form 700 - fppc home · fppc form 700 (2018/2019) fppc advice email: [email protected] fppc...

December 2018

2018/2019Statement ofEconomic Interests

Form 700

California Fair Political Practices Commission1102 Q Street, Suite 3000 • Sacramento, CA 95811Email Advice: [email protected] advice line: 1 (866) ASK-FPPC • 1 (866) 275-3772Telephone: (916)322-5660 • Website: www.fppc.ca.gov

A Public Document

Table of ContentsQuick Start Guide .....................................................p.2Who? Where? How? When? .................................... p.3Types of Statements ................................................. p.4Cover Page and Schedules

Cover Page ........................................................ p.5Schedule A-1 (Investments) ............................... p.7Schedule A-2 (Business Entities/Trusts) ............ p.9Schedule B (Real Property) ...............................p.11Schedule C (Income) .........................................p.13Schedule D (Gifts) ..............................................p.15Schedule E (Travel Payments) ...........................p.17

Restrictions and Prohibitions ....................................p.19Q & A ........................................................................p.20

Helpful Resources• Video Tutorials• Reference Pamphlet• Excel Version• FAQs• Gift and Travel Fact

Sheet for State and LocalOfficials

FPPC Form 700 (2018/2019)FPPC Advice Email: [email protected]

FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.govPage - 2

Quick Start GuideDetailed instructions begin on page 3.

WHEN IS THE FORM DUE?

• March1–ElectedStateOfficers,JudgesandCourtCommissioners,StateBoardandCommission members listed in Government Code Section 87200

• April1–Mostotherfilers

WHERE DO I FILE?MostpeoplefiletheForm700withtheiragency.Ifyou’renotsurewheretofileyourForm700,contactyourfilingofficerorthepersonwhoaskedyoutocompleteit.

ITEMS TO NOTE!• TheForm700isapublicdocument.

• Onlyfilersservinginactivemilitarydutymayreceiveanextensiononthefilingdeadline.

• Youmustalsoreportinterestsheldbyyourspouseorregistereddomesticpartner.

• Youragency’sconflictofinterestcodewillhelpyoutocompletetheForm700.Youareencouragedtoget yourconflictofinterestcodefromthepersonwhoaskedyoutocompletetheForm700.

NOTHING TO REPORT?Markthe“Noreportableinterests”boxonPart4oftheCoverPage,andsubmitonlythesignedCoverPage.Be sure to review each schedule carefully!

ScheduleCommon

Reportable InterestsCommon

Non-Reportable Interests

A-1: Investments

Stocks,includingthoseheldinanIRAor 401K. Each stock must be listed.

Insurancepolicies,governmentbonds,diversifiedmutualfunds,fundssimilartodiversifiedmutualfunds.

A-2:Business Entitites/Trusts

Businessentities,soleproprietorships,partnerships,LLCs,corporationsandtrusts.(e.g.Form1099filers).

Savingsandcheckingaccounts,andannuities.

B: Real Property

Rentalpropertyinfiler’sjurisdiction,orwithin two miles of the boundaries of thejurisdiction.

A residence used exclusively as a personal residence(suchasahomeorvacationproperty).

C:Income

Non-governmentalsalaries.Notethatfilersarerequiredtoreportonlyhalfoftheirspouse’sorpartner’ssalary.

Governmentalsalary(fromschooldistrict,forexample).

D:Gifts

Giftsfrombusinesses,vendors,orothercontractors(meals,tickets,etc.).

Gifts from family members.

E:Travel Payments

Travel payments from third parties (not youremployer).

Travel paid by your government agency.

Note:Likereportableinterests,non-reportableinterestsmayalsocreateconflictsofinterestandcouldbegroundsfordisqualificationfromcertaindecisions.

QUESTIONS? • [email protected]• (866)275-3772Mon-Thurs,9-11:30a.m.

E-FILING ISSUES?• Ifusingyouragency’ssystem,pleasecontacttechnicalsupportatyouragency.• IfusingFPPC’se-filingsystem,[email protected].



What’s NewGift Limit IncreaseThe gift limit increased to TBD for calendar years 2019 and 2020. The gift limit during in 2018 was $460 $470.

Who must file:• Electedandappointedofficialsandcandidateslistedin

Government Code Section 87200• Employees,appointedofficials,andconsultantsfiling

pursuanttoaconflictofinterestcode(“codefilers”). Obtain your disclosure categories, which describe the interests you must report, from your agency; they are not part of the Form 700

• Candidatesrunningforlocalelectiveofficesthataredesignatedinaconflictofinterestcode(e.g.,countysheriffs,cityclerks,schoolboardtrustees,andwaterboardmembers)

Exception: Candidates for a county central committeearenotrequiredtofiletheForm700.•Membersofnewlycreatedboardsandcommissionsnotyetcoveredunderaconflictofinterest code

•Employees in newly created positions of existing agencies

SeeReferencePamphlet,page3,atwww.fppc.ca.gov.

Where to file:87200 Filers

Stateoffices YouragencyJudicialoffices The clerk of your courtRetiredJudges Directly with FPPCCountyoffices YourcountyfilingofficialCityoffices YourcityclerkMulti-Countyoffices Youragency

Code Filers — State and Local Officials, Employees, and Consultants Designated in a Conflict of Interest Code:Filewithyouragency,board,orcommissionunlessotherwisespecifiedinyouragency’scode(e.g.,LegislativestafffilesdirectlywithFPPC).Inmostcases,theagency,board,orcommissionwillretainthestatements.

Members of Boards and Commissions of Newly Created Agencies: File with your newly created agency orwithyouragency’scodereviewingbody.

Employees in Newly Created Positions of Existing Agencies:Filewithyouragencyorwithyouragency’scodereviewingbody.SeeReferencePamphlet,page3.Candidates:Filewithyourlocalelectionsoffice.

How to file:The Form 700 is available at www.fppc.ca.gov. Form 700 schedules are also available in Excel format. All statementsmusthaveanoriginal“wet”signatureorbedulyauthorizedbyyourfilingofficertofileelectronically

under Government Code Section 87500.2. Instructions,examples,FAQs,andareferencepamphletareavailabletohelpansweryourquestions.

When to file:Annual Statements

March 1, 2019 - ElectedStateOfficers - JudgesandCourtCommissioners - State Board and StateCommissionMemberslisted

in Government Code Section 87200 April 1, 2019

- MostotherfilersIndividualsfilingunderconflictofinterestcodesincityandcountyjurisdictionsshouldverifytheannualfilingdatewiththeirlocalfilingofficers.

Statementspostmarkedbythefilingdeadlineareconsideredfiledontime.

Statements of 30 pages or less may be faxed by the deadline as long as the originally signed paper version is sentbyfirstclassmailtothefilingofficialwithin24hours.

Assuming Office and Leaving Office StatementsMostfilersfilewithin30daysofassumingorleavingofficeor within 30 days of the effective date of a newly adopted oramendedconflictofinterestcode.

Exception:

IfyouassumedofficebetweenOctober1, 2018,and December31, 2018,andfiledanassumingofficestatement,youarenotrequiredtofileanannualstatementuntilMarch2,2020,orApril1,2020,whichever is applicable. Inthatcase,the annual statement will cover the day after you assumed officethroughDecember31,2019. See Reference Pamphlet,pages6and7,foradditionalexceptions.

Candidate StatementsFilenolaterthanthefinalfilingdateforthedeclarationof candidacy or nomination documents. A candidate statementisnotrequiredifyoufiledany an assuming officeorannualstatement(otherthanaleavingofficestatement)forthesamejurisdictionwithin60daysbeforefilingadeclarationofcandidacyorothernominationdocuments.

Late Statements

Thereisnoprovisionforfilingdeadlineextensionsunlessthefilerisservinginactivemilitaryduty.(Seep.20forinformationonpenaltiesandfines.)

AmendmentsStatementsmaybeamendedatanytime.Youareonlyrequiredtoamendtheschedulethatneedstoberevised.Itisnotnecessarytoamendtheentirefiledform.Obtainamendment schedules at www.fppc.ca.gov.



Types of Statements

Assuming Office Statement: Ifyouareanewlyappointedofficialorarenewlyemployedinapositiondesignated,orthatwillbedesignated,inastateorlocalagency’sconflictofinterestcode,yourassumingofficedateisthedateyouweresworninorotherwiseauthorizedtoserveintheposition.Ifyouareanewlyelectedofficial,yourassumingofficedateisthedateyou were sworn in.

• Investments,interestsinrealproperty,andbusinesspositionsheldonthedateyouassumedtheofficeorpositionmustbereported.Inaddition,income(includingloans,gifts,andtravelpayments)receivedduring the 12 months prior to the date you assumed the officeorpositionisreportable.

ForpositionssubjecttoconfirmationbytheStateSenateortheCommissiononJudicialPerformance,yourassumingofficedateisthedateyouwereappointedornominated to the position.

Example:MariaLopezwasnominatedbytheGovernortoserveonastateagencyboardthatissubjecttostateSenateconfirmation.TheassumingofficedateisthedateMaria’snominationissubmittedtotheSenate.Mariamustreportinvestments,interestsinrealproperty,andbusinesspositionssheholdsonthatdate,andincome(includingloans,gifts,andtravelpayments)receivedduringthe12months prior to that date.

Ifyourofficeorpositionhasbeenaddedtoanewlyadoptedornewlyamendedconflictofinterestcode,usetheeffectivedateofthecodeoramendment,whicheverisapplicable.

• Investments,interestsinrealproperty,andbusinesspositions held on the effective date of the code or amendmentmustbereported.Inaddition,income(includingloans,gifts,andtravelpayments)receivedduring the 12 months prior to the effective date of the code or amendment is reportable.

Annual Statement: Generally,theperiodcoveredisJanuary1,2018,throughDecember31,2018.IftheperiodcoveredbythestatementisdifferentthanJanuary1,2018,throughDecember31,2018,(forexample,youassumedofficebetweenOctober1,2017,andDecember31,2017 or you arecombiningstatements),youmustspecifytheperiodcovered.

• Investments,interestsinrealproperty,businesspositionsheld,andincome(includingloans,gifts,andtravelpayments)receivedduringtheperiodcoveredby the statement must be reported. Do not change the preprinteddatesonSchedulesA-1,A-2,andBunlessyouarerequiredtoreporttheacquisitionordispositionof an interest that did not occur in 2018.

• Ifyourdisclosurecategorychangesduringareportingperiod,discloseundertheoldcategoryuntiltheeffectivedateoftheconflictofinterestcodeamendmentand disclose under the new disclosure category through the end of the reporting period.

Leaving Office Statement: Generally,theperiodcoveredisJanuary1,2018, through the date you stopped performing the duties of yourposition.IftheperiodcovereddiffersfromJanuary1,2018,throughthedateyoustoppedperformingthedutiesofyourposition(forexample,youassumedofficebetween October1,2017,andDecember31,2017,or youarecombiningstatements),theperiodcoveredmustbespecified.Thereportingperiodcancoverpartsoftwocalendar years.

• Investments,interestsinrealproperty,businesspositionsheld,andincome(includingloans,gifts,andtravelpayments)receivedduringtheperiodcoveredby the statement must be reported. Do not change the preprinteddatesonSchedulesA-1,A-2,andBunlessyouarerequiredtoreporttheacquisitionordispositionof an interest that did not occur in 2018.

Candidate Statement: Ifyouarefilingastatementinconnectionwithyourcandidacyforstateorlocaloffice,investments,interestsinrealproperty,andbusinesspositionsheldonthedateoffilingyourdeclarationofcandidacymustbereported.Inaddition,income(includingloans,gifts,andtravelpayments)receivedduringthe12monthsprior to the date offilingyourdeclarationofcandidacyisreportable.DonotchangethepreprinteddatesonSchedulesA-1,A-2,andB.

Candidates running for local elective offices(e.g.,county sheriffs,cityclerks,schoolboardtrustees,orwaterdistrictboardmembers)mustfilecandidatestatements,asrequiredbytheconflictofinterestcodefortheelectedposition. The code may be obtained from the agency of the elected position.

Amendments: Ifyoudiscovererrorsoromissionsonanystatement,fileanamendmentassoonaspossible.Youareonlyrequiredto amend the schedule that needs to be revised; it is not necessarytorefiletheentireform.Obtainamendmentschedules from the FPPC website at www.fppc.ca.gov.

Notethatonceyoufileyourstatement,youmaynotwithdraw it. All changes must be noted on amendment schedules.



Leaving Office: Date Left / / (Check one)

The period covered is January 1, 2018, through the date of leaving office.

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

Annual: The period covered is January 1, 2018, through December 31, 2018.

The period covered is / / , through December 31, 2018.

Statement of economic intereStS

cover PageA PubliC DoCument

I have used all reasonable diligence in preparing this statement. I have reviewed this statement and to the best of my knowledge the information contained herein and in any attached schedules is true and complete. I acknowledge this is a public document.

I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Date Signed (month, day, year)

3. Type of Statement (Check at least one box)

State Judge or Court Commissioner (Statewide Jurisdiction)

Multi-County County of

City of Other

2. Jurisdiction of Office (Check at least one box)

Candidate: Date of Election and office sought, if different than Part 1:

Assuming Office: Date assumed / /

Date InitialFilingReceivedOfficial Use Only

Please type or print in ink.

700FAIR POLITICAL PRACTICES COMMISSION

CALIFORNIA FORM

Agency Name (Do not use acronyms)

Division, board, Department, District, if applicable Your Position

1. Office, Agency, or Court

name of filer (laSt) (firSt) (middle)

MaIlIng aDDreSS Street CItY State ZIP CoDe

( )DaYtIMe telePhone nuMber E-MAiL ADDrESS

(business or Agency Address Recommended - Public Document)

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

5. Verification

► If filing for multiple positions, list below or on an attachment. (Do not use acronyms)

agency: Position:

-or-

-or-

None - no reportable interests on any schedule

4. Schedule Summary (must complete)Schedules attached

Schedule A-1 - investments – schedule attached Schedule A-2 - investments – schedule attached Schedule B - Real Property – schedule attached

► Total number of pages including this cover page:

-or-

Schedule C - income, loans, & business Positions – schedule attached Schedule D - Income – Gifts – schedule attached Schedule E - Income – Gifts – Travel Payments – schedule attached



• Ifyouragencyisamulti-countyoffice,listeachcountyinwhichyouragencyhasjurisdiction.

• Ifyouragencyisnotastateoffice,court,countyoffice,cityoffice,ormulti-countyoffice(e.g.,schooldistricts,specialdistrictsandJPAs),checkthe“other”boxandenterthecountyorcityinwhichtheagencyhasjurisdiction.

Example: ThisfilerisamemberofawaterdistrictboardwithjurisdictioninportionsofYubaandSutterCounties.

Part 3. Type of StatementCheck at least one box. The period covered by a statement isdeterminedbythetypeofstatementyouarefiling.Ifyouare completing a 2018 annualstatement,do not change the pre-printeddatestoreflect2019.Yourannualstatementisused for reporting the previous year’s economic interests. EconomicinterestsforyourannualfilingcoveringJanuary1,2019,throughDecember31,2019,willbedisclosedonyourstatementfiledin2020. SeeReferencePamphlet,page4.

Combining Statements: Certain types of statements may be combined.Forexample,ifyouleaveofficeafterJanuary1,butbeforethedeadlineforfilingyourannualstatement,youmaycombineyourannualandleavingofficestatements.Filebytheearliestdeadline.ConsultyourfilingofficerortheFPPC.

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 onanyschedule,checkthe“Noreportableinterests”box. Please do not attach any blank schedules.

Part 5. VerificationCompletetheverificationbysigningthestatementandentering the date signed. All statements must have an original “wet”signatureorbedulyauthorizedbyyourfilingofficertofileelectronicallyunderGovernmentCodeSection87500.2.Instructions,examples,FAQs,andareferencepamphletareavailabletohelpansweryourquestions. When you sign your statement, you are stating, under penalty of perjury, that it is true and correct.Onlythefilerhasauthoritytosignthestatement.Anunsignedstatementisnotconsideredfiledandyoumaybesubjecttolatefilingpenalties.

InstructionsCover Page

Enteryourname,mailingaddress,anddaytimetelephonenumber in the spaces provided. Because the Form 700 is a public document, you may list your business/office address instead of your home address.

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

or court. Consultants must enter the public agency name ratherthantheirprivatefirm’sname.(Examples:StateAssembly;BoardofSupervisors;OfficeoftheMayor;DepartmentofFinance;HopeCountySuperiorCourt)

• Indicatethenameofyourdivision,board,ordistrict,ifapplicable.(Examples:DivisionofWasteManagement;BoardofAccountancy;District45).Do not use acronyms.

• Enter your position title. (Examples: Director; Chief Counsel;CityCouncilMember;StaffServicesAnalyst)

• Ifyouholdmultiplepositions(i.e.,acitycouncilmemberwhoalsoisamemberofacountyboardorcommission),youmayberequiredtofilestatementswitheachagency.Tosimplifyyourfilingobligations,youmaycompleteanexpanded statement.

• Todothis,enterthenameoftheotheragency(ies)withwhichyouarerequiredtofileandyourpositiontitle(s)inthe space provided. Do not use acronyms. Attach an additional sheet if necessary. Complete one statement coveringthedisclosurerequirementsforallpositions.Eachcopymustcontainanoriginalsignature.Therefore,beforesigningthestatement,makeacopyforeachagency.Signeachcopywithanoriginalsignatureandfilewith each agency.

Ifyouassumeorleaveapositionafterafilingdeadline,youmustcompleteaseparatestatement.Forexample,acity council member who assumes a position with a county specialdistrictaftertheApril1annualfilingdeadlinemustfileaseparateassumingofficestatement.Insubsequentyears,thecitycouncilmembermayexpandhisorherannualfilingtoinclude both positions.

Example:Scott Baker Brian Bourne is a city council member for the City of Lincoln and a board member for the Camp Far West IrrigationDistrict–amulti-countyagencythatcoversPlacerandYubacounties.Scott Brian will complete one Form 700usingfulldisclosure(asrequiredforthecityposition)andcoveringinterestsinbothPlacerandYubacounties(asrequiredforthemulti-countyposition)andlistbothpositionsontheCoverPage.Beforesigningthestatement,Scott Brian will make a copy and sign both statements. One statement willbefiledwithCityofLincolnandtheotherwillbefiledwithCampFarWestIrrigationDistrict.Bothwillcontainanoriginalsignature.

Part 2. Jurisdiction of Office• Checktheboxindicatingthejurisdictionofyouragency

and,ifapplicable,identifythejurisdiction.Judges,judicialcandidates,andcourtcommissionershavestatewidejurisdiction.AllotherfilersshouldreviewtheReferencePamphlet,page13,todeterminetheirjurisdiction.

State Judge or Court Commissioner (Statewide Jurisdiction)

Multi-County County of

City of Other

2. Jurisdiction of Office (Check at least one box)

Agency Name (Do not use acronyms)

Division, board, Department, District, if applicable Your Position

1. Office, Agency, or Court

► If filing for multiple positions, list below or on an attachment. (Do not use acronyms)

agency: Position:

x Yuba & Sutter Counties

Board MemberN/A

N/A

Feather River Irrigation District



Which Schedule Do I Use?

Common Reportable InterestsSchedule A-1 Stocks,includingthoseheldinanIRAora401K

Schedule A-2 Businessentities(includingcertainindependentcontracting),soleproprietorships,partnerships,LLCs,corporations,andtrusts

Schedule B Rentalpropertyinthejurisdiction,orwithintwomilesoftheboundariesofthejurisdiction

Schedule C Non-governmentalsalariesofpublicofficialandspouse/registereddomesticpartner

Schedule D Giftsfrombusinesses(suchasticketstosportingorentertainmentevents)

Schedule E Travel payments from third parties (not your employer)

Common Non-Reportable InterestsSchedule A-1 Insurancepolicies,governmentbonds,diversifiedmutualfunds,certainfundssimilar

todiversifiedmutualfunds(suchasexchangetradedfunds)andinvestmentsheldincertainretirementaccounts.SeeReferencePamphlet,page13,fordetailedinformation.(Regulation18237)

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 Governmentalsalary(suchasaschooldistrict)

Schedule D Gifts from family members

Schedule E Travel paid by your government agency

Remember:

9 Markthe“Noreportableinterests”boxonPart4oftheScheduleSummaryontheCoverPageifyoudetermineyouhavenothingtodiscloseandfiletheCoverPageonly.Makesureyoucarefully read all instructions to ensure proper reporting.

9 The Form 700 is a public document.

9 Mostindividualsmustconsulttheiragency’sconflictofinterestcodeforreportableinterests.

9 MostindividualsfiletheForm700withtheiragencies.



IFAPPLICABLE,LISTDATE:

/ / / / ACQuIRED DISPOSED











18 18 18 18

1818

181818

Name

►NAMEOFBuSINESSENTITY

GENERALDESCRIPTIONOFTHISBuSINESS











Comments:

SCHEDULE A-1Investments

Stocks,Bonds,andOther Interests(Ownership Interest isLessThan10%)

Investments must be itemized.Do not attach brokerage or financial statements.


CALIFORNIA FORM

FAIRMARKETvALuE $2,000 -$10,000 $10,001 -$100,000 $100,001 -$1,000,000 Over$1,000,000






18

NATuREOF INvESTMENT Stock Other

(Describe) Partnership IncomeReceived of $0 - $499

IncomeReceivedof$500orMore (Report on Schedule C)


(Describe) Partnership IncomeReceivedof$0 -$499














1818



Instructions – Schedules A-1 and A-2Investments

“Investment”meansafinancialinterestinanybusinessentity (including a consulting business or other independent contractingbusiness)thatislocatedin,doingbusinessin,planningtodobusinessin,orthathasdonebusinessduringtheprevioustwoyearsinyouragency’sjurisdictioninwhichyou,yourspouseorregistereddomesticpartner,oryourdependentchildrenhadadirect,indirect,orbeneficialinteresttotaling$2,000ormoreatanytimeduringthereportingperiod.(SeeReferencePamphlet,page13.)

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

in margin or brokerage accounts and managed investment funds(SeeReferencePamphlet,page13.)

• Sole proprietorships• Yourownbusinessoryourspouse’sorregistered

domesticpartner’sbusiness(SeeReferencePamphlet,page8,forthedefinitionof“businessentity.”)

• Yourspouse’sorregistereddomesticpartner’sinvestments even if they are legally separate property

• Partnerships(e.g.,alawfirmorfamilyfarm)• Investmentsinreportablebusinessentitiesheldina

retirementaccount(SeeReferencePamphlet,page15.)• Ifyou,yourspouseorregistereddomesticpartner,

anddependentchildrentogetherhada10%orgreaterownership interest in a business entity or trust (including alivingtrust),youmustdiscloseinvestmentsheldbythebusinessentityortrust.(SeeReferencePamphlet,page15,formoreinformationondisclosingtrusts.)

• Business trusts

You are not required to disclose:• Governmentbonds,diversifiedmutualfunds,certainfunds

similartodiversifiedmutualfunds(suchasexchangetradedfunds)andinvestmentsheldincertainretirementaccounts.(SeeReferencePamphlet,page13,fordetailedinformation.)(Regulation18237)

• Bankaccounts,savingsaccounts,moneymarketaccountsandcertificatesofdeposits

• Insurancepolicies• Annuities• Commodities• Shares in a credit union• Governmentbonds(includingmunicipalbonds)• Retirement accounts invested in non-reportable interests

(e.g.,insurancepolicies,mutualfunds,orgovernmentbonds)(SeeReferencePamphlet,page15.)

• Governmentdefined-benefitpensionplans(suchasCalPERSandCalSTRSplans)

• Certain interests held in a blind trust (See Reference Pamphlet,page16.)

Use Schedule A-1toreportownershipoflessthan10%(e.g.,stock).ScheduleC(Income)mayalsoberequiredifthe investment is not a stock or corporate bond. (See second examplebelow.)

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

To Complete Schedule A-1:Donotattachbrokerageorfinancialstatements.

• Disclose the name of the business entity.• Provide a general description of the business activity of

theentity(e.g.,pharmaceuticals,computers,automobilemanufacturing,orcommunications).

• Check the box indicating the highest fair market value of yourinvestmentduringthereportingperiod.Ifyouarefilingacandidateoranassumingofficestatement,indicatethefairmarketvalueonthefilingdateorthedateyoutookoffice,respectively.

• Identifythenatureofyourinvestment(e.g.,stocks,warrants,options,orbonds).

• Anacquiredordisposedofdateisonlyrequiredifyouinitiallyacquiredorentirelydisposedoftheinvestmentinterest during the reporting period. The date of a stock dividendreinvestmentorpartialdisposalisnotrequired.Generally,thesedateswillnotapplyifyouarefilingacandidateoranassumingofficestatement.

Examples:JohnSmith Frank Byrd holds a state agency position. His conflictofinterestcoderequiresfulldisclosureofinvestments.John Frankmustdisclosehisstockholdingsof$2,000ormore in any company that is located in or does business inCalifornia,aswellasthosestocksheldbyhisspouseorregistered domestic partner and dependent children.

SusanJones Alice Lance is a city council member. She has a4%interest,worth$5,000,inalimitedpartnershiplocatedin the city. Susan Alice must disclose the partnership on Schedule A-1 and income of $500 or more received from the partnership on Schedule C.

Reminders• Doyouknowyouragency’sjurisdiction?• Did you hold investments at any time during the period

covered by this statement?• Codefilers–yourdisclosurecategoriesmayonlyrequiredisclosureofspecificinvestments.











18 18

18 1818 18

SCHEDULE A-2Investments, Income, and Assets

of Business Entities/Trusts(Ownership Interest is10%orGreater)

Comments:

Name

Address (Business Address Acceptable)

Name

Address (Business Address Acceptable)

FAIRMARKETvALuE $0-$1,999 $2,000 -$10,000 $10,001 -$100,000 $100,001 -$1,000,000 Over$1,000,000

FAIRMARKETvALuE $0-$1,999 $2,000 -$10,000 $10,001 -$100,000 $100,001 -$1,000,000 Over$1,000,000



INvESTMENT REALPROPERTY

NameofBusinessEntity, if Investment,or Assessor’sParcelNumberorStreetAddressofRealProperty

Description of Business Activity orCity or Other Precise Location of Real Property

INvESTMENT REALPROPERTY

NameofBusinessEntity, if Investment,or Assessor’sParcelNumberorStreetAddressofRealProperty

Description of Business Activity orCity or Other Precise Location of Real Property

►4. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD OR LEASED BY THE BUSINESS ENTITY OR TRUST

►4. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD OR LEASED BY THE BUSINESS ENTITY OR TRUST

Check one Trust,go to 2 BusinessEntity,complete the box, then go to 2

Check one Trust,go to 2 BusinessEntity,complete the box, then go to 2

►2. IDENTIFY THE GROSS INCOME RECEIVED (INCLUDE YOUR PRO RATA SHARE OF THE GROSS INCOME TO THE ENTITY/TRUST)

►2. IDENTIFY THE GROSS INCOME RECEIVED (INCLUDE YOUR PRO RATA SHARE OF THE GROSS INCOME TO THE ENTITY/TRUST)

Name

700

Check one box: Check one box:

YOuRBuSINESSPOSITION YOuRBuSINESSPOSITION



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

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

$10,001 -$100,000 OvER$100,000

$10,001 -$100,000 OvER$100,000

FAIR POLITICAL PRACTICES COMMISSION

CALIFORNIA FORM

►1. BUSINESS ENTITY OR TRUST ►1. BUSINESS ENTITY OR TRUST

NATuREOF INTEREST Property Ownership/Deed of Trust Stock Partnership

Leasehold Other

Check box if additional schedules reporting investments or real property are attached

Yrs. remaining

NATuREOF INTEREST Property Ownership/Deed of Trust Stock Partnership

Leasehold Other

Check box if additional schedules reporting investments or real property are attached

Yrs. remaining

18 18

Other

NATuREOF INvESTMENT Partnership Sole Proprietorship

Other

NATuREOF INvESTMENT Partnership Sole Proprietorship

None Noneor or Names listedbelow Names listedbelow

►3. LIST THE NAME OF EACH REPORTABLE SINGLE SOURCE OF INCOME OF $10,000 OR MORE (Attach a separate sheet if necessary.)

►3. LIST THE NAME OF EACH REPORTABLE SINGLE SOURCE OF INCOME OF $10,000 OR MORE (Attach a separate sheet if necessary.)



Instructions – Schedule A-2Investments, 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 contractingbusiness)ortrust(includingalivingtrust)inwhichyou,yourspouseorregistereddomesticpartner,andyourdependentchildren,togetherorseparately,hada10%orgreaterinterest,totaling$2,000ormore,duringthereportingperiodandwhichislocatedin,doingbusinessin,planningtodobusinessin,orwhichhasdonebusinessduringtheprevioustwoyearsinyouragency’sjurisdiction.(SeeReferencePamphlet,page13.)Atrustlocatedoutsideyouragency’sjurisdictionisreportableifitholdsassetsthatarelocatedinordoingbusinessinthejurisdiction.Donotreportatrustthatcontainsnon-reportableinterests.Forexample,a trust containing only your personal residence not used in wholeorinpartasabusiness,yoursavingsaccount,andsomemunicipalbonds,isnotreportable.

Also report on Schedule A-2 investments and real property held by that entity or trust if your pro rata share of the investmentorrealpropertyinterestwas$2,000ormoreduring the reporting period.

To Complete Schedule A-2:Part 1. Disclose the name and address of the business entity ortrust.Ifyouarereportinganinterestinabusinessentity,check“BusinessEntity”andcompletetheboxasfollows:

• 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.

• Ifyouinitiallyacquiredorentirelydisposedofthisinterestduringthereportingperiod,enterthedateacquiredordisposed.

• Identifythenatureofyourinvestment.• Disclosethejobtitleorbusinesspositionyouheldwiththe

entity,ifany(i.e.,ifyouwereadirector,officer,partner,trustee,employee,orheldanypositionofmanagement).Abusiness 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 fromthebusinessentityortrust,aswellasyourcommunitypropertyinterestinyourspouse’sorregistereddomesticpartner’sshare.Gross income is the total amount of income beforedeductingexpenses,losses,ortaxes.

Part 3. Disclose the name of each source of income that is locatedin,doingbusinessin,planningtodobusinessin,orthat has done business during the previous two years in your agency’sjurisdiction,asfollows:

• Disclose each source of income and outstanding loan to the business entity or trustidentifiedinPart1ifyour pro rata share of the gross income (including your communitypropertyinterestinyourspouse’sorregistereddomesticpartner’sshare)tothebusinessentityortrustfromthatsourcewas$10,000ormoreduringthereporting

period.(SeeReferencePamphlet,page11,forexamples.)Incomefromgovernmentalsourcesmaybereportableif not considered salary. See Regulation 18232. Loans fromcommerciallendinginstitutionsmadeinthelender’sregular course of business on terms available to members ofthepublicwithoutregardtoyourofficialstatusarenotreportable.

• Disclose each individual or entity that was a source ofcommissionincomeof$10,000ormoreduringthereportingperiodthroughthebusinessentityidentifiedinPart1.(SeeReferencePamphlet,page8,foranexplanationofcommissionincome.)

Youmayberequiredtodisclosesourcesofincomelocatedoutsideyourjurisdiction.Forexample,youmayhaveaclientwhoresidesoutsideyourjurisdictionwhodoesbusinessonaregularbasiswithyou.Suchaclient,ifareportablesourceof$10,000ormore,mustbedisclosed.

Mark“None”ifyoudonothaveanyreportable$10,000sources of income to disclose. Using Phrases such as “variousclients”or“notdisclosingsourcespursuanttoattorney-clientprivilege” maytriggerarequestforanamendment to your statementisnotadequatedisclosure. (See Reference Pamphlet,page14,for details about requestinginformationonprocedurestorequest an exemption fromdisclosingprivilegedinformation.)

Part 4. Report any investments or interests in real property held or leased by the entity or trustidentifiedinPart1ifyourproratashareoftheinterestheldwas$2,000ormoreduringthe reporting period. Attach additional schedules or use FPPC’sForm700Excelspreadsheetifneeded.

• Check the applicable box identifying the interest held as real property or an investment.

• Ifinvestment,providethenameanddescriptionofthebusiness entity.

• Ifrealproperty,reportthepreciselocation(e.g.,anassessor’sparcelnumberoraddress).

• 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 areutilizingyourresidenceforbusinesspurposes.)

• Identifythenatureofyourinterest.• Enterthedateacquiredordisposedonlyifyouinitially

acquiredorentirelydisposedofyourinterestintheproperty or investment during the reporting period.



NAMEOFLENDER*

ADDRESS (Business Address Acceptable)

BuSINESSACTIvITY, IFANY,OFLENDER





18 1818 18

SCHEDULE BInterests in Real Property

(IncludingRental Income)

Name

►ASSESSOR’SPARCELNuMBERORSTREET ADDRESS

►ASSESSOR’SPARCELNuMBERORSTREET ADDRESS

CITY CITY

INTERESTRATE TERM(Months/Years)

% None

SOuRCESOFRENTAL INCOME: Ifyouowna10%orgreaterinterest, list thenameofeach tenant that isasinglesourceofincomeof$10,000ormore.

SOuRCESOFRENTAL INCOME: Ifyouowna10%orgreaterinterest, list thenameofeach tenant that isasinglesourceofincomeof$10,000ormore.

NATuREOF INTEREST

Ownership/Deed of Trust Easement

Leasehold Yrs. remaining Other

NATuREOF INTEREST

Ownership/Deed of Trust Easement

Leasehold Yrs. remaining Other

Comments:



IFRENTALPROPERTY,GROSSINCOMERECEIvED

OvER$100,000

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

$10,001 -$100,000

IFRENTALPROPERTY,GROSSINCOMERECEIvED

OvER$100,000

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

$10,001 -$100,000

HIGHESTBALANCEDuRINGREPORTINGPERIOD

Guarantor, ifapplicable

OvER$100,000

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

$10,001 -$100,000


CALIFORNIA FORM

NAMEOFLENDER*




% None

Guarantor, ifapplicable


OvER$100,000

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

$10,001 -$100,000

* Youarenotrequiredtoreportloansfrom a commercial lending institutionsmadeinthelender’sregularcourseofbusinessontermsavailabletomembersofthepublicwithoutregardtoyourofficialstatus.Personalloansandloansreceivednotinalender’sregularcourseofbusinessmustbedisclosedasfollows:

None None



• Ifyoureceivedrentalincome,checktheboxindicatingthegross amount you received.

• Ifyouhada10%orgreaterinterestinrealpropertyandreceivedrentalincome,listthenameofthesource(s)ifyour pro rata share of the gross income from any single tenantwas$10,000ormoreduringthereportingperiod.Ifyoureceivedatotalof$10,000ormorefromtwoormoretenantsactinginconcert(inmostcases,thiswillapplytomarriedcouples),disclosethenameofeachtenant.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. - Describethelender’sbusinessactivity. - Disclose the interest rate and term of the loan. For variableinterestrateloans,disclosetheconditionsoftheloan(e.g.,Prime+2)ortheaverageinterestrate paid during the reporting period. The term of a loan is the total number of months or years given for repayment of the loan at the time the loan was established.

- Check the box indicating the highest balance of the loan during the reporting period.

- Identifyaguarantor,ifapplicable.

Ifyouhavemorethanonereportable loan on a single pieceofrealproperty,reporttheadditionalloan(s)onSchedule C.

Example: JoeNelson Allison Gande is a city planning commissioner. Duringthereportingperiod, Joe she received rental incomeof$12,000,fromasingle tenant who rented property Joe she owned in the city’sjurisdiction.IfJoe Allison hadreceived$6,000eachfromtwotenants,thetenants’nameswouldnotberequiredbecause no single tenant paidher$10,000ormore.Amarried couple would be is considered a single tenant.

Instructions – Schedule BInterests in Real Property

Reminders• IncomeandloansalreadyreportedonScheduleBarenotalsorequiredtobereportedonScheduleC.

• RealpropertyalreadyreportedonScheduleA-2,Part4isnotalsorequiredtobereportedonScheduleB.

•Codefilers– doyourdisclosurecategoriesrequiredisclosure of real property?

Reportinterestsinrealpropertylocatedinyouragency’sjurisdictioninwhichyou,yourspouseorregistereddomesticpartner,oryourdependentchildrenhadadirect,indirect,orbeneficialinteresttotaling$2,000ormoreanytimeduringthe reporting period. Real property is also considered to be “withinthejurisdiction”ofalocalgovernmentagencyiftheproperty or any part of it is located within two miles outside theboundariesofthejurisdictionorwithintwomilesofanyland owned or used by the local government agency. (See ReferencePamphlet,page13.)

Interests in real property include:• Anownershipinterest(includingabeneficialownership

interest)• Adeedoftrust,easement,oroptiontoacquireproperty• Aleaseholdinterest(SeeReferencePamphlet,page14.)• A mining lease• An interest in real property held in a retirement account

(SeeReferencePamphlet,page15.)• An interest in real property held by a business entity or

trustinwhichyou,yourspouseorregistereddomesticpartner,andyourdependentchildrentogetherhada10%orgreaterownershipinterest(ReportonScheduleA-2.)

• Yourspouse’sorregistereddomesticpartner’sinterestsinreal property that are legally held separately by him or her

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

exclusivelyasapersonalresidence(However,aresidencein which you rent out a room or for which you claim a businessdeductionmaybereportable.Ifreportable,report the fair market value of the portion claimed as a tax deduction.)Please note: A non-reportable residence can still be groundsforaconflictofinterestandmaybedisqualifying.

• Interestsinrealpropertyheldthroughablindtrust(SeeReferencePamphlet,page16,forexceptions.)

To Complete Schedule B:• Reportthepreciselocation(e.g.,anassessor’sparcel

numberoraddress)oftherealproperty.• Check the box indicating the fair market value of your

interest in the property (regardless of what you owe on the property).

• Enterthedateacquiredordisposedonlyifyouinitiallyacquiredorentirelydisposedofyourinterestintheproperty during the reporting period.

• Identifythenatureofyourinterest.Ifitisaleasehold,disclose the number of years remaining on the lease.

name of lender*

address (Business Address Acceptable)

business activity, if any, of lender

if applicable, list date:

/ / / / acquired disposed



18 1818 18

Schedule BInterests in Real Property

(including rental income)

name

► ASSESSOR’S PARCEL NUMBER OR street address


city city

interest rate term (months/years)

% none

sources of rental income: if you own a 10% or greater interest, list the name of each tenant that is a single source of income of $10,000 or more.


nature of interest

ownership/deed of trust easement

leasehold yrs. remaining other

nature of interest



comments:

fair market value $2,000 - $10,000 $10,001 - $100,000 $100,001 - $1,000,000 over $1,000,000


if rental property, gross income received

over $100,000

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

$10,001 - $100,000


over $100,000

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

$10,001 - $100,000

highest balance during reporting period

guarantor, if applicable

over $100,000

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

$10,001 - $100,000

FPPC Form 700 (2017/2018) Sch. BFPPC Advice Email: [email protected]

FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov

700FaIR PolItIcal PRactIceS commISSIon

calIFoRnIa FoRm

name of lender*




% none



over $100,000

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

$10,001 - $100,000

* You are not required to report loans from commercial lending institutions made in the lender’s regular course of business on terms available to members of the public without regard to your official status. Personal loans and loans received not in a lender’s regular course of business must be disclosed as follows:

none none

4600 24th Street

Sacramento

Henry Wells

Sophia Petroillo

2121 Blue Sky Parkway, Sacramento

Restaurant Owner

8 15 Years

name of lender*







18 1818 18

Schedule BInterests in Real Property

(including rental income)

name



city city


% none



nature of interest



nature of interest



comments:




over $100,000

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

$10,001 - $100,000


over $100,000

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

$10,001 - $100,000



over $100,000

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

$10,001 - $100,000

FPPC Form 700 (2017/2018) Sch. BFPPC Advice Email: [email protected]


700FaIR PolItIcal PRactIceS commISSIon

calIFoRnIa FoRm

name of lender*




% none



over $100,000

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

$10,001 - $100,000

* You are not required to report loans from commercial lending institutions made in the lender’s regular course of business on terms available to members of the public without regard to your official status. Personal loans and loans received not in a lender’s regular course of business must be disclosed as follows:

none none

4600 24th Street

Sacramento

Henry Wells

Sophia Petroillo

2121 Blue Sky Parkway, Sacramento

Restaurant Owner

8 15 Years



(Real property, car, boat, etc.) (Real property, car, boat, etc.)

SCHEDULE CIncome, Loans, & Business

Positions(Other thanGiftsandTravelPayments)

GROSSINCOMERECEIvED No Income - Business Position Only No Income - Business Position OnlyGROSSINCOMERECEIvED

Name

OvER$100,000 OvER$100,000 $500-$1,000 $500-$1,000 $1,001 -$10,000 $1,001 -$10,000 $10,001 -$100,000 $10,001 -$100,000


CALIFORNIA FORM

► 1. INCOME RECEIVED NAMEOFSOuRCEOF INCOME


BuSINESSACTIvITY, IFANY,OFSOuRCE

YOuRBuSINESSPOSITION

► 1. INCOME RECEIVED NAMEOFSOuRCEOF INCOME



YOuRBuSINESSPOSITION

NAMEOFLENDER*




% None


$500-$1,000

$1,001 -$10,000

$10,001 -$100,000

OvER$100,000

Comments:

► 2. LOANS RECEIVED OR OUTSTANDING DURING THE REPORTING PERIOD

* Youarenotrequiredtoreportloansfrom a commercial lending institutions,oranyindebtednesscreatedaspartofaretailinstallmentorcreditcardtransaction,madeinthelender’sregularcourseofbusinessontermsavailabletomembersofthepublicwithoutregardtoyourofficialstatus.Personalloansandloansreceivednotinalender’sregular course of business must be disclosed as follows:

SECuRITYFORLOAN

None Personal residence

Real Property

Guarantor

Other

Street address

City

(Describe)

CONSIDERATIONFORWHICHINCOMEWASRECEIvED Salary Spouse’sor registereddomesticpartner’s income

(Forself-employeduseScheduleA-2.)

Partnership (Less than10%ownership.For10%orgreateruse ScheduleA-2.)

Sale of

Other

CONSIDERATIONFORWHICHINCOMEWASRECEIvED Salary Spouse’sor registereddomesticpartner’s income

(Forself-employeduseScheduleA-2.)

Partnership (Less than10%ownership.For10%orgreateruse ScheduleA-2.)

Sale of

Other

(Describe) (Describe)

(Describe) (Describe)

Rental Income, list each source of $10,000 or more Rental Income, list each source of $10,000 or moreCommission or Commission or

Loan repayment Loan repayment



Instructions – Schedule CIncome, 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 isthetotalamountofincomebeforedeductingexpenses,losses,ortaxesandincludesloansotherthanloansfromacommerciallendinginstitution.(SeeReferencePamphlet,page11.)Youmustalsoreportthesourceofincometoyourspouse 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 islocatedin,doingbusinessin,planningtodobusinessin,or has done business during the previous two years in your agency’sjurisdiction.(SeeReferencePamphlet,page13,formoreinformationaboutdoingbusinessinthejurisdiction.)Reportable sources of income may be further limited by yourdisclosurecategorylocatedinyouragency’sconflictofinterest code.

Reporting Business Positions:Youmustreportyourjobtitlewitheachreportablebusinessentity 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,perdiem,andreimbursementforexpenses

including travel payments provided by your employer• Communitypropertyinterest(50%)inyourspouse’s

orregistereddomesticpartner’sincome-report the employer’s name and all other required information

• Incomefrominvestmentinterests,suchaspartnerships,reported on Schedule A-1

• CommissionincomenotrequiredtobereportedonScheduleA-2(SeeReferencePamphlet,page8.)

• Grossincomefromanysale,includingthesaleofahouseorcar(Reportyourproratashareofthetotalsaleprice.)

• RentalincomenotrequiredtobereportedonScheduleB• Prizes or awards not disclosed as gifts• Payments received on loans you made to others • Anhonorariumreceivedpriortobecomingapublicofficial

(SeeReferencePamphlet,page10,concerningyourabilitytoreceivefuturehonoraria.)

• Incentivecompensation(SeeReferencePamphlet,page12.)

You are not required to report:• Salary,reimbursementforexpensesorperdiem,or

socialsecurity,disability,orothersimilarbenefitpaymentsreceived by you or your spouse or registered domestic partnerfromafederal,state,orlocalgovernmentagency.

• Stock dividends and income from the sale of stock unless thesourcecanbeidentified.

• IncomefromaPERSretirementaccount.

(SeeReferencePamphlet,page11,formoreexceptionstoincomereporting.)

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.

• Identifytheconsiderationforwhichtheincomewasreceived.

• Forincomefromcommissionsales,checktheboxindicating the gross income received and list the name of eachsourceofcommissionincomeof$10,000ormore.SeeReferencePamphlet,page8.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 Schedule A-2.

• Disclosethejobtitleorbusinessposition,ifany,thatyouheldwiththebusinessentity,evenifyoudidnotreceiveincome 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.

- Forvariableinterestrateloans,disclosetheconditionsoftheloan(e.g.,Prime+2)ortheaverageinterestratepaid 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.

• Identifythesecurity,ifany,fortheloan.

Reminders• Codefilers–yourdisclosurecategoriesmaynotrequire

disclosure of all sources of income.• Ifyouoryourspouseorregistereddomesticpartnerare

self-employed,reportthebusinessentityonScheduleA-2.• DonotdiscloseonScheduleCincome,loans,orbusiness

positions already reported on Schedules A-2 or B.



SCHEDULE DIncome – Gifts

Comments:

Name


CALIFORNIA FORM

►NAMEOFSOuRCE (Not an Acronym)



DATE (mm/dd/yy) vALuE DESCRIPTIONOFGIFT(S)

/ / $

/ / $

/ / $





/ / $

/ / $

/ / $





/ / $

/ / $

/ / $





/ / $

/ / $

/ / $





/ / $

/ / $

/ / $





/ / $

/ / $

/ / $



Instructions – Schedule DIncome – Gifts

Reminders• Giftsfromasinglesourcearesubjecttoa$470 TBD

limit during 2018 in 2019.(SeeReferencePamphlet,page10.)

•Codefilers– you only need to report gifts from reportable sources.

Gift Tracking Mobile Application

•FPPC has created a gift tracking app for mobile devicesthathelpsfilerstrackgiftsandprovidesaquickand easy way to upload the information to the Form 700.visitFPPC’swebsitetodownloadtheapp.

A gift is anything of value for which you have not provided equalorgreaterconsiderationtothedonor.Agiftisreportableifitsfairmarketvalueis$50ormore.Inaddition,multiple gifts totaling $50 or more received during the reporting period from a single source must be reported.

Itistheacceptanceofagift,nottheultimateusetowhichitisput,thatimposesyourreportingobligation.Exceptasnotedbelow,youmustreportagiftevenifyouneveruseditorifyougave it away to another person.

Iftheexactamountofagiftisunknown,youmustmakeagoodfaithestimateoftheitem’sfairmarketvalue.Listingthevalueofagiftas“over$50”or“valueunknown”isnotadequatedisclosure.Inaddition,ifyoureceivedagiftthroughanintermediary,youmustdisclosethename,address,andbusiness activity of both the donor and the intermediary.Youmayindicateanintermediaryeitherinthe“source”fieldafterthenameorinthe“comments”sectionatthebottomof Schedule D.

Commonly reportable gifts include:• Tickets/passes to sporting or entertainment events• Tickets/passes to amusement parks• Parkingpassesnotusedforofficialagencybusiness• Food,beverages,andaccommodations,includingthose

provided in direct connection with your attendance at a convention,conference,meeting,socialevent,meal,orlikegathering

• Rebates/discounts not made in the regular course of businesstomembersofthepublicwithoutregardtoofficialstatus

• Weddinggifts(SeeReferencePamphlet,page16)• Anhonorariumreceivedpriortoassumingoffice(Youmay

reportanhonorariumasincomeonScheduleC,ratherthanasagiftonScheduleD,ifyouprovidedservicesofequalorgreatervaluethanthepaymentreceived.SeeReference Pamphlet,page10,regardingyourabilitytoreceivefuturehonoraria.)

• Transportationandlodging(SeeScheduleE.)• Forgiveness of a loan received by you

You are not required to disclose:• Giftsthatwerenotusedandthat,within30daysafter

receipt,werereturnedtothedonorordeliveredtoacharitable organization or government agency without being claimed by you as a charitable contribution for tax purposes

• Giftsfromyourspouseorregistereddomesticpartner,child,parent,grandparent,grandchild,brother,sister,andcertain other famly members (See Regulation 18942 for a completelist.).Theexceptiondoesnotapplyifthedonorwas acting as an agent or intermediary for a reportable source who was the true donor.

• Gifts of similar value exchanged between you and an individual,otherthanalobbyistregisteredtolobbyyourstateagency,onholidays,birthdays,orsimilaroccasions

• Gifts of informational material provided to assist you in the performanceofyourofficialduties(e.g.,books,pamphlets,reports,calendars,periodicals,oreducationalseminars)

• Amonetarybequestorinheritance(However,inheritedinvestments or real property may be reportable on other schedules.)

• Personalizedplaquesortrophieswithanindividualvalueofless than $250

• Campaign contributions• uptotwotickets,foryourownuse,toattendafundraiser

foracampaigncommitteeorcandidate,ortoafundraiserfor an organization exempt from taxation under Section 501(c)(3)oftheInternalRevenueCode.Theticketmustbe 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 apurposetoinfluenceyou.(SeeRegulation18943.)

• Freeadmission,food,andnominalitems(suchasapen,pencil,mousepad,notepadorsimilaritem)availabletoallattendees,attheeventatwhichtheofficialmakesaspeech(asdefinedinRegulation18950(b)(2)),solongasthe admission is provided by the person who organizes the event.

• Anyotherpaymentnotidentifiedabove,thatwouldotherwisemeetthedefinitionofgift,wherethepaymentismade by an individual who is not a lobbyist registered to lobbytheofficial’sstateagency,whereitisclearthatthegift was made because of an existing personal or business relationshipunrelatedtotheofficial’spositionandthereis no evidence whatsoever at the time the gift is made to suggestthedonorhadapurposetoinfluenceyou.

To Complete Schedule D:• Disclosethefullname(notanacronym),address,and,ifa

businessentity,thebusinessactivityofthesource.• Providethedate(month,day,andyear)ofreceipt,and

disclose the fair market value and description of the gift.



SCHEDULE EIncome – Gifts

Travel Payments, Advances,and Reimbursements

Name

Comments:


CALIFORNIA FORM

• Mark either the gift or income box.• Mark the “501(c)(3)” box for a travel payment that is related to a public purpose and that is

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.

• For gifts of travel, provide the travel destination.

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




CITYANDSTATE

501(c)(3)orDESCRIBEBuSINESSACTIvITY,IFANY,OFSOuRCE



CITYANDSTATE




CITYANDSTATE




CITYANDSTATE


►MuSTCHECKONE:

MadeaSpeech/Participated inaPanel

Other - Provide Description

Gift -or- Income

►IfGift,ProvideTravelDestination

►MuSTCHECKONE:



Gift -or- Income


►MuSTCHECKONE:



Gift -or- Income


►MuSTCHECKONE:



Gift -or- Income






Travel payments reportable on Schedule E include advances andreimbursementsfortravelandrelatedexpenses,including lodging and meals.

Giftsoftravelmaybesubjecttothegiftlimit.Inaddition,certaintravelpaymentsarereportablegifts,butarenotsubjecttothegiftlimit.Toavoidpossiblemisinterpretationor the perception that you have received a gift in excess of thegiftlimit,youmaywishtoprovideaspecificdescriptionofthe purpose of your travel. (See the FPPC fact sheet entitled “LimitationsandRestrictionsonGifts,Honoraria,Travel,andLoans” at www.fppc.ca.gov to read about travel for a public purposeundersection89506(a).)

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

governmentagencyforwhichyouprovidedservicesequalorgreaterinvaluethanthepaymentsreceived,suchasreimbursement for travel on agency business from your government agency employer.

• Apaymentfortravelfromanotherlocal,state,orfederalgovernment agency and related per diem expenses when thetravelisforeducation,trainingorotherinter-agencyprograms 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.

• Atravelpaymentthatwasreceivedfromanon-profitentityexemptfromtaxationunderInternalRevenueCodeSection501(c)(3)forwhichyouprovidedequalorgreaterconsideration,suchasreimbursementfortravelonbusinessfora501(c)(3)organizationforwhichyouareaboard member.Note: Certain travel payments may not be reportable if reported via e-mail on Form 801 by your agency.

To Complete Schedule E:• Disclosethefullname(notanacronym)andaddressofthe

source of the travel payment.• Identifythebusinessactivityifthesourceisabusiness

entity.• Checktheboxtoidentifythepaymentasagiftorincome,

reporttheamount,anddisclosethedate(s). - Travel payments are gifts if you did not provide servicesthatwereequaltoorgreaterinvaluethanthepaymentsreceived.Youmustdisclosegiftstotaling$50 or more from a single source during the period covered by the statement. Whenreportingtravelpaymentsthataregifts,youmustprovide a description of the gift,the date(s) received,and the travel destination.

- Travel payments are income if you provided services thatwereequaltoorgreaterinvaluethanthepaymentsreceived.Youmustdiscloseincometotaling

$500 or more from a single source during the period coveredbythestatement.Youhavetheburdenofproving the payments are income rather than gifts. Whenreportingtravelpaymentsasincome,youmustdescribe the services you provided in exchange for the payment.Youarenotrequiredtodisclosethedate(s)for travel payments that are income.

Example:City council member RickMaryClaire Chandler is the chairmanofa501(c)(6)tradeassociation,and the association pays for Rick her travel to attend its meetings. Because Rick MaryClaire is deemed tobeprovidingequalorgreater consideration for the travel payment by virtue of serving on the board,thispaymentmaybe reported as income. Payments for Rick MaryClaire to attend other events for which he she is not providing services are likely considered gifts. Notethatthesamepaymentfroma501(c)3wouldNOTbereportable.

Example:MayorKimtravelstoChinaonatriporganizedbyChinaSiliconvalleyBusinessDevelopment,aCalifornianon-profit,501(c)(6)organization.TheChengduMunicipalPeople’sGovernment pays for MayorKim’sairfareandtravelcosts,aswellashis meals and lodging duringthetrip.Thetrip’sagenda shows that the trip’spurposeistopromotejobcreationandeconomicactivity in China and in Siliconvalley,sothetripis reasonably related to a governmental purpose. Thus,MayorKimmustreportthegiftoftravel,butthegiftisexemptfromthegiftlimit.Inthiscase,thetravelpaymentsarenotsubjecttothegift limit because the source is a foreign government and because the travel is reasonably related to a governmental purpose.(Section89506(a)(2).)NotethatMayorKimcouldbedisqualifiedfromparticipatinginormakingdecisionsaboutTheChengduMunicipalPeople’sGovernmentfor12months.Also note that if China Silicon Valley Business Development (a501(c)(6)organization)paidforthetravelcostsratherthanthegovernmentalorganization,thepaymentswouldbesubjecttothegiftlimits.(SeetheFPPCfactsheet,LimitationsandRestrictionsonGifts,Honoraria,TravelandLoans,atwww.fppc.ca.gov.)

Instructions – Schedule ETravel Payments, Advances,

and Reimbursements

SChEDuLE EIncome – Gifts


Name

Comments:

FPPC Form 700 (2016/2017) Sch. EFPPC Advice Email: [email protected]


700FAIr POLITICAL PrACTICES COMMISSION

CALIFORNIA FORM

• 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.


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


►NAME OF SOURCE (Not an Acronym)


CITYANDSTATE




CITYANDSTATE




CITYANDSTATE




CITYANDSTATE


►MuSTCHECKONE:



Gift -or- Income

►If Gift, Provide Travel Destination

►MuSTCHECKONE:



Gift -or- Income


►MuSTCHECKONE:



Gift -or- Income


►MuSTCHECKONE:



Gift -or- Income




Health Services Trade Association

1230 K Street, Suite 610

Sacramento, CA

Association of Healthcare Workers

150.00

● Travel reimbursement forboard meeting.

Chengdu Municipal People's Government

2 Caoshi St, CaoShiJie, Qingyang Qu, Chengdu Shi,

Sichuan Sheng, China, 610000

09 04 09 08 3,874.38

● Travel reimbursement fortrip to China.

Sichuan Sheng, China

XX XX

Clear Page Print

SChEDuLE EIncome – Gifts


Name

Comments:

FPPC Form 700 (2016/2017) Sch. EFPPC Advice Email: [email protected]


700FAIr POLITICAL PrACTICES COMMISSION

CALIFORNIA FORM

• 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.






CITYANDSTATE




CITYANDSTATE




CITYANDSTATE




CITYANDSTATE


►MuSTCHECKONE:



Gift -or- Income


►MuSTCHECKONE:



Gift -or- Income


►MuSTCHECKONE:



Gift -or- Income


►MuSTCHECKONE:



Gift -or- Income




Health Services Trade Association

1230 K Street, Suite 610

Sacramento, CA

Association of Healthcare Workers

150.00

● Travel reimbursement forboard meeting.

Chengdu Municipal People's Government

2 Caoshi St, CaoShiJie, Qingyang Qu, Chengdu Shi,

Sichuan Sheng, China, 610000

09 04 09 08 3,874.38

● Travel reimbursement fortrip to China.

Sichuan Sheng, China

XX XX

Clear Page Print

http://www.fppc.ca.gov



Introduction Restrictions and Prohibitions

The Political Reform Act (Gov. Code Sections 81000-91014)requiresmoststateandlocalgovernmentofficialsand employees to publicly disclose their personal assets andincome.Theyalsomustdisqualifythemselvesfrom participating in decisions that may affect their personal economic interests. The Fair Political Practices Commission(FPPC)isthestateagencyresponsibleforissuingtheattachedStatementofEconomicInterests,Form700,andforinterpretingthelaw’sprovisions.

Gift ProhibitionGiftsreceivedbymoststateandlocalofficials,employees,andcandidatesaresubjecttoa limit. DuringIn2017 and 2018,thegiftlimitis was $470 from a single source during a calendar year. For yearsIn2019-2020,thegiftlimitincreased to TBD from a single source during a calendar year. Inaddition,stateofficials,statecandidates,andcertainstateemployeesaresubjecttoa$10limitpercalendarmonthongiftsfromlobbyistsandlobbyingfirmsregisteredwiththeSecretaryofState.SeeReferencePamphlet,page 10.

Stateandlocalofficialsandemployeesshouldcheckwiththeir agency to determine if other restrictions apply.

DisqualificationPublicofficialsare,undercertaincircumstances,requiredtodisqualifythemselvesfrommaking,participatingin,orattemptingtoinfluencegovernmentaldecisionsthatwill affect their economic interests. This may include intereststheyarenotrequiredtodisclose(i.e.e.g.,apersonalresidenceisoftennotreportable,butmaybedisqualifying).Forexample,apersonalresidenceisoftennotreportable,butmaybegroundsfordisqualification. Specificdisqualificationrequirementsapplyto87200filers(e.g.,citycouncilmembers,membersofboardsofsupervisors,planningcommissioners,etc.).Theseofficialsmust publicly identify the economic interest that creates a conflictofinterestandleavetheroombeforeadiscussionor vote takes place at a public meeting. For more information,consultGovernmentCodeSection87105,Regulation18707,andtheGuidetoRecognizingConflictsofInterestatwww.fppc.ca.gov.

Honorarium BanMoststateandlocalofficials,employees,andcandidatesare prohibited from accepting an honorarium for any speechgiven,articlepublished,orattendanceataconference,convention,meeting,orlikegathering.(SeeReferencePamphlet,page10.)

Loan RestrictionsCertainstateandlocalofficialsaresubjecttorestrictionsonloans.(SeeReferencePamphlet,page14.)

Post-Governmental EmploymentThere are restrictions on representing clients or employers before former agencies. The provisions apply to elected stateofficials,moststateemployees,localelectedofficials,countychiefadministrativeofficers,citymanagers,includingthechiefadministratorofacity,andgeneralmanagers or chief administrators of local special districts andJPAs.TheFPPCwebsitehasfactsheetsexplainingthe provisions.

Late FilingThefilingofficerwhoretainsoriginally-signedorelectronicallyfiledstatementsofeconomicinterestsmayimposeonanindividualafineforanystatementthatisfiledlate.Thefineis$10perdayuptoamaximumof$100.Latefilingpenaltiesmaybereducedorwaivedundercertaincircumstances.

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

For assistanceconcerningreporting,prohibitions,andrestrictions under the Act:

• [email protected].• CalltheFPPCtoll-freeat(866)275-3772.

Form 700 is a Public DocumentPublic Access Must Be Provided

StatementsofEconomicInterestsarepublicdocuments.Thefilingofficermustpermitanymember of the public to inspect and receive a copy of any statement.

• Statements must be available as soon as possible duringtheagency'sregularbusinesshours,butin any event not later than the second business day after the statement is received. Access to the Form700isnotsubjecttothePublicRecordsActprocedures.

• Noconditionsmaybeplacedonpersonsseekingaccess to the forms.

• Noinformationoridentificationmayberequiredfrom persons seeking access.

• Reproduction fees of no more than 10 cents per page may be charged.



Questions and Answers

GeneralQ. What is the reporting period for disclosing interests

onanassumingofficestatementoracandidatestatement?

A. Onanassumingofficestatement,discloseallreportableinvestments,interestsinrealproperty,andbusiness positions held on the date you assumed office.Inaddition,youmustdiscloseincome(includingloans,giftsandtravelpayments)receivedduringthe12monthspriortothedateyouassumedoffice.

Onacandidatestatement,discloseallreportableinvestments,interestsinrealproperty,andbusinesspositionsheldonthedateyoufileyourdeclarationofcandidacy.Youmustalsodiscloseincome(includingloans,giftsandtravelpayments)receivedduringthe12monthspriortothedateyoufileyourdeclarationofcandidacy.

Q.Iholdtwootherboardpositionsinadditiontomypositionwiththecounty.MustIfilethreestatementsofeconomic interests?

A. Yes,threearerequired.However,youmaycompleteone statement listing the county and the two boards on the Cover Page or an attachment as the agencies for whichyouwillbefiling.Reportyoureconomicinterestsusingthelargestjurisdictionandhighestdisclosurerequirementsassignedtoyoubythethreeagencies.Maketwocopiesoftheentirestatementbeforesigningit,signeachcopywithanoriginalsignature,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.Iamadepartmentheadwhorecentlybeganactingascitymanager.ShouldIfileasthecitymanager?

A. Yes.Fileanassumingofficestatementascitymanager.Personsservingas“acting,”“interim,”or“alternate”mustfileasiftheyholdthepositionbecausethey are or may be performing the duties of the position.

Q.Asadesignatedemployee,Ileftonestateagencytoworkforanotherstateagency.MustIfilealeavingofficestatement?

A. Yes.Youmayalsoneedtofileanassumingofficestatement for the new agency.

Q.MyspouseandIarecurrentlyseparatedandintheprocessofobtainingadivorce.MustIstillreportmyspouse’sincome,investments,andinterestsinrealproperty?

A. Yes.Apublicofficialmustcontinuetoreportaspouse’seconomic interests until such time as dissolution of marriageproceedingsisfinal.However,ifaseparateproperty agreement has been reached prior to that time,yourestrangedspouse’sincomemaynothavetobe reported. Contact the FPPC for more information.

Investment DisclosureQ.Ihaveaninvestmentinterestinsharesofstockina

companythatdoesnothaveanofficeinmyjurisdiction.MustIstilldisclosemyinvestmentinterestinthiscompany?

A. Probably.Thedefinitionof“doingbusinessinthejurisdiction”isnotlimitedtowhetherthebusinesshasanofficeorphysicallocationinyourjurisdiction.SeeReferencePamphlet,page13.

Q.MyspouseandIhavealivingtrust.Thetrustholdsrentalpropertyinmyjurisdiction,ourprimaryresidence,andinvestmentsindiversifiedmutualfunds.Ihavefulldisclosure. How is this trust disclosed?

A. Disclosethenameofthetrust,therentalpropertyanditsincomeonScheduleA-2.Yourprimaryresidenceandinvestmentsindiversifiedmutualfundsregisteredwith the SEC are not reportable.

Q.Iamrequiredtoreportallinvestments.IhaveanIRAthat contains stocks through an account managed by abrokeragefirm.MustIdisclosethesestockseventhoughtheyareheldinanIRAandIdidnotdecidewhich stocks to purchase?

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

Q. The value of my stock changed during the reporting period.HowdoIreportthevalueofthestock?

A. Youarerequiredtoreportthehighestvaluethatthestockreachedduringthereportingperiod.Youmayuse your monthly statements to determine the highest value.Youmayalsousetheentity’swebsitetodeterminethehighestvalue.Youareencouragedtokeep a record of where you found the reported value.



Questions and AnswersContinued

Q.Iamthesoleownerofmybusiness,anS-Corporation.Ibelievethatthenatureofthebusinessissuchthatitcannotbesaidtohaveany“fairmarketvalue”becauseithasnoassets.Ioperatethecorporationunderanagreementwithalargeinsurancecompany.Mycontract does not have resale value because of its natureasapersonalservicescontract.MustIreportthe fair market value for my business on Schedule A-2 of the Form 700?

A. Yes.Eveniftherearenotangibleassets,intangibleassets,suchasrelationshipswithcompaniesandclientsarecommonlysoldtoqualifiedprofessionals.The“fairmarketvalue”isoftenquantifiedforotherpurposes,suchasmaritaldissolutionsorestateplanning.Inaddition,theIRSpresumesthat“personalservicescorporations”haveafairmarketvalue.Aprofessional“bookofbusiness”andtheassociatedgoodwill that generates income are not without a determinablevalue.TheForm700doesnotrequireaprecise fair market value; it is only necessary to check a box indicating the broad range within which the value falls.

Q.IownstockinIBMandmustreportthisinvestmentonScheduleA-1.Iinitiallypurchasedthisstockintheearly1990s;however,Iamconstantlybuyingandsellingshares.MustInotethesedatesinthe“Acquired”and“Disposed”fields?

A. No.Youmustonlyreportdatesinthe“Acquired”or“Disposed”fieldswhen,duringthereportingperiod,youinitiallypurchaseareportableinvestmentworth$2,000or more or when you dispose of the entire investment. Youarenotrequiredtotrackthepartialtradingofaninvestment.

Q.Onlastyear’sfilingIreportedstockinEncoevaluedat$2,000-$10,000.Latelastyearthevalueofthisstockfellbelowandremainsatlessthan$2,000.Howshouldthisbereportedonthisyear’sstatement?

A. Youarenotrequiredtoreportaninvestmentifthevaluewaslessthan$2,000duringtheentire reporting period. However,becauseadisposeddateisnotrequiredforstocksthatfallbelow$2,000,youmaywanttoreportthestockandnoteinthe“comments”sectionthatthevaluefellbelow$2,000.Thiswouldbeforinformationalpurposesonly;itisnotarequirement.

Q. We have a Section 529 account set up to save money forourson’scollegeeducation.Isthisreportable?

A. IftheSection529accountcontainsreportableinterests(e.g.,commonstockvaluedat$2,000ormore),thoseinterests are reportable (not the actual Section 529 account).Iftheaccountcontainssolelymutualfunds,then nothing is reported.

Income DisclosureQ.IreportedabusinessentityonScheduleA-2.Clientsof

mybusinessarelocatedinseveralstates.MustIreportall clients from whom my pro rata share of income is $10,000ormoreonScheduleA-2,Part3?

A. No,onlytheclientslocatedinordoingbusinessonaregularbasisinyourjurisdictionmustbedisclosed.

Q.IbelieveIamnotrequiredtodisclosethenamesofclients from whom my pro rata share of income is $10,000ormoreonScheduleA-2becauseoftheirrighttoprivacy.Isthereanexceptionforreportingclients’names?

A. Regulation18740providesaprocedureforrequestinganexemptiontoallowaclient’snamenottobedisclosed 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.fppc.ca.gov. SeeReferencePamphlet,page14.

Q.Iamsoleownerofaprivatelawpracticethatisnotreportable based on my limited disclosure category. However,someofthesourcesofincometomylawpracticearefromreportablesources.DoIhavetodisclose this income?

A. Yes,eventhoughthelawpracticeisnotreportable,reportable sources of income to the law practice of $10,000ormoremustbedisclosed.Thisinformationwould be disclosed on Schedule C with a note in the “comments”sectionindicatingthatthebusinessentityis not a reportable investment. The note would be for informationalpurposesonly;itisnotarequirement.




Q.Iamthesoleownerofmybusiness.WheredoIdisclose my income - on Schedule A-2 or Schedule C?

A. Sources of income to a business in which you have an ownershipinterestof10%orgreateraredisclosedonScheduleA-2.SeeReferencePamphlet,page8,forthedefinitionof“businessentity.”

Q.Myhusbandisapartnerinafour-personfirmwhereall of his business is based on his own billings and collectionsfromvariousclients.HowdoIreportmycommunity property interest in this business and the income generated in this manner?

A. Ifyourhusband’sinvestmentinthefirmis10%orgreater,disclose100%ofhisshareofthebusinessonScheduleA-2,Part1and50%ofhisincomeonScheduleA-2,Parts2and3.Forexample,aclientofyourhusband’smustbeasourceofatleast$20,000duringthereportingperiodbeforetheclient’snameisreported.

Q.HowdoIdisclosemyspouse’sorregistereddomesticpartner’ssalary?

A. Report the name of the employer as a source of income on Schedule C.

Q.Iamadoctor.Forpurposesofreporting$10,000sourcesofincomeonScheduleA-2,Part3,arethepatients or their insurance carriers considered sources of income?

A. Ifyourpatientsexercisesufficientcontrolbyselectingyouinsteadofotherdoctors,thenyourpatients,ratherthantheirinsurancecarriers,aresourcesofincometoyou.(SeeReferencePamphlet,page14,foradditionalinformation.)

Q.Ireceivedaloanfrommygrandfathertopurchasemyhome.Isthisloanreportable?

A. No.Loansreceivedfromfamilymembersarenotreportable.

Q.Manyyearsago,Iloanedmyparentsseveralthousanddollars,whichtheypaidbackthisyear.DoIneedtoreport this loan repayment on my Form 700?

A. No.Paymentsreceivedonaloanmadetoafamilymember are not reportable.

Real Property DisclosureQ. During this reporting period we switched our principal

placeofresidenceintoarental.Ihavefulldisclosureandthepropertyislocatedinmyagency’sjurisdiction,soitisnowreportable.BecauseIhavenotreportedthispropertybefore,doIneedtoshowan“acquired”date?

A. No,youarenotrequiredtoshowan“acquired”datebecauseyoupreviouslyownedtheproperty.However,youmaywanttonoteinthe“comments”sectionthatthe property was not previously reported because it was used exclusively as your residence. This would be for informationalpurposesonly;itisnotarequirement.

Q.Iamacitymanager,andIownarentalpropertylocatedinanadjacentcity,butonemilefromthecitylimit.DoIneed to report this property interest?

A. Yes.Youarerequiredtoreportthispropertybecauseit is located within 2 miles of the boundaries of the city you manage.

Q.MustIreportahomethatIownasapersonalresidencefor my daughter?

A. Youarenotrequiredtodiscloseahomeusedasapersonal residence for a family member unless you receiveincomefromit,suchasrentalincome.

Q.Iamaco-signeronaloanforarentalpropertyownedbyafriend.SinceIamlistedonthedeedoftrust,doIneedtoreportmyfriend’spropertyasaninterestinrealproperty on my Form 700?

A. No.Simplybeingaco-signeronaloanforpropertydoes not create a reportable interest in real property for you.

Gift DisclosureQ. IfIreceivedareportablegiftoftwoticketstoaconcert

valuedat$100each,butgavetheticketstoafriendbecauseIcouldnotattendtheconcert,doIhaveanyreporting obligations?

A. Yes.Sinceyouacceptedthegiftandexerciseddiscretionandcontroloftheuseofthetickets,youmustdisclose the gift on Schedule D.



Q. MaryJulia and JoeJaredBenson,amarriedcouple,want to give a piece of artwork to a county supervisor. Iseachspouseconsideredaseparatesourceforpurposes of the gift limit and disclosure?

A. Yes,eachspousemaymakeagiftvaluedatthegiftlimit duringacalendaryear.Forexample,during2018 thegiftlimitwas$470,sotheBensonsmayhavegiventhe supervisor artwork valued at no more than $940. The supervisor must identify JoeJared and MaryJulia Benson as the sources of the gift.

Q.IamaForm700filerwithfulldisclosure.Ouragencyholdsaholidayraffletoraisefundsforalocalcharity.Ibought$10worthofraffleticketsandwonagiftbasket valued at $120. The gift basket was donated by DougBrewer,acitizeninourcity.Atthesameevent,Iboughtraffleticketsfor,andwonaquiltvaluedat$70.Thequiltwasdonatedbyacoworker.Arethesereportable gifts?

A. Because the gift basket was donated by an outside source(notanagencyemployee),youhavereceivedareportable gift valued at $110 (the value of the basket lesstheconsiderationpaid).Thesourceofthegiftis Doug Brewer and the agency is disclosed as the intermediary.Becausethequiltwasdonatedbyanemployeeofyouragency,itisnotareportablegift.

Q.Myagencyisresponsiblefordisbursinggrants.Anapplicant(501(c)(3)organization)metwithagencyemployeestopresentitsapplication.Atthismeeting,the applicant provided food and beverages. Would the food and beverages be considered gifts to the employees? These employees are designated in our agency’sconflictofinterestcodeandtheapplicantisareportable source of income under the code.

A.Yes.Ifthevalueofthefoodandbeveragesconsumedbyanyonefiler,plusanyothergiftsreceivedfromthesame source during the reporting period total $50 or more,thefoodandbeverageswouldbereportedusingthefairmarketvalueandwouldbesubjecttothegiftlimit.

Q.Ireceivedfreeadmissiontoaneducationalconferencerelatedtomyofficialduties.Partoftheconferencefeesincludedaroundofgolf.Isthevalueofthegolfconsidered informational material?

A. No.Thevalueofpersonalbenefits,suchasgolf,attendanceataconcert,orsportingevent,aregiftssubjecttoreportingandlimits.


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