices that are
designated in a conflict of interest code (e.g., county
sheriffs, city clerks, school board trustees, and water
board members)
Exception: Candidates for a county central committee are
not required to file the Form 700.
• Members of newly created boards and commissions not
yet covered under a conflict of interest code
• Employees in newly created positions of existing
agencies
See Reference Pamphlet, page 3, at www/ppc.ca.gov.
W4U to file:
87200 Filers
State offices Z Youragency
Judicial offices The clerk of your court
Retired Judges Directly with FPPC
County offices Your county filing official
City offices Your city clerk
Multi -County offices Your agency
Code Filers — State and Local Officials, Employees,
and Consultants Designated In a Conflict of Interest
Code: File with your agency, board, or commission unless
otherwise specified in your agency's code (e.g., Legislative
staff files directly with FPPC). In most cases, the agency,
board, or commission will retain the statements.
Members of Boards and Commissions of Newly
Created Agencies: File with your newly created agency
or with your agency's code reviewing body.
Employees In Newly Created Positions of Existing
Agencies: File with your agency or with your agency's
code reviewing body. See Reference Pamphlet, page 3.
Candidates: File with your local elections office.
How to file:
The Form 700 is available at wwwfppc.ca.gov. Form
700 schedules are also available in Excel format. All
statements must have an original "weC signature or be
duly authorized by your filing officer to file electronically
under Government Code Section 87500.2. Instructions,
examples, FAQs, and a reference pamphlet are available
to help answer your questions.
tv" to file:
Annual Statements
• March 1, 2018
- Elected State Officers
- Judges and Court Commissioners
- State Board and State Commission Members listed
in Government Code Section 87200
• April 2, 2018
- Most other filers
Individuals filing under conflict of interest codes in city and
county jurisdictions should verify the annual filing date with
their local filing officers.
Statements postmarked by the filing deadline are
considered filed on time.
Assuming Of cs and Leaving Office Statements
Most filers file within 30 days of assuming or leaving office
or within 30 days of the effective date of a newly adopted
or amended conflict of interest code.
Exception:
If you assumed office between October 1, 2017, and
December 31, 2017, and fled an assuming office statement,
you are not required to file an annual statement until March
1, 2019, or April 1, 2019, whichever is applicable. The
annual statement will cover the day after you assumed office
through December 31, 2018. See Reference Pamphlet,
pages 6 and 7, for additional exceptions.
Candidate Statements
File no later than the final filing date for the declaration of
candidacy or nomination documents.
Amendments
Statements may be amended at any time. You are only
required to amend the schedule that needs to be revised.
It is not necessary to amend the entire filed form. Obtain
amendment schedules at wwwfppc.ca.gov.
There Is no provision for filing deadline extensions
unless the filer is serving in active military duty.
Statements of 30 pages or less may be faxed by the
deadline as long as the originally signed paper version is
sent by first class mail to the fling official within 24 hours.
Introduction
The Political Reform Act (Gov. Code Sections 81000-
91014) requires most state and local government officials
and employees to publicly disclose their personal assets
and income. They also must disqualify themselves
from participating in decisions that may affect their
personal economic interests. The Fair Political Practices
Commission (FPPC) is the state agency responsible for
issuing the attached Statement of Economic Interests,
Form 700, and for interpreting the law's provisions.
Gift Prohibition
Gifts received by most state and local officials, employees,
and candidates are subject to a limit. During 2017 and
2018, the gift limit is $470 from a single source during a
calendar year.
In addition, state officials, state candidates, and certain
state employees are subject to a $10 limit per calendar
month on gifts from lobbyists and lobbying firms registered
with the Secretary of State. See Reference Pamphlet,
page 10.
State and local officials and employees should check with
their agency to determine if other restrictions apply.
Disqualification
Public officials are, under certain circumstances, required
to disqualify themselves from making, participating in, or
attempting to influence governmental decisions that will
affect their economic interests. This may include interests
they are not required to disclose (i.e., a personal residence
is often not reportable, but may be disqualifying). Specific
disqualification requirements apply to 87200 filers (e.g.,
city councilmembers, members of boards of supervisors,
planning commissioners, etc.). These officials must
publicly identify the economic interest that creates a
conflict of interest and leave the room before a discussion
or vote takes place at a public meeting. For more
information, consult Government Code Section 87105,
Regulation 18707, and the Guide to Recognizing Conflicts
of Interest at wwwfppc.ca.gov.
Honorarium Ban
Most state and local officials, employees, and candidates
are prohibited from accepting an honorarium for any
speech given, article published, or attendance at a
conference, convention, meeting, or like gathering. See
Reference Pamphlet, page 10.
Loan Restrictions
Certain state and local officials are subject to restrictions
on loans. See Reference Pamphlet, page 14.
Post -Governmental Employment
There are restrictions on representing clients or employers
before former agencies. The provisions apply to elected
state officials, most state employees, local elected officials,
county chief administrative officers, city managers,
including the chief administrator of a city, and general
managers or chief administrators of local special districts
and JPAs. The FPPC website has fact sheets explaining
the provisions.
Late Filing
The filing officer who retains originally -signed or
electronically filed statements of economic interests may
impose on an individual a fine for any statement that is filed
late. The fine is $10 per day up to a maximum of $100.
Late filing penalties may be reduced or waived under certain
circumstances.
Persons who fail to timely file their Form 700 may be
referred to the FPPC's Enforcement Division (and in some
cases, to the Attorney General or district attorney) for
investigation and possible prosecution. In addition to the
late filing penalties, a fine of up to $5,000 per violation may
be imposed.
For assistance concerning reporting, prohibitions, and
restrictions under the Act:
• Email questions to advice@fppc.ce.gov.
• Call the FPPC toll-free at (866) 275-3772.
Form 700 is a Public Document
Public Access Must Be Provided
Statements of Economic Interests are public
documents. The filing officer must permit any
member of the public to inspect and receive a copy
of any statement.
• Statements must be available as soon as possible
during the agency's regular business hours, but
in any event not later than the second business
day after the statement is received. Access to the
Form 700 is not subject to the Public Records Act
procedures.
• No conditions may be placed on persons seeking
access to the forms.
• No information or identification may be required
from persons seeking access.
• Reproduction fees of no more than 10 cents per
page may be charged.
FPPC Form 700(2017/2018)
FPPC Advice Email: advice®fppc.w.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc,w.gov
Introduction
Types of Form 700 Filings
Assuming Office Statement:
If you are a newly appointed official or are newly employed
in a position designated, or that will be designated, in
a state or local agency's conflict of interest code, your
assuming office date is the date you were sworn in or
otherwise authorized to serve in the position. If you are a
newly elected official, your assuming office date is the date
you were sworn in.
• Investments, interests in real property, and business
positions held on the date you assumed the office
or position must be reported. In addition, income
(including bans, gifts, and travel payments) received
during the 12 months prior to the date you assumed the
office or position is reportable.
For positions subject to confirmation by the State Senate
or the Commission on Judicial Performance, your
assuming office date is the date you were appointed or
nominated to the position.
Example:
Maria Lopez was nominated by the Governor to serve
on a state agency board that is subject to state Senate
confirmation. The assuming office date is the date Maria's
nomination is submitted to the Senate. Made must report
investments, interests in real property, and business
positions she holds on that date, and income (including
loans, gifts, and travel payments) received during the 12
months prior to that date.
If your office or position has been added to a newly
adopted or newly amended conflict of interest code, use
the effective date of the code or amendment, whichever is
applicable.
• Investments, interests in real property, and business
positions held on the effective date of the code or
amendment must be reported. In addition, income
(including loans, gifts, and travel payments) received
during the 12 months prior to the effective date of the
code or amendment is reportable.
Annual Statement:
Generally, the period covered is January 1, 2017,
through December 31, 2017. If the period covered by
the statement is different than January 1, 2017, through
December 31, 2017, (for example, you assumed office
between October 1, 2016, and December 31, 2016 or you
are combining statements), you must specify the period
covered.
• Investments, interests in real property, business
positions held, and income (including loans, gifts, and
travel payments) received during the period covered
by the statement must be reported. Do not change the
preprinted dates on Schedules A-1, A-2, and B unless
you are required to report the acquisition or disposition
of an interest that did not occur in 2017.
• If your disclosure category changes during a reporting
period, disclose under the old category until the
effective date of the conflict of interest code amendment
and disclose under the new disclosure category through
the and of the reporting period.
Leaving Office Statement:
Generally, the period covered is January 1, 2017,
through the date you stopped performing the duties of
your position. If the period covered differs from January
1, 2017, through the date you stopped performing the
duties of your position (for example, you assumed office
between October 1, 2016, and December 31, 2016, or
you are combining statements), the period covered must
be spect ied. The reporting period can cover parts of two
calendar years.
• Investments, interests in real property, business
positions held, and income (including loans, gifts, and
travel payments) received during the period covered
by the statement must be reported. Do not change the
preprinted dates on Schedules A-1, A-2, and B unless
you are required to report the acquisition or disposition
of an interest that did not occur in 2017.
Candidate Statement:
If you are filing a statement in connection with your
candidacy for state or local office, investments, interests
in real property, and business positions held on the date
of filing your declaration of candidacy must be reported.
In addition, income (including loans, gifts, and travel
payments) received during the 12 months prior to the date
of filing your declaration of candidacy is reportable. Do not
change the preprinted dates on Schedules A-1, A-2, and B.
Candidates running for local elective offices (e.g., county
sheriffs, city clerks, school board trustees, or water
district board members) must file candidate statements,
as required by the conflict of interest code for the elected
position. The code may be obtained from the agency of
the elected position.
Amendments:
If you discover errors or omissions on any statement, file
an amendment as soon as possible. You are only required
to amend the schedule that needs to be revised; it is not
necessary to refile the entire form. Obtain amendment
schedules from the FPPC website at wwwfppc.ca.gov.
FPPC Form 700 (2017/2018(
FPPC AdOce Email: sdvice®ippc.o.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.o.gov
Types of Statements
Instructions
Cover Page
Enter your name, mailing address, and daytime telephone
number in the spaces provided. Because the Form 700 Is
a public document, you may list your businessfoffice
address Instead of your home address.
Part 1. Office, Agency, or Court
• Enter the name of the office sought or held, or the agency
or court. Consultants must enter the public agency name
rather than their private firm's name. (Examples: State
Assembly; Board of Supervisors; Office of the Mayor,
Department of Finance; Hope County Superior Court)
• Indicate the name of your division, board, or district, if
applicable. (Examples: Division of Waste Management;
Board of Accountancy; District 45). Do not use acronyms.
• Enter your position title. (Examples: Director; Chief
Counsel; City Council Member, Staff Services Analyst)
• If you hold multiple positions (i.e., a city council member
who also is a member of a county board or commission),
you may be required to file statements with each agency.
To simplify your filing obligations, you may complete an
expanded statement.
• To do this, enter the name of the other agency(les) with
which you are required to file and your position Weis) in
the space provided. Do not use acronyms. Attach an
additional sheet If necessary. Complete one statement
covering the disclosure requirements for all positions.
Each copy must contain an original signature. Therefore,
before signing the statement, make a copy for each
agency. Sign each copy with an original signature and file
with each agency.
If you assume or leave a position after a filing deadline,
you must complete a separate statement. For example, a
city council memberwho assumes a position with a county
special district after the April 1 annual filing deadline must file
a separate assuming office statement. In subsequent years,
the city council member may expand his or her annual filing to
include both positions.
Example:
Scott Baker is a city council member for the City of Lincoln
and a board member for the Camp Far West Irrigation
District - a multi -county, agency that covers Placer and
Yuba counties. Scott will complete one Form 700 using full
disclosure (as required for the city position) and covering
interests in both Placer and Yuba counties (as required for
the multi -county position) and list both positions on the Cover
Page. Before signing the statement, Scott will make a copy
and sign both statements. One statement will be filed with
City of Lincoln and the other will be filed with Camp Far West
Irrigation District. Both will contain an original signature.
Part 2. Jurisdiction of Office
• Check the box indicating the jurisdiction of your agency
and, if applicable, identify the jurisdiction. Judges, judicial
candidates, and court commissioners have statewide
jurisdiction. All other filers should review the Reference
Pamphlet, page 13, to determine their jurisdiction.
• If your agency is a multi -county office, list each county in
which your agency has jurisdiction.
If your agency is not a state office, court, county office, city
office, or multi -county office (e.g., school districts, special
districts and JPAs), check the "other" box and enter the
county or city in which the agency has jurisdiction.
Example:
This filer is a member of a water district board with jurisdiction
in portions of Yuba and Sutter Counties.
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Part 3. Type of Statement
Check at least one box. The period covered by a statement
is determined by the type of statement you are fling. If you
are completing a 2017 annual statement, do not change the
pre-printed dates to reflect 2018. Your annual statement is
used for reporting the previous year's economic interests.
Economic interests for your annual filing covering January 1,
2018, through December 31, 2018, will be disclosed on your
statement fled In 2019. See Reference Pamphlet, page 4.
Combining Statements: Certain types of statements may be
combined. For example, if you leave office after January 1,
but before the deadline for filing your annual statement, you
may combine your annual and leaving office statements. File
by the earliest deadline. Consult your filing officer or the
FPPC.
Part 4. Schedule Summary
• Complete the Schedule Summary after you have reviewed
each schedule to determine if you have reportable
interests.
• Enter the total number of completed pages including the
cover page and either check the box for each schedule you
use to disclose interests; or if you have nothing to disclose
on any schedule, check the "No reportable interests" box.
Please do not attach any blank schedules.
Part 5. Verification
Complete the verification by signing the statement and
entering the date signed. All statements must have an original
"wet" signature or be duly authorized by your filing officer to
file electronically under Government Code Section 87500.2.
Instructions, examples, FACE, and a reference pamphlet are
available to help answer your questions. When you sign
your statement, you are stating, under penalty of perjury,
that It is true and correct. Only the filer has authority to sign
the statement. An unsigned statement is not considered filed
and you may be subject to late filing penalties.
FPPC Form 700 (2017/2018)
FPPC Advice Email: advice@fppc.ce.gov
FPPC Toll -Free Helpline: 806/275-3772 wwwJp,,c.ca.Vv
Inrtruc0ons-1
Date Initial Filing Received
STATEMENT OF ECONOMIC INTERESTS
COVER PAGE
Please type or prof in ink.
III of FILER dw (FIRST) (MODLF)
1. Office, Agency, or Court
Agency Name (Do no use acronyms)
Division, Board, Department, District, ft applicable Your Position
� If filing for multiple positions, list below or on an attachment
(Do not use eopnyms)
Agency:
Position:
2. Jurisdiction Of Office (Check at least one boa)
❑ state
❑ Judge or Gaud Commissioner (Statewide Jurisdiction)
❑ fifultiCGunty
❑ County of
❑ City of
❑ Other
3. Type of Statement (check at roast one baa)
❑ Annual: The period cevered is January 1, 2017, through
❑ Leaving Office: Date Left —J --- J
December 31, 2017.
(Check one)
bry
The pedal covered is JJ
through O The period covered is January 1, 2017, through the dale of
December 31, 2017,
ffice. leaving o
or-
❑ Assuming Office: Date assumed JJ
O The period covered is — — — J through
the date of leaving office.
❑ Candidate: Date of Election and office sol I different than Part 1:
4. Schedule Summary (must complete) ► Total number of pages including this cover page:
Schedules attached
❑ Schedule Ad - miesments - schedule attached Schedule C - Income, Loans, 8 Business Positrons - schedule attached
❑ Schedule A-2 - Invesmerds - schedule adached Schedule D - Income - Gifts - schedule attached
❑ Schedule B - Real Property- schedule attached ❑ Schedule E - Income - Gifts - Travel Payments - schedule attached
-or.
❑ None - No reportable interests on any schedule
5. Verification
MAILING AGORE55 anal cnY STATE LP cooE
(aroiii RrA IAeaew Remnmervba-RO1c oaae l
MYTIME TELEPHONE NUMBER I EAU-AOmEss
I have used all reasonable diigence in preparing this statement I have reviewed this statement and to the best of my kn es edge the information contained
herein and in any attached schedules is true and complete. I acknoMedge this is a pudic document.
1 ce" under penalty of perjury under the laws of the Site of California that the foregoing is true and conduct.
(my91.Os:W1 (Fh Ma vgmz%^9mf5afemeNwiM Wu'aMoTffi'.1
FPPC Form 700 (2017/2018)
FPPC Advice Email: advice@fppc.m.gov
FPPC Toll -Free Helpline: 866/2753772 www.ippc.ca.gcv
Which Schedule Do I Use?
Common Reportable Interests
Schedule A-1 Stocks, including those held in an IRAor a 401 K
Schedule A-2 Business entities (including certain independent contracting), sole proprietorships
Common Non -Reportable Interests
Schedule A-1
partnerships, LLCs, corporations, and trusts
Schedule B
Rental property in the jurisdiction, or within two miles of the boundaries of the
jurisdiction
Schedule C
Non-governmental salaries of public official and spouse/registered domestic partner
Schedule D
Gifts from businesses (such as tickets to sporting or entertainment events)
Schedule E
Travel payments from third parties (not your employer)
Common Non -Reportable Interests
Schedule A-1
Insurance policies, government bonds, diversified mutual funds, certain funds similar
to diversified mutual funds (such as exchange traded funds) and investments held
in certain retirement accounts. See Reference Pamphlet, page 13, for detailed
information. (Regulation 18237)
Schedule A-2
Savings and checking accounts and annuities
Schedule B
A residence used exclusively as a personal residence (such as a home or vacation
cabin)
Schedule C
Governmental salary (such as a school district)
Schedule D
Gifts from family members
Schedule E
Travel paid by your government agency
Remember:
✓ Mark the "No reportable interests" box on Part 4 of the Schedule Summary on the Cover Page
if you determine you have nothing to disclose and file the Cover Page only. Make sure you
carefully read all instructions to ensure proper reporting.
✓ The Form 700 is a public document.
✓ Most Individuals must consult their agency's conflict of interest code for reportable
Interests.
✓ Most individuals file the Form 700 with their agencies.
FPPC Form Too (2017/2018)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov
Instructions -3
Questions and Answers
General
Q. What is the reporting period for disclosing interests
on an assuming office statement or a candidate
statement?
A. On an assuming office statement, disclose all
reportable investments, interests in real property, and
business positions held on the date you assumed
office. In addition, you must disclose income (including
loans, gifts and travel payments) received during the 12
months prior to the date you assumed office.
On a candidate statement, disclose all reportable
investments, interests in real property, and business
positions held on the date you file your declaration of
candidacy. You must also disclose income (including
loans, gifts and travel payments) received during the
12 months prior to the date you file your declaration of
candidacy.
Q. I hold two other board positions in addition to my
position with the county. Must I file three statements of
economic interests?
A. Yes, three are required. However, you may complete
one statement listing the county and the two boards on
the Cover Page or an attachment as the agencies for
which you will be filing. Report your economic interests
using the largest jurisdiction and highest disclosure
requirements assigned to you by the three agencies.
Make two copies of the entire statement before
signing it, sign each copy with an original signature,
and distribute one original to the county and to each
of the two boards. Remember to complete separate
statements for positions that you leave or assume
during the year.
Q. I am a department head who recently began acting as
city manager. Should I file as the city manager?
A. Yes. File an assuming office statement as city
manager. Persons serving as "acting; "interim; or
"alternate" must file as if they hold the position because
they are or may be performing the duties of the
position.
Q. As a designated employee, I left one state agency to
work for another state agency. Must I file a leaving
office statement?
A. Yes. You may also need to file an assuming office
statement for the new agency.
Q. My spouse and I are currently separated and in the
process of obtaining a divorce. Must I still report my
spouse's income, investments, and interests in real
property?
A. Yes. A public official must continue to report a spouse's
economic interests until such time as dissolution of
marriage proceedings is final. However, if a separate
property agreement has been reached prior to that
time, your estranged spouse's income may not have to
be reported. Contact the FPPC for more information.
Investment Disclosure
Q. I have an investment interest in shares of stock in a
company that does not have an office in my jurisdiction.
Must I still disclose my investment interest in this
company?
A. Probably. The definition of "doing business in the
jurisdiction" is not limited to whether the business has
an office or physical location in your jurisdiction. See
Reference Pamphlet, page 13.
Q. My spouse and I have a living trust. The trust holds
rental property in my jurisdiction, our primary residence,
and investments in diversified mutual funds. I have full
disclosure. How is this trust disclosed?
A. Disclose the name of the trust, the rental property and
its income on Schedule A-2. Your primary residence
and investments in diversified mutual funds registered
with the SEC are not reportable.
Q. I am required to report all investments. I have an IRA
that contains stocks through an account managed by
a brokerage firm. Must I disclose these stocks even
though they are held in an IRA and I did not decide
which stocks to purchase?
A. Yes. Disclose on Schedule A-1 or A-2 any stock worth
$2,000 or more in a business entity located in or doing
business in your jurisdiction.
FPPC Form ]00(201)/2019)
FPPC Advice Email: advice@fpp,.ca.gov
FPPC Toll -Free Helpline: 866/2]5-3]22 www.fppc.ca.gov
Instructions -0
Questions and Answers
Continued
Q. I am the sole owner of my business, an S -Corporation.
I believe that the nature of the business is such that it
cannot be said to have any'fair market value" because
it has no assets. I operate the corporation under
an agreement with a large insurance company. My
contract does not have resale value because of its
nature as a personal services contract. Must I report
the fair market value for my business on Schedule A-2
of the Form 700?
A. Yes. Even if there are no tangible assets, intangible
assets, such as relationships with companies and
clients are commonly sold to qualified professionals.
The "fair market value" is often quantified for other
purposes, such as marital dissolutions or estate
planning. In addition, the IRS presumes that 'personal
services corporations" have a fair market value. A
professional "book of business" and the associated
goodwill that generates income are not without a
determinable value. The Form 700 does not require a
precise fair market value; it is only necessary to check
a box indicating the broad range within which the value
falls.
Q. I own stock in IBM and must report this investment
on Schedule A-1. I initially purchased this stock in
the early 1990s; however, I am constantly buying
and selling shares. Must I note these dates in the
"Acquired" and "Disposed" fields?
A. No. You must only report dates in the "Acquired" or
"Disposed" fields when, during the reporting period, you
initially purchase a reportable investment worth $2,000
or more or when you dispose of the entire investment.
You are not required to track the partial trading of an
investment.
Q. On last year's filing I reported stock in Encoe valued at
$2,000-$10,000. Late last year the value of this stock
fell below and remains at less than $2,000. How should
this be reported on this year's statement?
A. You are not required to report an investment if the value
was less than $2,000 during the entire reporting period.
However, because a disposed date is not required for
stocks that fall below $2,000, you may want to report
the stock and note in the "comments" section that the
value fell below $2,000. This would be for informational
purposes only; it is not a requirement.
Q. We have a Section 529 account set up to save money
for our son's college education. Is this reportable?
A. If the Section 529 account contains reportable interests
(e.g.. common stock valued at $2,000 or more), those
interests are reportable (not the actual Section 529
account). If the account contains solely mutual funds,
then nothing is reported.
Income Disclosure
Q. I reported a business entity on Schedule A-2. Clients of
my business are located in several states. Must I report
all clients from whom my pro rata share of income is
$10,000 or more on Schedule A-2, Part 3?
A. No, only the clients located in or doing business on a
regular basis in your jurisdiction must be disclosed.
Q. I believe I am not required to disclose the names of
clients from whom my pro rata share of income is
$10,000 or more on Schedule A-2 because of their right
to privacy. Is there an exception for reporting clients'
names?
A. Regulation 18740 provides a procedure for requesting
an exemption to allow a client's name not to be
disclosed if disclosure of the name would violate a
legally recognized privilege under California or Federal
law. This regulation may be obtained from our website
at www/ppc.ca.gov. See Reference Pamphlet, page
14.
Q. I am sole owner of a private law practice that is not
reportable based on my limited disclosure category.
However, some of the sources of income to my law
practice are from reportable sources. Do I have to
disclose this income?
A. Yes, even though the law practice is not reportable,
reportable sources of income to the law practice of
$10,000 or more must be disclosed. This information
would be disclosed on Schedule C with a note in the
"comments" section indicating that the business entity
is not a reportable investment. The note would be for
informational purposes only; it is not a requirement.
FPPC Form 70012017/20181
FPPC Advice Email: advice@Ippcca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov
Instructions -5
Questions and Answers
Continued
Q. 1 am the sole owner of my business. Where do I
disclose my income - on Schedule A-2 or Schedule C?
A. Sources of income to a business in which you have an
ownership interest of 10% or greater are disclosed on
Schedule A-2. See Reference Pamphlet, page 8, for
the definition of "business entity."
Q. My husband is a partner in a four -person firm where
all of his business is based on his own billings and
collections from various clients. How do I report my
community property interest in this business and the
income generated in this manner?
A. If your husband's investment in the firm is 10% or
greater, disclose 100% of his share of the business
on Schedule A-2, Part 1 and 50% of his income on
Schedule A-2, Parts 2 and 3. For example, a client of
your husband's must be a source of at least $20,000
during the reporting period before the client's name is
reported.
Q. How do I disclose my spouse's or registered domestic
partner's salary?
A. Report the name of the employer as a source of income
on Schedule C.
Q. I am a doctor. For purposes of reporting $10,000
sources of income on Schedule A-2, Part 3, are the
patients or their insurance carriers considered sources
of income?
A. If your patients exercise sufficient control by selecting
you instead of other doctors, then your patients, rather
than their insurance carriers, are sources of income to
you. See Reference Pamphlet, page 14, for additional
information.
Q. 1 received a loan from my grandfather to purchase my
home. Is this loan reportable?
A. No. Loans received from family members are not
reportable.
Q. Many years ago, I loaned my parents several thousand
dollars, which they paid back this year. Do I need to
report this loan repayment on my Form 700?
A. No. Payments received on a loan made to a family
member are not reportable.
Real Property Disclosure
Q. During this reporting period we switched our principal
place of residence into a rental. I have full disclosure
and the property is located in my agency's jurisdiction,
w it is now reportable. Because I have not reported
this property before, do I need to show an "acquired"
date?
A. No, you are not required to show an "acquired" date
because you previously owned the property. However,
you may want to note in the "comments" section that
the property was not previously reported because it was
used exclusively as your residence. This would be for
informational purposes only; it is not a requirement.
Q. I am a city manager, and I own a rental property located
in an adjacent city, but one mile from the city limit. Do I
need to report this property, interest?
A. Yes. You are required to report this property because
it is located within 2 miles of the boundaries of the city
you manage.
Q. Must I report a home that I own as a personal residence
for my daughter?
A. You are not required to disclose a home used as a
personal residence for a family member unless you
receive income from it, such as rental income.
Q. I am a co-signer on a loan for a rental property owned
by a friend. Since I am listed on the deed of trust, do I
need to report my friend's property as an interest in real
property on my Form 700?
A. No. Simply being a co-signer on a loan for property
does not create a reportable interest in real property for
you.
Gift Disclosure
Q. If I received a reportable gift of two tickets to a concert
valued at $100 each, but gave the tickets to a friend
because I could not attend the concert, do I have any
reporting obligations?
A. Yes. Since you accepted the gift and exercised
discretion and control of the use of the tickets, you must
disclose the gift on Schedule D.
FPPC Form 70012017/20181
FPPC Advice Email: advlce@afppc.ca.8ov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov
Instructims-6
Questions and Answers
Continued
Q. Mary and Joe Benson, a married couple, want to give a Q. I received free admission to an educational conference
piece of artwork to a county supervisor. Is each spouse related to my official duties. Part of the conference
considered a separate source for purposes of the gift fees included a round of golf. Is the value of the golf
limit and disclosure? considered informational material?
A. Yes, each spouse may make a gift valued at the gift
limit during a calendar year. For example, during 2017
the gift limit was $470, so the Bensons may have given
the supervisor artwork valued at no more than $940.
The supervisor must identify Joe and Mary Benson as
the sources of the gift.
Q. 1 am a Form 700 filer with full disclosure. Our agency
holds a holiday raffle to raise funds for a local charity.
I bought $10 worth of raffle tickets and won a gift
basket valued at $120. The gift basket was donated by
Doug Brewer, a citizen in our city. At the same event,
I bought raffle fickets for, and won a quilt valued at
$70. The quilt was donated by a coworker. Are these
reportable gifts?
A. Because the gift basket was donated by an outside
source (not an agency employee), you have received a
reportable gift valued at $110 (the value of the basket
less the consideration paid). The source of the gift
is Doug Brewer and the agency is disclosed as the
intermediary. Because the quilt was donated by an
employee of your agency, it is not a reportable gift.
Q. My agency is responsible for disbursing grants. An
applicant (501(c)(3) organization) met with agency
employees to present its application. At this meeting,
the applicant provided food and beverages. Would
the food and beverages be considered gifts to the
employees? These employees are designated in our
agency's conflict of interest code and the applicant is a
reportable source of income under the code.
A. Yes. If the value of the food and beverages consumed
by any one filer, plus any other gifts received from the
same source during the reporting period total $50 or
more, the food and beverages would be reported using
the fair market value and would be subject to the gift
limit.
A. No. The value of personal benefits, such as golf,
aftendance at a concert, or sporting event, are gifts
subject to reporting and limits.
FPPC Form 70012017/2018)
FPPC Advlm Email: advice@fppc.o.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.cx.gov
Instructions -7
Instructions — Schedules A-1 and A-2
Investments
"Investment" means a financial interest In any business
entity (including a consulting business or other independent
contracting business) that is located in, doing business in,
planning to do business in, or that has done business during
the previous two years in your agency's jurisdiction in which
you, your spouse or registered domestic partner, or your
dependent children had a direct, indirect, or beneficial interest
totaling $2,000 or more at any time during the reporting
period. See Reference Pamphlet, page 13.
Reportable investments include:
• Stocks, bonds, warrants, and options, including those held
in margin or brokerage accounts and managed investment
funds (See Reference Pamphlet, page 13.)
• Sole proprietorships
• Your own business or your spouse's or registered
domestic partner's business (See Reference Pamphlet,
page 8, for the definition of "business entity.")
• Your spouse's or registered domestic partner's
investments even if they are legally separate property
• Partnerships (e.g., a law firm or family farm)
• Investments in reportable business entities held in a
retirement account (See Reference Pamphlet, page 15.)
• If you, your spouse or registered domestic partner,
and dependent children together had a 10% or greater
ownership interest in a business entity or trust (Including
a living trust), you must disclose investments held by the
business entity or trust. See Reference Pamphlet, page
15, for more information on disclosing trusts.
• Business trusts
You are not required to disclose:
• Government bonds, diversified mutual funds, certain funds
similar to diversified mutual funds (such as exchange
traded funds) and investments held in certain retirement
accounts. See Reference Pamphlet, page 13, for detailed
Information. (Regulation 18237)
• Bank accounts, savings accounts, money market accounts
and certificates of deposits
• Insurance policies
• Annuities
• Commodities
• Shares in a credit union
Government bonds (including municipal bonds)
Retirement accounts invested in non -reportable interests
(e.g., insurance policies, mutual funds, or government
bonds) (See Reference Pamphlet, page 15.)
Reminders
• Do you know your agency's jurisdiction?
e Did you hold investments at any time during the period
covered by this statement?
e Code filers — your disclosure categories may only
require disclosure of specific investments.
Government defined -benefit pension plans (such as
CalPERS and CaISTRS plans)
Certain interests held in a blind trust (See Reference
Pamphlet, page 16.)
Use Schedule A-1 to report ownership of less than 10%
(e.g., stock). Schedule C (Income) may also be required if
the investment is not a stock or corporate bond. See second
example below.
Use Schedule A-2 to report ownership of 10% or greater
(e.g., a sole proprietorship).
To Complete Schedule A-1:
Do not attach brokerage or financial statements.
• Disclose the name of the business entity.
• Provide a general description of the business activity of
the entity (e.g., pharmaceuticals, computers, automobile
manufacturing, or communications).
• Check the box Indicating the highest fair market value of
your investment during the reporting period. If you are
fling a candidate or an assuming office statement, indicate
the fair market value on the filing date or the date you took
office, respectively.
• Identity the nature of your investment (e.g., stocks,
warrants, options, or bonds).
• An acquired or disposed of date is only required If you
initially acquired or entirely disposed of the investment
interest during the reporting period. The date of a stock
dividend reinvestment or partial disposal is not required.
Generally, these dates will not apply if you are filing a
candidate or an assuming office statement.
Examples:
John Smith holds a state agency position. His conflict of
interest code requires full disclosure of investments. John
must disclose his stock holdings of $2,000 or more in any
company that is located In or does business in Califs mia,
as well as those stocks held by his spouse or registered
domestic partner and dependent children.
Susan Jones is a city council member. She has a 4%
interest, worth $5,000, in a limited partnership located in the
city. Susan must disclose the partnership on Schedule A-1
and income of $500 or more received from the partnership on
Schedule C.
FPPC Form 700 (2017/2018)
FPPC Advice Email: advice@fppc.m.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.mgov
Instructions -9
10
SCHEDULE A-1
Investments
Stocks, Bonds, and Other Interests ame
(Ownership Interest is Lass Than 10%)
Do not attach brokerage o.......tial statements.
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE
❑1x,000-510.000 ❑$10,am-sloco00
❑ $,00m, - E1.wo,ow ❑ Over sf'M'wo
NATURE OF INVESTMENT
❑ 91mN ❑ OHer
N 89
PermweM1l11ReceWetl of SO - U
$OSS
O Iwonoonne RemWed of 8500 or Moro (Report on SmeNN L)
IF APPLICABLE, LIST DATE:
�J1-17 JJ 17
ACQUIRED DISPOSED
e NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE
❑ $a000 - $10,000 ❑ slo-wl - sloo,ow
❑ $loom,-s1Ao0A0o ❑ Wer $1,000,000
NATURE OF INVESTMENT
❑ Sbb OTw
Oerule l
PenmreM1lD O Income RemWw of $0 - Use
Inc°me RamWea of $500 or More IReP+n on, sdNo,.e C)
IF APPLICABLE, LIST DATE:
JJ 17 JJ -77
ACQUIRED DISPOSED
NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE
❑ $2,000 - $10,000 ❑ swoo, - s100,wo
❑ sloo.Dol - S1.aD0,0a0 ❑ om s1,aoD,000
NATURE OF INVESTMENT
❑ Stark OIM1w
In..
PenmmM1lp O Income Remimof E
O ImmRamWeE S - SOBS
b 45W or More IRepwr on SMMWn C)
IF APPLICABLE, LIST DATE:
--J--J-17— ---J--J-17—
ACQUIRED
/_/77ACQUIRED DISPOSED
Comments:
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE
❑ $2,000 -110,000 ❑ sla.00l - slag000
❑slocoof- $Im000 ❑Dw, sl Aaopao
NATURE OF INVESTMENT
IC-mmU
E] PerIMo,hip O In.. RemWeE of So - UN
O In.. RemWeE d S50a or Mom f.wen m sNemA, cf
IF APPLICABLE, LIST DATE:
JJ 17 _/_) 17
ACQUIRED DISPOSED
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE
❑12,000-510,000 ❑$10,.01-SIOO.0o
❑ s,00.wl - $I,wcoa0 ❑ Orer $1,000,000
NATURE OF INVESTMENT
El SlucA rl OIMr
Deemnm
PeMeMip O Income RemNeG of $p - or
O IntgnB RamiveE of $5W or Mm (Rancor on SMeLUN Lf
IF APPLICABLE, LIST DATE:
JJ 17 JJ 77
ACQUIRED DISPOSED
� NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE
❑ S;Lwo - s,o,wo M S10.Da1 - s,00.o00
NATURE OF INVESTMENT
Sbd F-1 mor
Deunnel
❑ PeRmmMp O Inconle Remhretl of SO -
O Illcol110 REmWeE or of SNOW or Mom (Rapwl on SCMmM CJ
IF APPLICABLE. LIST DATE:
--/--J-17— --J--j-17
ACQUIRED DISPOSED
FPPC Form ]00(3017/1038) Sch. A-1
FPPC AdI Ercall: advIce@fppc.ca.gw
FPPC Toll-Fme Helpllrre:866/375-3773 www.fppc.w.SOV
Instructions — Schedule A-2
Investments, Income, and Assets of Business Entities/Trusts
Use Schedule A-2 to report investments in a business
entity (Including a consulting business or other independent
contracting business) or trust (including a living trust) in
which you, your spouse or registered domestic partner,
and your dependent children, together or separately, had a
10% or greater interest, totaling $2,000 or more, during the
reporting period and which is located in, doing business in,
planning to do business in, or which has done business during
the previous two years in your agency's jurisdiction. See
Reference Pamphlet, page 13. A trust located outside your
agency's jurisdiction is reportable if it holds assets that am
located in or doing business in the jurisdiction. Do not report
a trust that contains non -reportable interests. For example,
a trust containing only your personal residence not used in
whole or in part as a business, your savings account, and
some municipal bonds, is not reportable.
Also report on Schedule A-2 investments and real property
held by that entity or trust if your pro rete share of the
investment or real property interest was $2,000 or more
during the reporting period.
To Complete Schedule A•2:
Part 1. Disclose the name and address of the business entity
or trust. If you are reporting an interest in a business entity,
check 'Business Entity" and complete the box as follows:
• Provide a general description of the business activity of the
entity.
• Check the box indicating the highest fair market value of
your investment during the reporting period.
• If you initially acquired or entirely disposed of this interest
during the reporting period, enter the date acquired or
disposed.
Identify the nature of your investment.
• Disclose the job this or business position you held with the
entity, if any (i.e., if you were a director, officer, partner,
trustee, employee, or held any position of management). A
business position held by your spouse is not reportable.
Part 2. Check the box indicating your pro rata share of the
gross Income received by the business entity or trust. This
amount includes your pro rata share of the gross income
from the business entity or trust, as well as your community
property interest in your spouse's or registered domestic
partner's share. Groes income is the total amount of income
before deducting expenses, losses, or taxes.
Part 3. Disclose the name of each source of income that is
located in, doing business in, planning to do business in, or
that has done business during the previous two years in your
agency's jurisdiction, as follows:
• Disclose each source of income and outstanding loan
to the business entity or trust identified in Part 1 if
your pro rata share of the gross income (including your
community property interest in your spouse's or registered
domestic partner's sham) to the business entity or trust
from that source was $10,000 or more during the reporting
period. See Reference Pamphlet, page 11, for examples.
Income from governmental sources may be reportable
if not considered salary. See Regulation 18232. Loans
from commercial lending institutions made in the lender's
regular course of business on terms available to members
of the public without regard to your official status are not
reportable.
• Disclose each individual or entity that was a source
of commission Income of $10,000 or more during the
reporting period through the business entity identified
in Part 1. See Reference Pamphlet, page 8, for an
explanation of commission income.
You may be required to disclose sources of income located
outside your jurisdiction. For example, you may have a client
who resides outside your jurisdiction who does business on a
regular basis with you. Such a client, if a reportable source of
$10,000 or more, must be disclosed.
Mark "None" If you do not have any reportable $10,000
sources of income to disclose. Using phrases such as
"various clients" or "not discloeing sources pursuant to
attorney-client privilege" may trigger a request for an
amendment to your statement. See Reference Pamphlet,
page 14, for details about requesting an exemption from
disclosing privileged information.
Pert 4. Report any investments or interests in real property
held or leased by the entity or treat identified in Part 1 if your
pro rete sham of the interest held was $2,000 or more during
the reporting period. Attach additional schedules or use
FPPC's Form 700 Excel spreadsheet if needed.
• Check the applicable box identifying the interest held as
real property or an investment.
• If investment, provide the name and description of the
business entity.
• If real property, report the precise location (e.g., an
assessor's parcel number or address).
• Check the box indicating the highest fair market value
of your interest in the real property or investment during
the reporting period. (Report the fair market value of the
portion of your residence claimed as a tax deduction if you
are utilizing your residence for business purposes.)
• Identify the nature of your interest.
• Enter the date acquired or disposed only if you initially
acquired or entirely disposed of your interest in the
property or investment during the reporting period.
FPK Form 70012037/2018)
FPPE Advice Email: advice@fppc.w.gov
FPP[ Toll -Free Helpline: 1166/275-3T72 www.fppc.w.gov
Imorucdons-10
SCHEDULE A-2
Investments, Income, and Assets
of Business Entities/Trusts
(Ownership Interest is 10% or Greater)
CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
Address (Business Acidnew APPaplers) Addreee (Boewess Address Acceplabi
Check one Check Co.
❑ Trust. PO IO P ❑ BUdneBe ElIft NTpI1M Me Sets, fl— so 10 2 [1 Trust, ao m 2 ❑ Business Entry. oumpwe the EPA, earn to 2
GENERAL DESCRIPTION OF THIS BUSINESS 111 GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
S500 S1 000
$1 0.1 Sir 00C
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
$0 - $1,888
OF EACH REPORTABLE SINGLE SOURCE OF
FI $0 - 81,588
52,000 - 510,000 _lJ 17 JJ 17
INCOML (IF
❑ $2 NO - S10,000 JJ 17 JJ17
S1Owl-5100,000 ACQUIRED DISPOSED
$10.001-s10D,00D ACQUIRED DISPOSED
$10,001 - $1,000,000
JJ 17
El$10,001 - 51,004000
Over 51,000,000
ACQUIRED
E] ow SI.M,000
NATURE OF INVESTMENT
NATURE OF INVESTMENT
Pennership E) Sole ProyHwarshlp
El Partnership E] Sure Propdeership Q
O Property W beenf- owed of Trust
El Stork
PBMereNp
YOUR BUSINESS POSITION —
YOUR BUSINESS POSITION
�$500 - $1 000 OVER $100.00i)
$I Doi 510000
S500 S1 000
$1 0.1 Sir 00C
El OvER 5100 000
P 1 LI51 IIIL NAME
OF EACH REPORTABLE SINGLE SOURCE OF
F ]. LIST TME NAME
OF EACH REPORTABLE SINI
INCOML (IF
5111000 OR MORE Inn.. .,Y.1
INCOME OF $10.000 OR MORE mn.m..=wae�
110,001 - $100,000
JJ 17
JJ 17
$t0OA01-51,000,000
ACQUIRED
DISPOSED
C lack one Ow.
n INVESTMENT L] REAL PROPERTY
Nems of Buweaau Entry, If InveptrneM, �
Assessors Percw Number PC Street Add w Reel Pmpen,
Wecriptlon
Of Business AWRY g
CM be Other Pre dee Location of Real PropeM
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
52,000 - 410,000
$10.001 - 5100.000 --/—J-LT JJ 17
5100,001-$1.000.000 ACQUIRED DISPOSED
Over 51.000.000
NATURE OF INTEREST
E] Properly CaerahluDaed w Tmet 0 BMk C] PerOenhip
❑ Leeearod vre. nmNnMB El Ower
CMck box M additional usaidules Proodinp Inwwmeate or Paul propety
ere wbmed
7 (INVESTMENT F-1 REAL PROPERTY
Nene w Budneee EMM. K InvMmaw, g
AsNMNmla Parcel Number or Strew Address IN Reel PropeM
Description of Business AdAwy g
Cly or Other Predau Locetlon of Real
Property
FAIR MARKET VALUE
IF APPLICABLE. LIST
DATE:
U."-510,000
110,001 - $100,000
JJ 17
JJ 17
$t0OA01-51,000,000
ACQUIRED
DISPOSED
❑ Clear $1,004000
NATURE OF INTEREST
O Property W beenf- owed of Trust
El Stork
PBMereNp
leaealeltl
vL] Wer
n. nmenslp
❑ Chea Wx n Mkltlonal schaduka repomne Inwahnents Or real pmpem
ere enemas
FPPC Form ]00(2017/2018) Sch. A-2
FPPC Advice Email: advice@fppc.ca.gov
FPPCTall-Free Helpllne:866/275-3772 wvvw.fppc.a.gov,
Instructions — Schedule B
Interests in Real Property
Report interests In real property located in your agency's
jurisdiction in which you, your spouse or registered domestic
partner, or your dependent children had a direct, indirect, or
beneficial interest totaling $2,000 or more any time during
the reporUng period. Real property is also considered to be
'within the jurisdiction" of a local government agency if the
property or any part of It Is located within two miles outside
the boundaries of the jurisdiction or within two miles of any
land owned or used by the local government agency. See
Reference Pamphlet, page 13.
Interests In real property Include:
• An ownership interest (including a beneficial ownership
interest)
• A deed of trust, easement, or option to acquire property
• A leasehold interest (See Reference Pamphlet, page 14.)
• Amining lease
• An interest in real property held in a retirement account
(See Reference Pamphlet, page 15.)
• An interest in real property held by a business entity or
trust in which you, your spouse or registered domestic
partner, and your dependent children together had a 10%
or greater ownership interest (Report on Schedule A-2.)
• Your spouse's or registered domestic partner's interests in
real property that are legally held separately by him or her
You are 1142 required to report:
• A residence, such as a home or vacation cabin, used
exclusively as a personal residence (However, a residence
in which you rent out a room or for which you claim a
business deduction may be reportable. If reportable,
report the fair market value of the portion claimed as a tax
deduction.)
Please note: A non -reportable residence can still be
grounds for a conflict of interest and may be disqualifying.
• Interests in real property held through a blind trust (See
Reference Pamphlet, page 16, for exceptions.)
To Complete Schedule B:
• Report the precise location (e.g., an assessor's parcel
number or address) of the real property.
• Check the box indicating the fair market value of your
Interest in the property (regardless of what you owe on the
Property)
• Enter the date acquired or disposed only If you initially
acquired or entirely disposed of your interest in the
property during the reporting period.
• Identify the nature of your interest. If it is a leasehold,
disclose the number of years remaining on the lease.
Reminders
• Income and loans already reported on Schedule B are
not also required to be reported on Schedule C.
• Real property already reported on Schedule A-2, Part 4
Is not also required to be reported on Schedule B.
• Code filers- do your disclosure categories require
disclosure of real property?
If you received rental income, check the box indicating the
gross amount you received.
If you had a 10% or greater interest in real property and
received rental income, list the name of the source(s) if
your pro rata share of the gross income from any single
tenant was $10,000 or more during the reporting period. If
you received a total of $10,000 or more from two or more
tenants acting in concert (in most cases, this will apply
to marred couples), disclose the name of each tenant,
otherwise, mark 'None."
Loans from a private lender that total $500 or more and
are secured by real property may be reportable. Loans
from commercial lending Institutions made in the
lender's regular course of business on terms available
to members of the public without regard to your official
status are not reportable.
When reporting a loan:
- Provide the name and address of the lender.
Describe the lender's business activity.
- Disclose the interest rate and term of the loan. For
variable interest rale loans, disclose the conditions
of the loan (e.g., Prime + 2) or the average interest
rate paid during the reporting period. The term of
a loan is the total number of months or years given
for repayment of the loan at the Uma the loan was
established.
- Check the box indicating the highest balance of the
loan during the reporting period.
- Identify a guarantor, if applicable.
If you have mom than one
reportable loan on a single
piece of real property, report
the additional loan(s) on
Schedule C.
Example:
Joe Nelson is a city planning
commissioner. Joe received
rental income of $12,000
during the reporting period
from a single tenant who
rented property Joe owned
in the city's jurisdiction. If Joe
had received the $12,000
from two or more tenants, the
tenants' names would not be
required as long as no single
tenant paid $10,000 or more.
A manned couple would be
considered a single tenant.
FPPC Form 700 (2017/2018)
FPPC Advice Email: advice@fppc.ca.gcv
FPPC Toll -Free Helpline: 866/275-5772 www.fppc.ca.gnv
Innructions-12
SCHEDULE B
Interests in Real Property
(Including Rental Income)
� ASSESSOR'S PARCEL NUMBER OR
CITY
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
E] $2,000 - 410,000
❑ slo.aol-amo.000
❑ sloo,aol -51,000,000 ACQUIRED DISPOSED
❑ Over $1.000,000
NATURE OF INTEREST
❑ ous"looses or Trust ❑ EeasmMe
❑ uuhdd ❑
Ym, IwNIMq Otlw
IF RENTAL PROPERTY, GROSS INCOME RECEIVED
❑ so -scree ❑ ON - stops ❑ sl.00t - $to."
❑ slo,OD1 -stool." ❑ OVER $100,000
SOURCES OF RENTAL INCOME: If you own a 10% or greater
IRereet list the name of each tenent that is a single source of
Income of $10,000 or more.
❑ None
CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS
CITY
FAIR MARKET VALUE
IF APPLICABLE, LIST DATE:
❑ sa.coo - slo,o00
❑ slow' -stogaoo
JJ 1 JJ 1�
❑ slooxn -$two son
ACQUIRED DISPOSED
❑ Ouer $1,000,000
NATURE OF INTEREST
❑ OwasMNlprDeea a Trust
❑ easement
❑ LNBeIgM
❑
YM. neehiss pMr
IF RENTAL PROPERTY, GROSS INCOME RECEIVED
❑So - apse ❑woo - stoop ❑$1so' -sto,000
❑ slox,-simo00 ❑ OVER 5100.000
SOURCES OF RENTAL INCOME: If you own a 10% or greater
Interest, list the nein , of each tenant that is a single source of
income of $10,000 or mare.
❑ None
II
A 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:
NAME OF LENDER'
ADDRESS (aus4gss AdURu Ass she Me)
BUSINESS ACTIVITY, IF ANY, OF LENDER
INTEREST RATE TERM(MonMWeers)
% ❑ NOM
HIGHEST BALANCE DURING REPORTING PERIOD
❑seas - $toxo ❑$toot -$1s,000
❑ stop$, - slm000 ❑ OVER sto0,000
❑ G—Ror, x Bpgo-AeN
Comments:
NAME OF LENDER'
ADDRESS (Buelasu Adamee Aucepeah)
BUSINESS ACTIVT', IF ANY, OF
INTEREST RATE TERM lMMxnwe.e)
% ❑ None
HIGHEST BALANCE DURING REPORTING PERIOD
❑ON-$1,ow ❑ six, -sto.soo
❑ $10.001 -11100.00) ❑ OVER $100.000
❑ Guarantor. If eppllwde
FPPC Form 700 (2017/2018) Sch. B
FPPC Advice Email; advice®fppaw.8ov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.w.8ov
Instructions — Schedule C
Income, Loans, & Business Positions
(Income Other Than Gifts and Travel Payments)
Reporting Income:
Report the source and amount of gross income of $500 or
more you received during the reporting period. Gross income
Is the total amount of income before deducting expenses,
losses, or taxes and includes loans other than loans from a
ocmmercial lending institution. See Reference Pamphlet,
page 11. You must also report the source of income to your
spouse or registered domestic partner if your community
property share was $500 or more during the reporting period.
The source and income must be reported only if the source
is located in, doing business in, planning to do business in,
or has done business during the previous two years In your
agency's jurisdiction. See Reference Pamphlet, page 13,
for more information about doing business in the jurisdiction.
Reportable sources of income may be further limited by
your disclosure category located In your agency's conflict of
interest code.
Reporting Business Positions:
You must report your job title with each reportable business
entity even if you received no income during the reporting
period. Use the comments section to indicate that no income
was received.
Commonly reportable Income and loans Include:
• Salary/wages, per diem, and reimbursement for expenses
including travel payments provided by your employer
• Community property interest (50%) in your spouse's
or registered domestic partner's income - report the
employer's name and all other requlmd Information
• Income from investment interests, such as partnerships,
reported on Schedule A-1
• Commission income not required to be reported on
Schedule A-2 (See Reference Pamphlet, page 8.)
• Gross income from any sale, including the sale of a house
or car (Report your pro rata share of the total sale price.)
• Rental income not required to be reported on Schedule B
• Prizes or awards not disclosed as gifts
• Payments received on loans you made to others
• An honorarium received prior to becoming a public official
(See Reference Pamphlet, page 10, concerning your ability
to receive future honoraria.)
• Incentive compensation (See Reference Pamphlet, page
12.)
Reminder
• Code filers - your disclosure categories may not require
disclosure of all sources of income.
• If you or your spouse or registered domestic partner are
self-employed, report the business entity on Schedule A-2.
• Do not disclose on Schedule C income, loans, or business
positions already reported on Schedules A-2 or B.
You are= required to report:
• Salary, reimbursement for expenses or per diem, or
social security, disability, or other similar benefit payments
received by you or your spouse or registered domestic
partner from a federal, state, or local government agency.
Stock dividends and income from the sale of stock unless
the source can be identified.
• Income from a PERS retirement account.
See Reference Pamphlet, page 11, for more exceptions to
Income reporting.
To Complete Schedule C:
Part 1. Income Received/Business Position Disclosure
• Disclose the name and address of each source of income
or each business entity with which you held a business
Position.
• Provide a general description of the business activity if the
source is a business entity.
• Check the box indicating the amount of gross income
received.
• Identify the consideration for which the Income was
mosived.
• For income from commission sales, check the box
indicating the gross income received and list the name of
each source of commission income of $10,000 or more.
See Reference Pamphlet, page 8. Note: If you receive
commission Income on a regular basis or have an
ownership Interest of 10% or more, you must disclose
the business entity and the Income on Schetluie A-2.
• Disclose the job title or business position, if any, that you
held with the business entity, even it you did not receive
income during the reporting period.
Part 2. Loans Received or Outstanding During the
Reporting Period
• Provide the name and address of the lender.
• Provide a general description of the business activity if the
lender is a business entity.
• Check the box indicating the highest balance of the loan
during the reporting period.
• Disclose the interest rate and the term of the loan.
- For variable interest rate loans, disclose the conditions
of the loan (e.g., Prime +2) or the average interest rate
paid during the reporting period.
- The term of the loan is the total number of months or
years given for repayment of the loan at the time the
loan was entered Into.
Identify the security, if any, for the loan.
FPPC Form 700 (3017/2018)
FPPC Advice Email: advice@fppao.eov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.8ov
Instructions -1a
SCHEDULE C
Income, Loans, & Business
Positions
(Other than Gifts and Travel Payments)
NAME OF SOURCE OF INCOME
ADDRESS (Buvmas Addrem Aco ASMSM)
BUSINESS ACTIVITY, IF ANY. OF SOURCE
YOUR BUSINESS POSITION
GROSS INCOME RECEIVED ❑ No Inooms - suaral Position Only
❑ moo -$1,880 ❑111.001-$10.000
$+0001 - $100000 ❑ OVER $100.000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
❑ Sebry ❑ SpOMm's Or replalered domestic penlars Ircnne
(For salfempbyeE use SCnetlule A4.)
❑ Padmrehlp (Lem teen +0% W eensNp. For 10% or g.Mr use
Schadub M2.)
❑ sale o
(Rrx popxry, w, eeM. acl
❑ Loan NpaYraam
F-1 commission or ❑ Rendl lnoom . ar oaN ame a dsio W o -nim
CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
NAME OF SOURCE OF INCOME
ADDRESS (Bualrroes ACUNSIN A.WMINe)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOUR BUSINESS POSITION
GROSS INCOME RECENED ❑ No Inome - meNlma PmMbn ONy
❑ $$00 - 61.000 ❑ $1,Om - $10,000
El $10001 - $100,000 ❑ OVER $ID0000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
❑ SWn ❑ SINNONSIM or registered domeaGo pamlel a in.
(For mlieRNOWd use SchedIN A-2.)
❑ PeNMRSNp (Leas Nen 10%ownership. For 10%, or Bower use
SMedile A-2.)
M Sale or
Loan repai mMN
El Commkdon w
~pgsrly. W, dM. Mc)
RarNtl Income, aM Sem— ✓ are— v—
[Mar I I OMer
IOeacrrEe) (prppe)
' 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:
NAME OF LENDER'
ADDRESS (eoelnem ALGeea ACoepbbb)
IF ANY, OF LENDER
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $600 -:1,000
❑ $1,001 - $10,000
❑ $10,om - s1w."
E] OVER $100,000
Comments:
INTEREST RATE TERM (Momhs/Yeare)
% ❑ None
SECURITY FOR LOAN
C None ❑ Fani re ISSNEE
❑ Rel PmpMy
I!
C
Fli Form 70012017/20111) Sch. C
FPPC Advice Email: advke*fppc.ca.$oMr
FPPC Toll -Free Helpline: 866/2753772 vaww.fppc.ca.gov
Instructions - Schedule D
Income - Gifts
A gift is anything of value for which you have not provided
equal or greater consideration to the donor. A gift is
reportable if its fair market value is $50 or more. In addition,
multiple gifts totaling $50 or more received during the
reporting period from a single source must be reported.
It Is the acceptance of a gift, not the ultimate use to which it is
put, that imposes your reporting obligation. Except as noted
below, you must report a gift even if you never used it or if you
gave it away to another person.
If the exact amount of a gift is unknown, you must make a
good faith estimate of the item's fair market value. Listing
the value of a gift as "over $50" or "value unknown" is not
adequate disclosure. In addition, if you received a gift through
an intermediary, you must disclose the name, address, and
business activity of both the donor and the intermediary. You
may indicate an intermediary either in the "source" field
after the name or in the "comments" section at the bottom
of Schedule D.
Commonly reportable gifts Include:
• Tickets/passes to sporting or entertainment events
• Tickets/passes to amusement parks
• Parking passes not used for official agency business
• Food, beverages, and accommodations, including those
provided In direct connection with your attendance at a
convention, conference, meeting, social event, meal, or like
gathering
• Rebates/discounts not made in the regular course of
business to members of the public without regard to official
status
• Wedding gifts (See Reference Pamphlet, page 18)
• An honorarium received prior to assuming office (You may
report an honorarium as income on Schedule C, rather
than as a gift on Schedule D, if you provided services of
equal or greater value then the payment received. See
Reference Pamphlet, page 10, regarding your ability to
receive future honorana.)
• Transportation and lodging (See Schedule E.)
• Forgiveness of a loan received by you
You are 1141 required to disclose:
• Gifts that were not used and that, within 30 days after
receipt, were returned to the donor or delivered to a
charitable organization or government agency without
Reminders
• Gifts from a single source am subject to a 5470 limit
during 2017. See Reference Pamphlet, page 10.
• Code filers - you only need to report gifts from
reportable sources.
Gift Tracking Mobile Application
• FPPC has created a gift tracking app for mobile
devices that helps filers track gifts and provides a quick
and easy way to upload the information to the Form
700. Visit FPPC's website to download the app.
being claimed by you as a charitable contribution for tax
purposes
Gifts from your spouse or registered domestic partner,
child, parent, grandparent, grandchild, brother, sister, and
certain other famly member: (See Regulation 18942 for a
complete list.). The exception does not apply if the donor
was acting as an agent or intermediary for a reportable
source who was the We donor.
Gifts of similar value exchanged between you and an
individual, other than a lobbyist registered to lobby your
state agency, on holidays, birthdays, or similar occasions
Gifts of informational material provided to assist you in the
performance of your official duties (e.g., books, pamphlets,
reports, calendars, periodicals, or educational seminars)
A monetary bequest or inheritance (However, inherited
investments or real property may be reportable on other
schedules.)
Personalized plaques or trophies with an individual value of
less than $250
Campaign contributions
• Up to two tickets, for your own use, to attend a fundraiser
for a campaign committee or candidate, or to a fundraiser
for an organization exempt from taxation under Section
501(c)(3) of the Internal Revenue Code. The ficket must
be received from the organization or committee holding the
fundraiser.
• Gifts given to members of your immediate family if the
source has an established relationship with the family
member and there is no evidence to suggest the donor had
a purpose to influence you. (See Regulation 18943.)
• Free admission, food, and nominal items (such as a pen,
pencil, mouse pad, note pad or similar item) available to
all attendees, at the event at which the official makes a
speech (as defined in Regulation 18950(b)(2)), so long as
the admission is provided by the person who organizes the
event.
• Any other payment not identified above, that would
otherwise meet the definition of gift, where the payment is
made by an individual who is not a lobbyist registered to
lobby the official's state agency, where it is clear that the
gift was made because of an existing personal or business
relationship unrelated to the official's position and there
is no evidence whatsoever at the time the gift is made to
suggest the donor had a purpose to influence you.
To Complete Schedule D:
• Disclose the full name (not an acronym), address, and, H a
business entity, the business activity of the source.
• Provide the date (month, day, and year) of receipt, and
disclose the fair market value and description of the gift.
FPPC Form 700 (2017/2018)
FPPC Advice Email: advice@fppc.ca.8ov
FPPC Toll -Free Helpline:888/275-3772 www.fppc.ra.gov
Immuctions-16
NAME OF SOURCE (Na! an Awbym)
ADDRESS (Bueineu Atldmae A=WaW)
BUSINESS ACTIVITY, IF ANY. OF SOURCE
DATE (mMddyy) VALUE
JJ— S
JJ_ q
JJ— E
e NAME OF SOURCE (NIX AT Anmym)
DESCRIPTION OF
SCHEDULE D
Income — Gifts
ADDRESS (Bualrleu Address Accaph0k)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (.Wddtyy) VALUE DESCRIPTION OF G1FT(S)
JJ— ?
JJ— s
JJ— A
P NAME OF SOURCE (Nd an A.")
ADDRESS(BudR. Addnea ACCephee)
BUSINESS ACTIVITY, W ANY, OF SOURCE
DATE (RNVdNyy) VALUE DESCRIPTION OF OIFT(S)
JJ_ a
JJ_ q
JJ— q
Comments:
CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
e NAME OF SOURCE (W AN ACmrrym)
ADDRESS (Bu.. AEOreae ACCIANNI
BUSINESS ACTIVITY, IF ANY. OF SOURCE
OATE (mMd4yy) VALUE DESCRIPTION OF GIFT(S)
JJ— S
JJ— F
• NAME OF SOURCE (NIX u Anonym)
ADDRESS (BuMnew AWAue AceplaI
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DAM(Namidyy) VALUE DESCRIPTION OF OIFT(S)
JJ—g
JJ— 5
JJ— A
W NAME OF SOURCE (Not en AC o rP)
ADDRESS (BuRNI Addeea Acceptable)
BUSINESS ACTIVITY. IF ANY. OF SOURCE
DATE (mMddyy) VALUE DESCRIPRON OF GIFT(S)
JJ—
JJ—
JJ—
FPPC Form 70012017/20181Sch. D
FPPC Advice Email: adWce@Fppc.ca.gov
FPPC Tall -Free Helpline: 866/275-3772 www.Ippc.ca.gc V
Instructions — Schedule E
Travel Payments, Advances,
and Reimbursements
Travel payments reportable on Schedule E include advances
and reimbursements for travel and related expenses,
including lodging and meals.
Gifts of travel may be subject to the gift limit. In addition,
certain travel payments are reportable gifts, but are not
subject to the gift limit. To avoid possible misinterpretation
or the perception that you have received a gift in excess of
the gift limit, you may wish to provide a specific description of
the purpose of your travel. See the FPPC fact sheet entitled
"Limitations and Restrictions on Gifts, Honoraria, Travel, and
Loans" at www/ppc.ca.gov.
You are n2l required to disclose:
• Travel payments received from any state, local, or federal
government agency for which you provided services equal
or greater In value than the payments received, such as
reimbursement for travel on agency business from your
government agency employer.
• A payment for travel from another local, state, or federal
government agency and related per diem expenses when
the travel is for education, training or other inter -agency
programs or purposes.
• Travel payments received from your employer in the
normal course of your employment that are included in the
income reported on Schedule C.
• A travel payment that was received from a non-profit
entity exempt from taxation under Internal Revenue
Code Section 501(c)(3) for which you provided equal or
greater consideration, such as reimbursement for travel on
business for a 501(c)(3) organization for which you are a
board member.
Note: Certain travel payments may not be reportable
H reported on Form 801 by your agency.
To Complete Schedule E:
• Disclose the full name (not an acronym) and address of the
source of the travel payment.
• Identify the business activity if the source is a business
entity.
• Check the box to identify the payment as a gift or income,
report the amount, and disclose the date(s).
- Travel payments are gets if you did not provide
services that were equal to or greater in value than the
payments received. You must disclose gifts totaling
$50 or more from a single source during the period
covered by the statement.
When reporting travel payments that are gifts, you must
provide a description of the gift, the date(s) received,
and the travel destination.
Travel payments are Income if you provided services
that were equal to or greater in value than the
payments received. You must disclose income totaling
$500 or more from a single source during the period
covered by the statement. You have the burden of
proving the payments are income rather than gifts.
When reporting travel payments as income, you must
describe the services you provided in exchange for the
payment. You are not required to disclose the date(s)
for travel payments that are income.
Example:
City council member Rick Chandler is the chairman of a 501
(c)(6) trade association and the association pays for Rick's
travel to attend its meetings. Because Rick is deemed to be
providing equal or greater
consideration for the
travel payment by virtue of
serving on the board, this
payment may be reported
as income. Payments
for Rick to attend other
events for which he is not
providing services are
likely considered gifts.
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FPPC Form 700 (2017/2018)
FPPC Advice Email: advice@fppc.ca.8ov
FPPC Toll -Free Helpline: 866/275-3772 www.fpFc.ca.eov
Instructions -I8
SCHEDULE E
Income — Gifts
Travel Payments, Advances,
and Reimbursements
CALIFORNIAFORM 700
FAIR POLITICAL PRACTICES COMMISSION
• Mark either the gift or income box.
• Mark the "501(c)(3)" box for a travel payment received from a nonprofit 501(c)(3) organization
or the "Speech" box if you made a speech or participated in a panel. These payments are not
subject to the gift limit, but may result in a disqualifying conflict of interest.
s For gifts of travel, provide the travel destination.
P NAME OF SOURCE (Not an Acronym)
ADDRESS (Bualnesa Addreas Att.MabK)
Cm' AND STATE
E] 681 (ck3) or DESCRIBE BUSINESSACMITY, IFANY OF SOURCE
DATE(S): JJ_ -JJ_ AMTS
(Y SAM
M MUST CHECK ONE: El Gift or- F1 Income
O Made a Sp RE WPartldpated in a Panel
Q Other - Pnwlde Description
* S OM, Provide TrrvN DasdnMbn
* NAME OF SOURCE (Not an A.M)
ADDRESS (Bushman Address ANMMM6M)
CITY AND STATE
E) 501 (Cft3) or DESCRIBE BUSINESSACTI ITY,, FANY, OF SOURCE
DATE(S): JJ_-JJl_ AMTS
(If gift)
1A MUST CHECK ONE: El Gift cr- n Income
Q Mede a SpescNPertidpeted in a Panel
Q Other - Provide Description
W If Or, Provide Trawl Destination
Comments:
A NAME OF SOURCE (Not en ACmnym)
ADDRESS (Sunman Adeass AoSeplai
CITY AND STATE
E) 581 (c)(3) or DESCRIBE BUSINESSACTMITY, IFAN(,, OF SOURCE
DATE(S):---/--J---J—J— AMTS
(n Be)
P, MUST CHECK ONE: E] Gift Of- F-1 Income
O Made a Speech/Participated in a Panel
O Other - Provide De tenpeon
ll� If OR Wm1tle Tmvel Dxtlnellon
P NAME OF SOURCE (Not an Awmm)
ADDRESS (BueMees Acenew Acceprenk)
CITY AND STATE
❑ Set (c)(3) Pr DESCRIBE BUSINESSACITA",, WARY, OF SOURCE
DATE(s):JJ_-JJ— AMTS
lneiN
1A MUST CHECK ONE: E] Gift or- F1 Income
O Made a Speech PeNdpeted In a Panel
Q Other - Provide Description
A If GR, Provlde Trewl Destination
FPPC Form 700 (2017/20181 Sch. E
FPPC Advice Email: advice"Ilac.oUll
FPPC Toll -Free Helpline:8661275-3772 www.fppc.ce.gov
2017/2018
Form 700
Statement of
•.
Economic Interests
Reference
Pamphlet
California Fair Political Practices Commission
Email Advice: advice@fppc.ca.gov
Toll-free advice line: 1 (866) ASK-FPPC • (866) 275-3772
Telephone: (916) 322.5660 • Website: www.fppc.ca.gov
December 2017
Contents
Who Must File.......
Types of Form 700
Where to File..........
1f171TITIT-T l[
Terms & Definitions
Page 3
Page 4
Page 5
Page 7
Page B
FPPC Form 700 Reference Pamphlet (201]/2010(
FPPC Advice Email: advica@fppc.ca.gov
FPPC Toll -Free Helpline: 8fi 70 772 www.fppc.ca.gov
Ref. Pamphlet - 2
Who Must File
1. Officials and Candidates Specified in Gov.
Code Section 87200 and Members of Boards and
Commissions of Newly Created Agencies
The Act requires the following individuals to fully disclose
their personal assets and income described in Form 700,
Statement of Economic Interests:
State Offices
Governor
• Lieutenant Governor
• Attorney General
• Controller
• Insurance Commissioner
• Secretary of State
• Treasurer
• Members of the State Legislature
• Superintendent of Public Instruction
• State Board of Equalization Members
• Public Utilities Commissioners
• State Energy Resources Conservation and
Development Commissioners
• State Coastal Commissioners
• Fair Political Practices Commissioners
• State public officials (including employees and
consultants) who manage public investments
• Elected members of and candidates for the Board of
Administration of the California Public Employees'
Retirement System
Elected members of and candidates for the Teachers'
Retirement Board
• Members of the High Speed Rail Authority
Other officials and employees of state boards,
commissions, agencies, and departments file Form 700 as
described in Part 2 on this page.
Judicial Offices
• Supreme, Appellate, and Superior Court Judges
• Court Commissioners
• Retired Judges, Pro -Tem Judges, and part-time Court
Commissioners who serve or expect to serve 30 days
or more in a calendar year
County and City Offices
• Members of Boards of Supervisors
• Mayors and Members of City Councils
• Chief Administrative Officers
• Dlstdct Attomeys
• County Counsels
• City Attorneys
• City Managers
• Planning Commissioners
• County and City Treasurers
• County and city public officials (including employees
and consultants) who manage public investments
Members of Boards and Commissions of Newly Created
Agencies
Members must fully disclose their investments, interests
in real property, business positions, and income (including
loans, gifts, and travel payments) until the positions are
covered under a conflict of interest code.
2. State and Local Officials, Employees, Candidates,
and Consultants Designated in a Conflict of Interest
Code ("Code Filers")
The Act requires every state and local government agency
to adopt a unique conflict of interest code. The code lists
each position within the agency filled by individuals who
make or participate in making governmental decisions that
could affect their personal economic interests.
The code requires individuals holding those positions
to periodically file Form 700 disclosing certain personal
economic interests as determined by the code's "disclosure
categories." These individuals are called "designated
employees" or "code filers."
Obtain your disclosure categories from your agency — they
are not contained in the Form 700. Persons with broad
decisionmaking authority must disclose more interests than
those in positions with limited discretion. For example, you
may be required to disclose only investments and business
positions in or income (including loans, gifts, and travel
payments) from businesses of the type that contract with
your agency, or you may not be required to disclose real
property interests.
In addition, certain consultants to public agencies may
qualify as public officials because they make, participate
in making, or am in a staff capacity for governmental
decisions. Agencies determine who is a consultant and the
level of disclosure and may use Form 805.
Note: An official who holds a position specified in Gov.
Code Section 87200 is not required to file statements
under the conflict of interest code of any agency that
has the same or a smaller jurisdiction (for example, a
state legislator who also sits on a state or local board or
commission).
Employees in Newly Created Positions of Existno
Aciencies
An individual hired for a position not yet covered under an
agency's conflict of interest code must file Form 700 if the
individual serves in a position that makes or participates in
making governmental decisions. These individuals must
file under the agency's broadest disclosure category until
the code is amended to include the new position unless
the agency has provided in writing a limited disclosure
requirement. The Form 804 may be used to satisfy this
requirement.
FPPC Form 700 Reference Pamphlet (2017/2018(
FPPC Advim Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 886127541772 w Iinpc.ce.gav
Ref. Pamphlet - 3
Types of Form 700 Filings
Assuming Office Statement:
If you are a newly appointed official or are newly employed
in a position designated, or that will be designated, in
a state or local agency's conflict of interest code, your
assuming office date is the date you were swom in or
otherwise authorized to serve in the position. If you are a
newly elected official, your assuming office date is the date
you were sworn in.
• Investments, interests in real property, and business
positions held on the date you assumed the office
or position must be reported. In addition, income
(inducing loans, gifts, and travel payments) received
during the 12 months prior to the date you assumed the
office or position is reportable.
For positions subject to confirmation by the State Senate
or the Commission on Judicial Performance, your
assuming office date is the date you were appointed or
nominated to the position.
Example:
Made Lopez was nominated by the Governor to serve
on a state agency board that is subject to stale Senate
confirmation. The assuming office date is the date Maria's
nomination is submitted to the Senate. Maria must report
investments, interests in real property, and business
positions she holds on that date, and income (including
loans, gifts, and travel payments) received during the 12
months prior to that date.
If your office or position has been added to a newly
adopted or newly amended conflict of interest code, use
the effective date of the code or amendment, whichever is
applicable.
• Investments, interests in real property, and business
positions held on the effective date of the code or
amendment must be reported. In addition, income
(including loans, gifts, and travel payments) received
during the 12 months prior to the effective date of the
code or amendment is reportable.
Annual Statement:
Generally, the period covered is January 1, 2017,
through December 31, 2017. If the period covered by
the statement is different than January 1, 2017, through
December 31, 2017, (for example, you assumed office
between October 1, 2016, and December 31, 2016, or you
are combining statements), you must specify the period
covered.
• Investments, interests in real property, business
positions held, and income (including loans, gifts, and
travel payments) received during the period covered
by the statement must be reported. Do not change the
preprinted dates on Schedules A-1, A-2, and B unless
you are required to report the acquisition or disposition
of an interest that did not occur in 2017.
• If your disclosure category changes during a
reporting period, disclose under the old category
until the effective date of the conflict of interest code
amendment and disclose under the new disclosure
category through the end of the reporting period.
Leaving Office Statement:
Generally, the period covered is January 1, 2017,
through the date you stopped performing the duties of
your position. If the period covered differs from January
1, 2017, through the date you stopped performing the
duties of your position (for example, you assumed office
between October 1, 2016, and December 31, 2016, or
you are combining statements), the period covered must
be specified. The reporting period can cover parts of two
calendar years.
• Investments, interests in real property, business
positions held, and income (including loans, gifts, and
travel payments) received during the period covered
by the statement must be reported. Do not change the
preprinted dates on Schedules A-1, A-2, and B unless
you are required to report the acquisition or disposition
of an interest that did not occur in 2017.
Candidate Statement:
If you are fling a statement in connection with your
candidacy for state or local office, investments, interests
in real property, and business positions held on the date
of filing your declaration of candidacy must be reported.
In addition, income (including loans, gifts, and travel
payments) received during the 12 months prior to the date
of filing your declaration of candidacy is reportable. Do not
change the preprinted dates on Schedules A-1, A-2, and B.
Candidates running for local elective offices (e.g., county
sheriffs, city clerks, school board trustees, or water
district board members) must file candidate statements,
as required by the conflict of interest code for the elected
position. The code may be obtained from the agency of
the elected position.
Amendments:
If you discover errors or omissions on any statement, file
an amendment as soon as possible. You are only required
to amend the schedule that needs to be revised; it is not
necessary to refile the entire form. Obtain amendment
schedules from the FPPC website at w .fppc.ca.gov.
FPPC Form 700 Reference Pamphlet (201712018)
FPPC Advice Email: advicsWppc.ca.gcv
FPPC Toll -Free Helpline: 8661275-3772 w fppc.ca.gov
Ret. Pamphlet - 4
Where to File
1. Officials Specified In Gov. Code Section 87200
(See Reference Pamphlet, page 3):
In most cases, the fling officials listed below will retain
a copy of your statement and forward the original to the
FPPC.
Filers
Where to File
87208 Filers
State offices
Your agency
Judicial offices
The clerk of your court
Retired Judges
Directly with FPPC
County offices
Your county filing official
City offices
Your city clerk
Multi -County offices
Your agency
87200 candidates
State offices
County elections official with
Judicial offices
whom you file your declaration
Multi -County offices
of candidacy
County offices
County elections official
City offices
City Clerk
Public Employees'
CalPERS
Retirement System
(CalPERS)
State Teachers'
CeISTRS
Retirement Board
CeISTRS)
Note: Individuals that invest public funds for a city or
county agency must file Form 700 with the agency. Unlike
most other 87200 filers, the original statement will not be
forwarded to the FPPC pursuant to Regulation 18753.
2. Code Filers — State and Local Officials,
Employees, Candidates, and Consultants Designated
In a Conflict of interest Code:
File with your agency, board, or commission unless
otherwise specified in your agency's conflict of interest
code. In most cases, the agency, board, or commission
will retain the statements.
Candidates for local elective offices designated in a conflict
of interest code file with the elections office where the
declaration of candidacy or other nomination documents
are filed.
3. Members of Boards and Commissions of Newly
Created Agencies:
File with your newly created agency or with your agency's
code reviewing body as provided by your code reviewing
body.
State Senate and Assembly staff members file statements
directly with the FPPC.
Exceptions:
• Elected state officers are not required to file statements
under any agency's conflict of interest code.
• Filers listed in Section 87200 are not required to file
statements under any agency's conflict of interest
code in the same jurisdiction. For example, a county
supervisor who is appointed to serve in an agency with
jurisdiction in the same county has no additional fling
obligations.
4. Positions Not Yet Covered Under a Conflict of
Interest Code
An individual hired for a position not yet covered under an
agency's conflict of interest code must file Form 700 if the
individual serves in a position that makes or participates in
making governmental decisions. These individuals must
file under the broadest disclosure category until the code
is amended to include the new position unless the agency
has provided in writing a limited disclosure requirement.
Agencies may use FPPC Form 804 for this disclosure.
Such individuals are referred to as "code filers" See
Regulation 18734.
FPPC Form 700 Reference Pamphlet (2017/2018)
FPPC Advice Email: advicettifppc.w.gov
FPPC Toll -Free Helpline: 866/2753772 w 1ppc.ca.gov
Ref. Pamphlet .5
When to File
Assuming Office Statements:
Filer
Deadline
Elected officials
30 drys after assuming office
Appointed positions specified
30 days after assuming office
In Gov. Code Section 87200
fu
fu
Newly created board and
10 days after appointment
commission members not
or nomination if subject
covered by a conflict of
to Senate or judicial
interest code
confirmation
Other appointed positions
(including those held by newly -
30 days after assuming office
hired employees) that are or
(30 days after appointment or
will be designated in a conflict
nomination If subject to Senate
of Interest code
confirmation)
Positions newly added to a
30 days after the effective
new or amended conflict of
date of the code or code
Interest code
amendment
Exceptions:
Elected state officers who assume office in December
or January are not required to file an assuming office
statement, but will file the next annual statement due.
If you complete a term of office and, within 30 days,
begin a new term of the same office (for example, you
are reelected or reappointed), you are not required to
file an assuming office statement. Instead, you will
simply file the next annual statement due.
If you leave an office specified in Gov. Code Section
87200 and, within 45 days, you assume another
office or position specified in Section 87200 that has
the same jurisdiction (for example, a city planning
commissioner elected as mayor), you are not required
to file an assuming office statement. Instead, you will
simply file the next annual statement due.
If you transfer from one designated position to another
designated position within the same agency, contact
your filing officer or the FPPC to determine your filing
obligations.
Late statements are subject to a late fine of
$10 per day per position up to $100 for each
day the statement is late.
Annual Statements:
1. Elected state officers (including members of the
state legislature, members elected to the Board of
Administration of the California Public Employees'
Retirement System and members elected to the
Teachers' Retirement Board);
Judges and court commissioners; and
Members of state boards and commissions specified in
Gov. Code Section 87200:
File no later than Thursday, March 1, 2018.
2. County and city officials specified in Gov. Code Section
87200:
File no later than Monday, April 2, 2018.
3. Multi -County officials:
File no later than Monday, April 2, 2018.
4. Stale and local officials and employees designated in a
conflict of interest code:
File on the date prescribed in the code (April 1 for most
filers).
Exception:
If you assumed office between October 1, 2017, and
December 31, 2017, and filed an assuming office
statement, you are not required to file an annual statement
until March 1, 2019, or April 1, 2019, whichever is
applicable. The annual statement will cover the day after
you assumed office through December 31, 2018.
Incumbent officeholders who file candidate statements
also must file annual statements by the specified
deadlines.
FPPC Form 700 Reference Pamphlet (201712018)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 8661275-3772 wwwfppc.ca.gov
Far. Pamphlet - 6
When to File -(continued)
Leaving Office Statements:
Leaving office statements must be fled no later than 30
days after leaving the office or position.
Exceptions:
• If you complete a term of office and, within 30 days,
begin a new term of the same office (for example, you
are reelected or reappointed), you are not required to
file a leaving office statement. Instead, you will simply
file the next annual statement due.
• If you leave an office specified in Gov. Code Section
87200 and, within 45 days, you assume another office
or position specified in Section 87200 that has the same
jurisdiction (for example, a city planning commissioner
elected as mayor), you are not required to file a leaving
office statement. Instead, you will simply file the next
annual statement due.
• If you transfer from one designated position to another
designated position within the same agency, contact
your filing officer or the FPPC to determine your filing
obligations.
Candidate Statements:
All candidates (including incumbents) for offices specified
in Gov. Code Section 87200 must file statements no later
than the final fling date for their declaration of candidacy.
Candidates seeking a position designated in a conflict of
interest code must file no later than the final filing date
for the declaration of candidacy or other nomination
documents.
Exception
A candidate statement is not required if you filed any
statement (other than a leaving office statement) for the
same jurisdiction within 60 days before filing a declaration
of candidacy or other nomination documents.
FPPC Form 700 Reference Pamphlet (201]/2018)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 88812753772 w fppc.ca.gov
Ref. Pamphlet -7
Terms & Definitions
The instructions located on the back of each schedule
describe the types of interests that must be reported. The
purpose of this section is to explain other terms used in
Form 700 that are not defined in the instructions to the
schedules or elsewhere.
Blind Trust: See Trusts, Reference Pamphlet, page 16.
Business Entity: Any organization or enterprise operated
for profit, including a proprietorship, partnership, firm,
business trust, joint venture, syndicate, corporation, or
associafion. This would include a business for which you
take business deductions for tax purposes (for example, a
small business operated in your home).
Code Filer: An individual who has been designated in
a state or local agency's conflict of interest code to file
statements of economic interests.
An individual hired on or after January 1, 2010 for a
position not yet covered under an agency's conflict of
interest code must file Form 700 if the individual serves
in a position that makes or participates in making
governmental decisions. These individuals must fie under
the broadest disclosure category until the code is amended
to include the new position unless the agency has provided
in writing a limited disclosure requirement. Agencies may
use FPPC Form 804 for such disclosure. See Regulation
18734.
Commission Income: "Commission income" means
gross payments of $500 or more received during the
period covered by the statement as a broker, agent, or
salesperson, including insurance brokers or agents, real
estate brokers or agents, travel agents or salespersons,
stockbrokers, and retail or wholesale salespersons, among
others.
In addition, you may be required to disclose the names of
sources of commission income if your pro rata share of the
gross income was $10,000 or more from a single source
during the reporting period. If your spouse or registered
domestic partner received commission income, you would
disclose your community property share (50%) of that
income (that is, the names of sources of $20,000 or more
in gross commission income received by your spouse or
registered domestic partner).
Report commission income as follows:
If the income was received through a business entity
in which you and your spouse or registered domestic
partner had a 10% or greater ownership interest (or if
you receive commission income on a regular basis as
an independent contractor or agent), use Schedule A-2.
If the income was received through a business entity
in which you or your spouse or registered domestic
partner did not receive commission income on a
regular basis or you had a less than 10% ownership
interest, use Schedule C.
The "source" of commission income generally includes all
parties to a transaction, and each is attributed the full value
of the commission.
Examples:
• You are a partner in Smith and Jones Insurance
Company and have a 50% ownership interest in the
company. You sold two Businessmen's Insurance
Company policies to XYZ Company during the reporting
period. You received commission income of $5,000
from the first transaction and $6,000 from the second.
On Schedule A-2, report your partnership interest in
and income received from Smith and Jones Insurance
Company in Parts 1 and 2. In Part 3, list both
Businessmen's Insurance Company and XYZ Company
as sources of $10,000 or more in commission income.
• You are a stockbroker for Prince Investments, but you
have no ownership interest in the fen. You receive
commission income on a regular basis through the
sale of stock to clients. Your total gross income from
your employment with Prince Investments was over
$100,000 during the reporting period. On Schedule
A-2, report your name as the name of the business
entity in Part 1 and the gross income you have
received in Part 2. (Because you are an employee of
Prince Investments, you do not need to complete the
information in the box in Part 1 indicating the general
description of business activity, fair market value, or
nature of investment.) In Part 3, list Pence Investments
and the names of any clients who were sources of
$10,000 or more in commission income to you.
• You are a real estate agent and an independent
contractor under Super Realty. On Schedule A-2,
Part 1, in addition to your name or business name,
complete the business entity description box. In
Part 2, identify your gross income. In Part 3, for each
transaction that resulted in commission income to you
of $10,000 or more, you must identify the brokerage
entity, each person you represented, and any person
who received a finder's or other referral fee for
referring a party to the transaction to the broker.
Note: If your pro rata share of commission income from
a single source is $500 or more, you may be required to
disqualify yourself from decisions affecting that source of
income, even though you are not required to report the
income. For information regarding disclosure of "incentive
compensation,' see Reference Pamphlet, page 12.
FPPC Form 700 Reference Pamphlet (201712018(
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Fres Ralplina: 888/2753772 www.ippc.ca.gov
Ref. Pamphlet - 8
Terms & Definitions - (continued)
Conflict of Interest: A public official or employee has a
conflict of interest under the Act when all of the following
occur:
• The official makes, participates in making, or uses
his or her official position to influence a governmental
decision;
• It is reasonably foreseeable that the decision will affect
the official's economic interest;
• The effect of the decision on the official's economic
interest will be material; and
• The effect of the decision on the official's economic
interest will be different than its effect on the public
generally.
Conflict of Interest Code: The Act requires every state
and local government agency to adopt a conflict of interest
code. The code may be contained in a regulation, policy
statement, or a city or county ordinance, resolution, or
other document.
An agency's conflict of interest code must designate all
officials and employees of, and consultants to, the agency
who make or participate in making governmental decisions
that could cause conflicts of interest. These individuals
are required by the code to file statements of economic
interests and to disqualify themselves when conflicts of
interest occur.
The disclosure required under a conflict of interest code for
a particular designated official or employee should include
only the kinds of personal economic interests he or she
could significantly affect through the exercise of his or her
official duties. For example, an employee whose duties
are limited to reviewing contracts for supplies, equipment,
materials, or services provided to the agency should be
required to report only those interests he or she holds
that are likely to be affected by the agency's contracts for
supplies, equipment, materials, or services.
Consultant: An individual who contracts with or whose
employer contracts with state or local government
agencies and who makes, participates in making, or acts
in a staff capacity for making governmental decisions. The
agency determines who is a consultant. Consultants may
be required to file Form 700. Such consultants would file
under full disclosure unless the agency provides in writing
a limited disclosure requirement. Agencies may use FPPC
Form 805 to assign such disclosure. The obligation to
file Form 700 is always imposed on the individual who is
providing services to the agency, not on the business or
firm that employs the individual.
FPPC Regulation 18700.3 defines "consultant" as an
individual who makes a governmental decision whether to:
Approve a rete, rule, or regulation
Adopt or enforce a law
• Issue, deny, suspend, or revoke any permit, license,
application, certificate, approval, order, or similar
authorization or entitlement
• Authorize the agency to enter into, modify, or renew, a
contract provided it is the type of contract that requires
agency approval
• Grant agency approval to a contract that requires
agency approval and to which the agency is a party, or
to the specifications for such a contract
• Grant agency approval to a plan, design, report, study,
or similar item
• Adopt, or grant agency approval of, policies,
standards, or guidelines for the agency or for any of its
subdivisions
A consultant also is an individual who serves in a staff
capacity with the agency and:
• participates in making a governmental decision; or
• performs the same or substanfially all the same duties
for the agency that would otherwise be performed by an
individual holding a position specified in the agency's
conflict of interest code.
Designated Employee: An official or employee of a state
or local government agency whose position has been
designated in the agency's conflict of interest code to file
statements of economic interests or whose position has
not yet been listed in the code but makes or participates in
making governmental decisions. Individuals who contract
with government agencies (consultants) may also be
designated in a conflict of interest code.
A federal officer or employee serving in an official federal
capacity on a state or local government agency is not a
designated employee.
Disclosure Categories: The section of an agency's
conflict of interest code that specifies the types of personal
economic interests officials and employees of the agency
must disclose on their statements of economic interests.
Disclosure categories are usually contained in an appendix
or attachment to the conflict of interest code. Contact your
agency to obtain a copy of your disclosure categories.
FPPC Form 700 Reference Pamphlet (201712018)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 888/275J772 w fppc.ca.gov
Ref. Pamphlet - 9
Terms & Definitions - (continued)
Diversified Mutual Fund: Diversifed portfolios of stocks,
bonds, or money market instruments that are managed
by investment companies whose business is pooling
the money of many individuals and investing it to seek
a common investment goal. Mutual funds are managed
by trained professionals who buy and sell securities. A
typical mutual fund will own between 75 to 100 separate
securities at any given time so they also provide instant
diversification. Only diversified mutual funds registered
with the Securities and Exchange Commission under
the Investment Company Act of 1940 are exempt from
disclosure. In addition, Regulation 18237 provides an
exception from reporting other funds that are similar to
diversified mutual funds. See Reference Pamphlet, page
13.
Elected Stale Officer: Elected state officers include
the Governor, Lieutenant Governor, Attorney General,
Insurance Commissioner, State Controller, Secretary
of State, State Treasurer, Superintendent of Public
Instruction, members of the State Legislature, members of
the State Board of Equalization, elected members of the
Board of Administration of the California Public Employees'
Retirement System and members elected to the Teachers'
Retirement Board.
Enforcement: The FPPC investigates suspected violations
of the Act. Other law enforcement agencies (the Attorney
General or district attorney) also may initiate investigations
under certain circumstances. If violations are found,
the Commission may initiate administrative enforcement
proceedings that could result in fines of up to $5,000 per
violation.
Instead of administrative prosecution, a civil action may
be brought for negligent or intentional violations by the
appropriate civil prosecutor (the Commission, Attorney
General, or district attorney), or a private party residing
within the jurisdiction. In civil actions, the measure
of damages is up to the amount or value not properly
reported.
Persons who violate the conflict of interest disclosure
provisions of the Act also may be subject to agency
discipline, including dismissal.
Finally, a knowing or willful violation of any provision
of the Act is a misdemeanor. Persons convicted of a
misdemeanor may be disqualified for four years from the
date of the conviction from serving as a lobbyist or running
for elective office, in addition to other penalties that may
be imposed. The Act also provides for numerous civil
penalties, including monetary penalties and damages, and
injunctive relief from the courts.
Expanded Statement: Some officials or employees
may have multiple filing obligations (for example, a city
council member who also holds a designated position with
a county agency, board, or commission). Such officials
or employees may complete one expanded statement
covering the disclosure requirements for all positions and
file a complete, originally signed copy with each agency.
Fair Market Value: When reporting the value of an
investment, interest in real property, or gift, you must
disclose the fair market value —the price at which the item
would sell for on the open market. This is particularly
important when valuing gifts, because the fair market value
of a gift may be different from the amount it cost the donor
to provide the gift. For example, the wholesale cost of a
bouquet of flowers may be $10, but the fair market value
may be $25 or more. In addition, there are special rules
for valuing free tickets and passes. Call or email the FPPC
for assistance.
Gift and Honoraria Prohibitions
Gift:
State and local officials who are listed in Gov. Code
Section 87200 (except judges — see below), candidates
for these elective offices (including judicial candidates),
and officials and employees of state and local government
agencies who are designated in a conflict of interest code
are prohibited from accepting a gift or gilts totaling more
than $470 in a calendar year from a single source.
In addition, elected stets officers, candidates for elective
$SaSfl offices, and officials and employees of lialit agencies
are subject to a $10 per calendar month limit on gifts from
lobbyists and lobbying fines registered with the Secretary
of State.
Honoraria:
State and local officials who are listed in Gov. Code
Section 87200 (except judges — see below), candidates
for these elective offices (including judicial candidates),
and employees of state and local government agencies
who are designated in a conflict of interest code are
prohibited from accepting honoraria for any speech given,
article published, or attendance at any public or private
conference, convention, meeting, social event, meal, or
like gathering.
FPPC Form 700 Reference Pamphlet (201712018)
FPPC Advice Email: advica@fppc.ca.gov
FPPC Toll -Free Helpline: 8881275-3772 wfiapcxa.gov
Ref. Pamphlet -10
Terms & Definitions - (continued)
Exceptions:
• Some gigs are not reportable or subject to the gift
and honoraria prohibitions, and other gifts may not
be subject to the prohibitions, but are reportable. For
detailed information, see the FPPC fact sheet entitled
"Limitations and Restrictions on Gifts, Honoraria,
Travel, and Loans," which can be obtained from your
filing officer or the FPPC website (www./ppc.ca.gov).
• The $470 gift limit and the honorarium prohibition do
not apply to a part-time member of the governing board
of a public institution of higher education, unless the
member is also an elected official.
• If you are designated in a state or local government
agency's conflict of interest code, the $470 gift limit
and honorarium prohibition are applicable only to
sources you would otherwise be required to report on
your statement of economic interests. However, this
exception is not applicable if you also hold a position
listed in Gov. Code Section 87200 (See Reference
Pamphlet, page 3.)
• For state agency officials and employees, the $10
lobbyistAobbying firm gift limit is applicable only to
lobbyists and lobbying fins registered to lobby your
agency. This exception is not applicable if you are an
elected state officer or a member or employee of the
State Legislature.
• Payments for articles published as part of the practice
of a bona fide business, trade, or profession, such as
teaching, are not considered honoraria. A payment for
an "article published" that is customarily provided in
connection with teaching includes text book royalties
and payments for academic tenure review letters. An
official is presumed to be engaged in the bona fide
profession of teaching if he or she is employed to teach
at an accredited university.
Judges:
Section 170.9 of the Code of Civil Procedure imposes gift
limits on judges and prohibits judges from accepting any
honorarium. Section 170.9 is enforced by the Commission
on Judicial Performance. The FPPC has no authority to
interpret or enforce the Code of Civil Procedure. Court
commissioners are subject to the gift limit under the
Political Reform Act.
Income Reporting: Reporting income under the Act is
different than reporting income for tax purposes. The
Act requires gross income (the amount received before
deducting losses, expenses, or taxes, as well as income
reinvested in a business entity) to be reported.
Pro Rata Share: The instructions for reporting income
refer to your pm rata share of the income received. Your
pro rata share is normally based on your ownership
interest in the entity or property. For example, if you are
a sole proprietor, you must disclose 100% of the gross
income to the business entity on Schedule A-2. If you own
25% of a piece of rental property, you must report 25% of
the gross rental income received. When reporting your
community property interest in your spouse's or registered
domestic partner's income, your pro rata share is 50% of
his or her income.
Separate Property Agreement: Generally, a public official
is required to disclose his or her community property share
of his or her spouse's income. But, when a public official
and his or her spouse have a legally separate property
agreement (e.g., prenuptial agreement), the official is
not required to report the spouse's community property
share of income, unless the funds are commingled with
community funds or used to pay for community expenses
or to produce or enhance the separate income of the
official.
Note: This reporting exception does not apply to
investments and interests in real property. Even if a public
official and his or her spouse have a separate property
agreement, the spouse's investments and interests in real
property must still be disclosed because the definitions
of reportable investments and interests in real property
include those held by the official's immediate family
(spouse, registered domestic partner, and dependent
children). These definitions are not dependent on
community property law.
Income to a Business Entity When you are required to
report sources of income to a business entity, sources
of rental income, or sources of commission income, you
are only required to disclose individual sources of income
of $10,000 or more. However, you maybe required to
disqualify yourself from decisions affecting sources of
$500 or more in income, even though you are not required
to report them.
Examples:
• Alice Ruiz is a partner in a business entity. She has a
25% interest. On Schedule A-2, she must disclose 25%
of the fair market value of the business entity; 25% of
the gross income to the business entity (even though all
of the income received was reinvested in the business
and she did not personally receive any income from the
business); and the name of each source of $40,000 or
more to the business.
FPPC Form 700 Reference Pamphlet (2017/1018)
FPPC Advice small: a dvlea®fppcxa,.v
FPPC Toll -Free Helpline: 886c?753772 w fppc.ca.gov
Ref. Pamphlet -11
Terms & Definitions- (continued)
Cynthia and Mark Johnson, a married couple, own
Classic Autos. Income to this business was $200,000.
In determining the amount to report for Income on
Schedule A-2, Part 2, Mark must include his 50% share
($100,000) and 50% of his spouse's share ($50,000).
Thus, his reportable income would be $150,000
and he will check the box indicafing $100,001-
$1,000,000. (Also see Reference Pamphlet, page 13,
for an example of how to calculate the value of this
investment.)
You are pg= required to report:
• Salary, reimbursement for expenses or per diem, social
security, disability, or other similar benefit payments
received by you or your spouse or registered domestic
partner from a federal, state, or local government
agency
• Atravel payment that was received from a non-profit
entity exempt from taxation under Internal Revenue
Code Section 501(c)(3) for which you provided equal or
greater consideration, such as reimbursement for travel
on business for a 601 (0)(3) organization for which you
are a board member.
• Campaign contributions
• A man bequest or cosh inheritance
• Returns on a security registered with the Securities and
Exchange Commission, including dividends, interest,
or proceeds from a sale of stocks or bonds unless the
purchaser can be identified.
• Redemption of a mutual fund
• Payments received under an insurance policy, including
an annuity
• Interest, dividends, or premiums on a time or demand
deposit in a financial institution, shares in a credit union,
an insurance policy, or a bond or other debt instrument
issued by a government agency
• Your spouse's or registered domestic partner's income
that is legally "separate" income so long as the funds
are not commingled with community funds or used to
pay community expenses
• Income of dependent children
• Automobile trade-in allowances from dealers
• Loans and loan repayments received from your
spouse or registered domestic partner, child, parent,
grandparent, grandchild, brother, sister, parent -in-
law, brother-in-law, sister-in-law, nephew, niece, aunt,
uncle, or first cousin unless he or she was acting as an
intermediary or agent for any person not covered by
this provision
• Alimony or child support payments
• Payments received under a defined benefit pension
plan qualified under Internal Revenue Code Section
401(a)
• Any loan from a commercial lending institution made
in the lender's regular course of business on terms
available to the public without regard to your official
status
• Any retail installment or credit card debts incurred in the
creditor's regular course of business on terms available
to the public without regard to your official status
• Loans made to others. However, repayments may be
reportable on Schedule C
• A loan you co-signed for another person unless you
made payments on the loan during the reporting period
Incentive Compensation: "Incentive compensation"
means income over and above salary that is either
ongoing or cumulative, or both, as sales or purchases of
goods or services accumulate. Incentive compensation is
calculated by a predetermined formula set by the official's
employer which correlates to the conduct of the purchaser
in direct response to the effort of the official.
Incentive compensation does not include:
• Salary
• Commission income (For information regarding
disclosure of 'commission income,"see Reference
Pamphlet, page 8.)
• Bonuses for activity not related to sales or markefing,
the amount of which is based solely on merit or hours
worked over and above a predetermined minimum
• Executive incentive plans based on company
performance, provided that the formula for determining
the amount of the executive's incentive income does
not include a correlation between that amount and
increased profits derived from increased business with
specific and identifiable clients or customers of the
company
• Payments for personal services which are not
marketing or sales
The purchaser is a source of income to the official if all
three of the following appy:
• the official's employment responsibilities include
directing sales or marketing activity toward the
purchaser; and
• there is direct personal contact between the official and
the purchaser intended by the official to generate sales
or business; and
• there is a direct relafionship between the purchasing
activity of the purchaser and the amount of the
incentive compensation received by the official.
FPPC Form 700 Reference Pamphlet (201712018(
FPPC Advice Email: advice@fppc,ca.gov
FPPC Toll -Free Helpline: 8661275-3772 wanvopc.ca.gov
Ref. Pamphlet -12
Terms & Definitions - (continued)
Report incentive compensation as follows:
In addition to salary, reimbursement of expenses, and
other income received from your employer, separately
report on Schedule C the name of each person
who purchased products or services sold, marketed
or represented by you if you received incentive
compensation of $500 or more attributable to the
purchaser during the period covered by the statement.
If incentive compensation is paid by your employer in
a lump sum, without allocation of amounts to specific
customers, you must determine the amount of incentive
compensation attributable to each of your customers.
This may be based on the volume of sales to those
customers.
(See Regulations 18700.1 and 18728.5 for more
information.)
Investment Funds: The term "investment" no longer
includes certain exchange traded funds, closed-end funds,
or funds held in an Internal Revenue Code qualified plan.
These non -reportable investment funds (1) must be bona
fide investment funds that pool money from more than 100
investors, (2) must hold securities of more than 15 issuers,
and (3) cannot have a stated policy of concentrating
their holdings in the same industry or business ("sector
funds"). In addition, the filer may not influence or control
the decision to purchase or sell the specific fund on
behalf of his or her agency during the reporting period or
influence or control the selection of any specific investment
purchased or sold by the fund. (Regulation 18237)
Investments and Interests in Real Property: When
disclosing investments on Schedules A-1 or A-2 and
interests in real property on Schedules A-2 or B, you must
include investments and interests in real property held by
your spouse or registered domestic partner, and those held
by your dependent children, as If you held them directly.
Examples:
• Terry Pearson, her husband, and two dependent
children each own $600 in stock in General Motors.
Because the total value of their holdings is $2,400,
Terry must disclose the stock as an investment on
Schedule A-1.
• Cynthia and Mark Johnson, a married couple, jointly
own Classic Autos. Mark must disclose Classic Autos
as an investment on Schedule A-2. To determine the
reportable value of the investment, Mark will aggregate
the value of his 50% interest and Cynthia's 50%
interest. Thus, if the total value of the business entity is
$150,000, he will check the box $100,001 - $1,000,000
in Part 1 of Schedule A-2. (Also see Reference
Pamphlet, page 11, for an example of how to calculate
reportable income.)
The Johnsons also own the property where Classic
Autos is located. To determine the reportable value
of the real property, Mark will again aggregate the
value of his 50% interest and Cynthia's 50% interest to
determine the amount to report in Part 4 of Schedule
A-2.
• Katie Smith rents out a room in her home. She
receives $6,000 a year in rental income. Katie will
report the fair market value of the rental portion of her
residence and the income received on Schedule B.
Jurisdiction: Report discloseable investments and
sources of income (including loans, gifts, and travel
payments) that are either located in or doing business in
your agency's jurisdiction, are planning to do business in
your agency's jurisdiction, or have done business during
the previous two years in your agency's jurisdiction,
and interests in real property located in your agency's
jurisdiction.
A business entity is doing business in your agency's
jurisdiction if the entity has business contacts on a regular
or substantial basis with a person who maintains a physical
presence in your jurisdiction.
Business contacts include, but are not limited to,
manufacturing, distributing, selling, purchasing, or
providing services or goods. Business contacts do not
include marketing via the Internet, telephone, television,
radio, or printed media.
The same criteria are used to determine whether an
individual, organization, or other entity is doing business in
your jurisdiction.
Exception:
Gifts are reportable regardless of the location of the donor.
For example, a state agency official with full disclosure
must report gifts from sources located outside of California.
(Designated employees/oode filers should consult their
disclosure catecories to determined the donor of a gift is of
the type that must be disclosed.)
When reporting interests in real property, if your jurisdiction
is the state, you must disclose real property, located within
the state Calgomia unless your agency's conflict of
interest code specifies otherwise.
For local agencies, an interest in real property is located in
your jurisdiction If any part of the property, is located in, or
within two miles of, the region, city, county, district, or other
geographical area in which the agency has jurisdiction, or if
the property is located within two miles of any land owned
or used by the agency.
FPPC Form 700 Reference Pamphlet (3017/2018)
FPPCAdvim Email: advlca@fppc.ca.8ov
FPPC Toll-Fre* Kalpline: 885/275-3772.1ppc.ca.gov
Ref. Pamphlet -13
Terms & Definitions - (continued)
See the following explanations to determine what your
jurisdiction is:
State Offices and All Courts: Your jurisdiction is the state
if you are an elected state officer, a state legislator, or
a candidate for one of these offices. Judges, judicial
candidates, and court commissioners also have statewide
jurisdiction. (In re Baty It 979) 5 FPPC Ops. 10) If you
are an official or employee of, or a consultant to, a state
board, commission, or agency, or of any court or the State
Legislature, your jurisdiction is the state.
County Offices: Yourjudsdiction is the county if you are
an elected county officer, a candidate for county office, or
if you are an official or employee of, or a consultant to, a
county agency or any agency with jurisdiction solely within
a single county.
Citv Offices: Your jurisdiction is the city if you are an
elected city officer, a candidate for city office, or you are an
official or employee of, or a consultant to, a city agency or
any agency with jurisdiction solely within a single city.
Multi -County Offices: If you are an elected officer,
candidate, official or employee of, or a consultant to
a multi -county agency, your jurisdiction is the region,
district, or other geographical area in which the agency
has jurisdiction. (Example: A water district has jurisdiction
in a portion of two counties. Members of the board are
only required to report interests located or doing business
in that portion of each county in which the agency has
jurisdiction.)
JPAsI: If you are an elected officer, candidate, official or
employee of, or a consultant to an agency not covered
above, your jurisdiction is the region, district, or other
geographical area in which the agency has jurisdiction.
See the multi -county example above.
Leasehold Interest: The term "interest in real property'
includes leasehold interests. An interest in a lease on real
property is reportable if the value of the leasehold interest
is $2,000 or more. The value of the interest is the total
amount of rent owed by you during the reporting period or,
for a candidate or assuming office statement, during the
prior 12 months.
You are not required to disclose a leasehold interest with a
value of less than $2,000 or a month-to-month tenancy.
Loan Reporting: Filers are not required to report loans
from commercial lending institutions or any indebtedness
created as part of retail installment or credit card
transactions that are made in the lender's regular course
of business, without regard to official status, on terms
available to members of the public.
Loan Restrictions: State and local elected and appointed
public officials are prohibited from receiving any personal
loan totaling more than $250 from an official, employee, or
consultant of their government agencies or any government
agency over which the official or the official's agency has
direction or control. In addition, loans of more than $250
from any person who has a contract with the official's
agency or an agency under the official's control are
prohibited unless the loan is from a commercial lending
institution or part of a retail installment or credit card
transaction made in the regular course of business on terms
available to members of the public.
State and local elected officials are also prohibited from
receiving any personal loan of $500 or more unless the
loan agreement is in writing and clearly states the terms of
the loan, including the parties to the loan agreement, the
date, amount, and term of the loan, the date or dates when
payments are due, the amount of the payments, and the
interest rate on the loan.
Campaign loans and loans from family members are not
subject to the $250 and $500 loan prohibitions.
A personal loan made to a public official that is not being
repaid or is being repaid below certain amounts will
become a gift to the official under certain circumstances.
Contact the FPPC for further information, or see the FPPC
fact sheet entitled "Limitations and Restrictions on Gifts,
Honoraria, Travel, and Loans," which can be obtained from
your filing officer or the FPPC website (wwwfbpc.ca.gov).
Privileged Information: FPPC Regulation 18740 sets
out specific procedures that must be followed in order
to withhold the name of a source of income. Under this
regulation, you are not required to disclose on Schedule
A-21 Part 3, the name of a person who paid fees or
made payments to a business entity If disclosure of the
name would violate a legally recognized privilege under
California or Federal law. However, you must provide
an explanation for nondisclosure separately stating, for
each undisclosed person, the legal basis for the assertion
of the privilege, facts demonstrating why the privilege
is applicable, and that to the best of your knowledge
you have not and will not make, participate in making,
or use your official position to influence a governmental
decision affecting the undisclosed person in violation of
Government Code Section 87100. This explanation may
be included with, or attached to, the public official's Form
700.
We note that the name of a source of income is privileged
only to a limited extent under California law. For example,
a name is protected by attorney-client privilege only
when facts concerning an attorney's representation of
an anonymous client are publicly known and those facts,
FPPC Form 700 Reference Pamphlet (201]/2018)
FPPC Advice Email: advlca,@fppc.ca.gov
FPPC Toll -Free Helpline: 8661275-3772 xrww.rppc.ca.gov
lief. Pamphlet -14
Terms & Definitions - (continued)
when coupled with disclosure of the client's identity,
might expose the client to an official investigation or to
civil or criminal liability. A patient's name is protected
by physician -patient privilege only when disclosure of
the patient's name would also reveal the nature of the
treatment received by the patient. A patient's name is
also protected if the disclosure of the patient's name
would constitute a violation by an entity covered under the
Federal Health Insurance Portability and Accountability Act
(also known as HIPAA).
Public Officials Who Manage Public Investments:
Individuals who invest public funds in revenue-producing
programs must file Form 700. This includes individuals
who direct or approve investment transactions, formulate
or approve investment policies, and establish guidelines
for asset allocations. FPPC Regulation 18700.3 defines
"public officials who manage public investments" to include
the following:
• Members of boards and commissions, including
pension and retirement boards or commissions, and
committees thereof, who exercise responsibility for the
management of public investments;
• High-level officers and employees of public agencies
who exercise primary responsibility for the management
of public investments (for example, chief or principal
investment officers or chief financial managers); and
• Individuals who, pursuant to a contract with a state
or local government agency, perform the same or
substantially all the same functions described above.
Registered Domestic Partners: Filers must report
investments and interests in real property held by, and
sources of income to, registered domestic partners. (See
Regulation 18229.)
Retirement Accounts (for example, deferred
compensation and Individual retirement accounts
(IRAs)): Assets held in retirement accounts must be
disclosed if the assets are reportable items, such as
common stock (investments) or real estate (interests
in real property). For help in determining whether your
investments and real property are reportable, see the
instructions to Schedules A-1, A-2, and B.
If your retirement account holds reportable assets, disclose
only the assets held in the account, not the account
itself. You may have to contact your account manager to
determine the assets contained in your account.
Schedule A-1: Report any business entity in which the
value of your investment interest was $2,000 or more
during the reporting period. (Use Schedule A-2 if you have
a 10% or greater ownership interest in the business entity.)
Schedule B: Report any piece of real property in which
the value of your interest was $2,000 or more during the
reporting period.
Examples:
• Alice McSherry deposits $500 per month into her
employer's deferred compensation program. She has
chosen to purchase shares in two diversified mutual
funds registered with the Securities and Exchange
Commission. Because her funds are invested solely
in non -reportable mutual funds (see Schedule A-1
instructions), Alice has no disclosure requirements with
regard to the deferred compensation program.
• Bob Allison has $6,000 in an individual retirement
account with an investment firm. The account
contains stock in several companies doing business
in his jurisdiction. One of his stock holdings, Mimic
Computers, reached a value of $2,500 during the
reporting period. The value of his investment in each of
the other companies was less than $2,000. Bob must
report Misac Computers as an investment on Schedule
A-1 because the value of his stock in that company was
$2,000 or more.
• Adrian Fisher has $5,000 in a retirement fund that
invests in real property located in her jurisdiction. The
value of her interest in each piece of real property held
in the fund was less than $2,000 during the reporting
period. Although her retirement fund holds reportable
assets, she has no disclosure requirement because she
did not have a $2,000 or greater interest in any single
piece of real property. If, in the future, the value of her
interest in a single piece of real property reaches or
exceeds $2,000, she will be required to disclose the
real property on Schedule B for that reporting period.
Trusts: Investments and interests in real property held
and income received by a trust (including a living trust) are
reported on Schedule A-2 if you, your spouse or registered
domestic partner, and your dependent children together
had a 10% or greater interest in the trust and your pro rata
share of a single investment or interest in real property was
$2,000 or more.
You have an interest in a trust if you are a trustor and:
• Can revoke or terminate the trust;
• Have retained or reserved any rights to the income or
principal of the trust or retained any reversionary or
remainder interest; or
• Have retained any power of appointment, including the
power to change the trustee or the beneficiaries.
Or you are a benefciary and:
Presently receive income; or
Have an irrevocable future right to receive income
or principal. (See FPPC Regulation 18234 for more
information.)
FPPC Form 700 Reference Pamphlet (20178010)
FPPC Advice Email: advice@fppc.ca.gov
FPPCToll-Free Helpline: 0001275.3772w fppc.ca.gov
Ref. Pamphlet -15
Terms & Definitions - (continued)
Examples:
• Sarah Murphy has set up a living trust that holds her
principal residence, stock in several companies that do
business in her jurisdiction, and a rental home in her
agency's jurisdiction. Since Sarah is the trustor and
can revoke or terminate the trust, she must disclose
any stock worth $2,000 or more and the rental home
on Schedule A-2. Sarah's residence is not reportable
bemuse it is used exclusively as her personal
residence.
• Ben Yee is listed as a beneficiary in his grandparents'
trust. However, Ben does not presently receive income
from the trust, nor does he have an irrevocable future
right to receive income or principal. Therefore, Ben
is not required to disclose any assets contained in his
grandparents'trust.
Blind Trusts:
A blind trust is a trust managed by a disinterested trustee
who has complete discretion to purchase and sell assets
held by the trust. If you have a direct, indirect, or beneficial
interest in a blind trust, you may not be required to disclose
your pro rata share of the trust's assets or income.
However, the trust must meet the standards set out in
FPPC Regulation 18235, and you must disclose reportable
assets originally transferred into the blind trust and income
from those original assets on Schedule A-2 until they have
been disposed of by the trustee.
Trustees:
If you are only a trustee, you do not have a reportable
interest in the trust. However, you may be required
to report the income you received from the trust for
performing trustee services.
Wedding Gifts: Wedding gifts must be disclosed if they
were received from a reportable source during the period
covered by the statement. Gifts valued at $50 or more are
reportable; however, a wedding gift is considered a gift to
both spouses equally. Therefore, you would count one-half
of the value of a wedding gift to determine if it is reportable
and need only report individual gifts with a total value of
$100 or more.
For example, you receive a place setting of china valued at
$150 from a reportable source as a wedding gift. Bemuse
the value to you is $50 or more, you must report the gift on
Schedule D, but may state its value as $75.
Wedding gifts are not subject to the $470 gift limit, but they
are subject to the $10 IobbyistAobbying fine gift limit for
state officials.
Privacy Information Notice
Information requested on all FPPC fors is used by the
FPPC to administer and enforce the Political Reform Act
(Gov. Code Sections 81000-91014 and California Code
of Regulations Sections 18110-18997). All information
required by these fors is mandated by the Political
Reform Act. Failure to provide all of the information
required by the Act is a violation subject to administrative,
criminal, or civil prosecution. All reports and statements
provided are public records open for public inspection and
reproduction.
If you have any questions regarding this Privacy Notice or
how to access your personal information, please contact
the FPPC at:
General Counsel
Fair Political Practices Commission
1102 Q Street, Suite 3000
Sacramento, CA 95811
(916)322-5660
(866)275-3772
FPPC Form 700 Reference Pamphlet (201712018)
FPPC Advice Email: advice@fppc.ca.gev
FPPC Toll -Free Helpline: 8661275-3772 v fppc.ca.gov
Ref. Pamphlet -16