application/nomination filing period: may 1 ......the final redistricting plan must provide fair and...

Application/Nomination for Appointment to Redistricting Commission

of 10

APPLICATION/NOMINATION FILING PERIOD: MAY 1 – JUNE 30, 2020

In accordance with San Diego Charter (Charter) section 5.1, the City of San Diego (City)’s Redistricting Commission (Commission) has the sole and exclusive authority to adopt plans which specify the boundaries of districts for the City Council. The Commission is composed of nine members and two alternate members, to be appointed by the Appointing Authority consisting of three retired judges no later than November 1, 2020. The alternate members must be available to serve if a Commission member cannot serve or resigns. The alternates have the duty to remain informed of the Commission’s business, so they are prepared to serve if called upon to do so.

APPOINTMENT TO THE REDISTRICTING COMMISSION: Charter section 5.1 requires that the appointees be registered voters in the City, who will give the Commission geographic, social and ethnic diversity, and who, in the judgment of the Appointing Authority, have a high degree of competency to carry out the Commission’s responsibilities. The appointees must include individuals with a demonstrated capacity to serve with impartiality in a nonpartisan role. The Appointing Authority must attempt to appoint one Commission member from each of the nine Council districts to the extent practicable, considering the extent of the applicant pool and each applicant’s qualifications to serve. The Appointing Authority must also attempt to appoint Commission members who possess working knowledge of the geography and neighborhoods of the City.

Commission members and alternates serve without compensation. Commission members, and their alternates, must serve until the redistricting plan adopted by the Commission becomes effective and the referendary deadline for the Final Redistricting Plan has passed. If the Final Redistricting Plan is rejected by referendum or by a legal challenge, Commission members and alternates must resume their service and must create a new plan in accordance with the Charter and other applicable law.

Commission applicants are subject to the Political Reform Act, San Diego Ethics Ordinance, and other applicable laws related to conflicts of interest. Commission appointees must file with the City Clerk a completed Statement of Economic Interests, Form 700, in accordance with controlling law. The scope of disclosure must be as required by the Commission’s conflict of interest code, decided by resolution of the City Council.

Persons who accept appointment to the Commission as a member, at the time of their appointment, must also file a written declaration with the City Clerk stating that within five years of the Commission’s adoption of a Final Redistricting Plan that they will not seek election to a City elective public office, specifically as the City’s Mayor, City Attorney, or a Councilmember.

RESPONSIBILITIES: With the assistance of needed staff and technical consultants, the Commission must adopt plans that redistrict the City into nine Council districts. Those districts will be used for all elections of Council members, including their recall, and for filling vacancies for a Council member seat. The districts formed must contain, as nearly as practicable, one-ninth of the total population of the City as shown by the 2020 Federal Decennial Census. The Final Redistricting Plan must provide fair and effective representation for all citizens of the City, including racial, ethnic, and language minorities, and be in conformance with the requirements of the United States Constitution and federal statutes. Districts must preserve identifiable communities of interest; be geographically compact; be composed of whole census units as developed by the U.S. Bureau of the Census; be composed of contiguous territory with reasonable access between population centers in the district, and not be drawn to benefit or protect incumbents.


of 10

MEETINGS: All Commission meetings must be open to the public, and the Commission must make every reasonable effort to provide the public with access to its proceedings. The Commission must hold its first meeting within 30 days after the members are appointed and must adopt its budget within 60 days.

At least nine public hearings must be held in various geographic areas of the City before the Commission prepares a preliminary redistricting plan. The Commission must file this preliminary plan with the City Clerk, along with a written statement of findings and reasons for adoption which includes notation of all criteria employed in the process and a full analysis and explanation of decisions made by the Commission. The preliminary plan must be filed at least 30 days before the final plan is adopted.

During the 30-day period after the preliminary plan is filed, at least five more public hearings must be held in various geographic areas of the City before the Commission adopts its Final Redistricting Plan. Once the Commission adopts the Final Redistricting Plan, if it is rejected by referendum, the same Commission must create a new plan.

APPLICATION/NOMINATION SUBMISSION:

Please submit the following via U.S. Mail to the Office of the City Clerk addressed at 202 C Street, MS2A San Diego, CA 92101:

Part 1. All pages of the completed and signed (wet signature) forms with any additional attachments that may expand on these sections.

Part 2. Signed (wet signature) of all Legal Disclosures, Acknowledgements, and Authorizations.

Part 3. At the time of filing the application, applicants/nominees are required to file a signed (wet signature) Statement of Economic Interest (Form 700). (PDF-Fillable Attached) Forms in alternative formats and accommodations for filing are available upon request. Please call (619) 533-4000 (voice) or (619) 236-7012 (TTY) or e-mail [email protected] for assistance from City Clerk staff.

IMPORTANT! Applications/nominations for the Redistricting Commission can only be submitted during the filing period, which runs from May 1, 2020 through June 30, 2020. Applications/nominations filed before May 1 or postmarked after June 30 will not be considered.

Please contact the City Clerk at [email protected] or 619-533-4000 if you need a reasonable modification to the requirement of filing by U.S. Mail, to allow an applicant or nominee to work out a physical drop-off to a member of the City Clerk's staff before the deadline.

Once your Application Packet has been received in full (Part 1, Part 2, Part 3), the Office of the City Clerk will confirm receipt by email to the email address provided on your application. It is necessary to submit a complete Application Packet even if an individual is being nominated by another individual or organization.

mailto:[email protected]


of 10

Related Information Links:

• San Diego City Charter: Section 5.1 - Redistricting Commission• San Diego Municipal Code: Chapter 2, Article 7, Division 14 - Redistricting Commission• Redistricting Commission Homepage (Timeline, Conflict of Interest Code, FAQs)• Ethics Commission FAQs• Statement of Economic Interests• 300 Word Statement of Qualifications - Word Count Guidelines Page 15

THIS INFORMATION WILL BE MADE AVAILABLE IN ALTERNATIVE FORMATS UPON REQUEST.

THIS IS A PUBLIC DOCUMENT, SUBJECT TO DISCLOSURE IN ACCORDANCE WITH THE CALIFORNIA PUBLIC RECORDS ACT AND OTHER APPLICABLE LAW.

https://docs.sandiego.gov/citycharter/Article%20II.pdf

https://docs.sandiego.gov/municode/MuniCodeChapter02/Ch02Art07Division14.pdf

https://www.sandiego.gov/city-clerk/redistricting-commission

https://www.sandiego.gov/ethics/faqs

https://www.sandiego.gov/city-clerk/elections/eid/economic

https://www.sandiego.gov/sites/default/files/city_clerk_administrative_guidelines.pdf


of 10

If additional space is needed to answer the following questions, please provide the information in an attachment.

PART 1 - Section A: General Information Name of Applicant (Last, First, MI):

Gender: (select one)

Male Female Nonbinary Decline to State Ethnicity: (select one)

Hispanic or Latino Not Hispanic or Latino Decline to State Race: (select all that apply)

American Indian or Alaska Native Asian Black or African American

Native Hawaiian or Other Pacific Islander White Two or More Races

Other: Decline to State Current Address (number, street, city, state, zip code): Council District #:

Length of Time at Current Address:

Year(s) Month(s) List All Previous Residences During the Past 5 years (number, street, city, state, zip code):

Phone: Email Address:

Check this box if you are a registered voter at your current address.


of 10

PART 1 - Section B: Employment History During Past 5 Years Employer Name: Type of Business:

Title/Position:

Business Address (number, street, city, state, zip code):

Start Date End Date

Employer Name: Type of Business:

Title/Position:


Start Date: End Date:

Employer Name: Type of Business:

Title/Position:




of 10

PART 1 – Section C: Military Service Branch: Rank at Discharge:


Branch: Rank at Discharge:


PART 1 - Section D: Education (High School, College/University or Other Educational History) School: Degree: Major: Year Earned:

PART 1 - Section E: Licenses or Certificates Type: Issuing State/Entity: License #: Issue/Expiration Date:


of 10

PART 1 - Section F: Public Office/Public Service Appointments Entity: Position Held: Dates: (From/To)

PART 1 - Section G: Civic/Community/Volunteer Experience Organization Name: Position Held: Dates: (From/To)

PART 1 - Section H: Professional/Technical/Other Relevant Organizations Organization Name: Position Held: Dates: (From/To)


of 10

PART 1 - Section I: Three References Familiar with Your Qualifications for This Appointment Name: Association with Reference: Phone: Email:

PART 1 - Section J: Statement of Qualifications (300 Words Maximum) Expressing in the applicant’s own words the reasons why the applicant believes he or she is qualified for the office, and signed by the applicant; or in the case of an individual nominated by another individual or an organization, a statement of qualifications not longer than 300 words expressing the reasons why the nominating individual or organization believes the nominee is qualified for the office. In the case of an individual nominated by another individual, the statement of qualifications must be signed by the nominating individual, the individual’s name, address, and telephone number must be provided. In the case of an individual nominated by an organization, the statement of qualifications must be signed by an officer of the organization on organization letterhead.


of 10

Applicant Acknowledgement and Certification By providing my signature below, I certify that all statements made in relation to my application to serve on the Redistricting Commission are true and complete to the best of my knowledge. I understand that I may be disqualified from serving on the Redistricting Commission if I knowingly make false statements or omit material information. I understand that all members and alternates serving on the Redistricting Commission must be registered voters in the City of San Diego. I understand that my application is a public record, subject to disclosure under the California Public Records Act and other applicable state law. I acknowledge that I may withdraw from the appointment process at any time, by written communication to the City of San Diego, Office of the City Clerk. I further understand that if I am appointed to serve on the Redistricting Commission for the City of San Diego, I will comply with all applicable laws and regulations related to conflicts of interest and governmental decisions, including the California Political Reform Act, California Government Code section 1090, and the City of San Diego’s Ethics Ordinance. These laws include the requirement that appointees complete annual public statements disclosing certain financial holdings, personal income, property ownership, receipt of gifts, and other financial interests. Additionally, these laws may require recusal from participation in a governmental decision where a conflict of interest exists. I acknowledge and agree to comply with these laws. Applicant/Nominee Name: Applicant/Nominee Signature: Date:

of 10

Nomination Acceptance (Nominees Only)

I understand that I am being nominated for appointment to the position of Redistricting Commission member for the City of San Diego, and hereby accept the nomination.

Nominee Name: Signature of Nominee: Date:

THANK YOU FOR YOUR INTEREST IN SERVING OUR CITY GOVERNMENT

of 7

PART 2: LEGAL DISCLOSURES, ACKNOWLEDGMENTS, AND AUTHORIZATIONS

Please note: These disclosures are required in order to comply with San Diego Municipal Code (SDMC) section 27.1408(d) and federal and state law. The Clerk, in coordination with the San Diego Police Department, will complete a criminal conviction background check for each applicant and the Appointing Authority will be informed of the results.

Additionally, the Appointing Authority may seek to verify the information provided on your application.

of 7

Police Background Investigation Advisory

I acknowledge that the San Diego Police Department will conduct a background investigation, including a review of any criminal convictions, in accordance with San Diego Municipal Code section 27.1408 and applicable federal and state law. I agree to provide my date of birth, Social Security number, and any other information required by the San Diego Police Department and requested by the City Clerk to complete the required investigation. Social Security Numbers will be separate from the application/nomination form and will not be made available to the public.

Applicant/Nominee Name: Signature of Applicant/Nominee: Date: Date of Birth: Social Security Number:

of 7

General California Law Disclosures for

Redistricting Commission Applicants/Nominees

The San Diego Charter, at section 5.1, and the San Diego Municipal Code require that Redistricting Commission (Commission) members have a demonstrated capacity to serve with impartiality in a nonpartisan role. Commission members have the responsibility to adopt plans that redistrict the City of San Diego (City) into nine Council districts, which will be used for all elections of Councilmembers. Each district must contain, as nearly as practicable, one-ninth of the total population of the City as shown by the Federal Decennial Census, and each redistricting plan must provide fair and effective representation for all citizens of the City, and be in conformance with the requirements of the United States Constitution and federal statutes.

The Appointing Authority for Commission members must attempt to appoint one Commission member from each of the nine Council districts to the extent practicable. Commission members must be registered to vote in the City of San Diego.

In accordance with San Diego Municipal Code section 27.1408(d), applicants are subject to a background check conducted by the San Diego Police Department to determine that they meet the requirements to serve. This background check will include review and verification of the information provided to the City in this application and review of law enforcement records.

I understand that any offer of appointment by the City to me to serve on the Redistricting Commission is conditioned upon satisfactory completion of all of the screening processes required for the Redistricting Commission, including the San Diego Police Department background check. Upon a determination by the City Clerk that my application establishes the minimum qualifications to serve on the Redistricting Commission, as established by the City Charter, ordinance of the City Council, or other controlling law, I will be asked to submit my fingerprints to the San Diego Police Department for the purpose of obtaining a criminal conviction report from the Federal Bureau of Investigation, California Department of Justice, and local law enforcement records. The San Diego Police Department may also review public and other records to verify the information in my application.

The City will not obtain an applicant’s credit report from a credit reporting agency unless expressly authorized under California Labor Code section 1024.5.

You are entitled to receive from the City copies of any public record (as defined by California Civil Code section 1786.53) obtained or used by the City in reviewing your application to serve on the Redistricting Commission.

You may waive your right to receive a copy of any public record, in accordance with California Civil Code section 1786.53, by checking this box.

I acknowledge the receipt of this disclosure, by signing below.

Applicant/Nominee Name: Signature of Applicant/Nominee: Date:

of 7

Fair Credit Reporting Act Disclosure for

Redistricting Commission Applicants/Nominees

The City of San Diego (City), acting through the San Diego Police Department, may conduct a background investigation related to your qualifications to serve on the Redistricting Commission. The City may obtain a consumer report or investigative consumer report, as defined by the federal Fair Credit Reporting Act, about you from a consumer reporting agency in connection with your application to serve on the Redistricting Commission. A consumer report is a compilation of information, including information about your character, general reputation, personal characteristics, and mode of living. The City may obtain information about you from personal interviews with sources, including your neighbors, friends, and associates. The City may also obtain information relating to your criminal conviction history, education, employment history, licenses, certifications, references, court records, and other background information.

You have the right, upon written request to the City made within a reasonable time after the receipt of this notice, to request disclosure of the nature and scope of any consumer report or investigative consumer report obtained by the City. If the City uses a third-party, consumer reporting agency to conduct any part of its background investigation, the City will provide to you the name of the consumer reporting agency and its address, telephone number, electronic mail address, and Internet website address, prior to the use of the third-party, consumer reporting agency. A summary of your rights under the Fair Credit Reporting Act may be found at: https://files.consumerfinance.gov/f/201504_cfpb_summary_your-rights-under-fcra.pdf. Upon request, the City will provide you with a written copy of these rights.



of 7

Applicant Authorization to Conduct Background Investigation Fair Credit Reporting Act

I have carefully read and understand the Fair Credit Reporting Act Disclosure. By my signature below, I authorize the City of San Diego (City) to proceed with a background investigation of my qualifications to serve on the City’s Redistricting Commission. I further authorize the release of my records to the City by law enforcement agencies, educational institutions (including public and private schools and universities), information service bureaus, courts (federal, state, and local), my past and present employers, and any other individuals, agencies, institutions, and other sources holding information pertinent to me.


Please check this box to receive a free copy of any consumer report or investigative consumer report obtained by the City from a consumer reporting agency.

of 7

California Investigative Consumer Reporting Agencies Act Disclosure for Redistricting Commission Applicants/Nominees

The City of San Diego (City) may request background information about you from an investigative consumer reporting agency in connection with your application to serve on the Redistricting Commission. The report ordered is defined by the Investigative Consumer Reporting Agencies Act (ICRAA), under the California Civil Code, as an “investigative consumer report.” This report may contain information about your character, general reputation, personal characteristics, and mode of living. It may also involve personal interviews with sources, including your neighbors, friends, or associates.

The City may also obtain information relating to your criminal conviction history, education, employment history, licenses, certifications, references, court records, and other background information.

If the City uses a third-party, investigative consumer reporting agency (ICRA), then the City will provide you with written notice of the ICRA’s name, address, telephone number, electronic mail address, and Internet website address before the City obtains an investigative consumer report.

Under California Civil Code section 1786.22, you have the right to view your file that the ICRA holds. By providing proper identification and duplication cost, you may obtain a copy of this information in person during the ICRA’s normal business hours and after providing reasonable notice of your request. Additionally, you may obtain a summary of all information contained in the ICRA’s file on you over the telephone, if you make a written request with proper identification for telephone disclosure and pre-pay the toll charge, if any, for the telephone call. You may also request that a copy of the file be sent to a specified address by certified mail. An ICRA complying with requests for certified mailings is not liable for disclosures to third parties caused by mishandling of mail after it leaves the ICRA.

If the City uses an ICRA, then the ICRA will provide trained personnel to explain any information furnished to you and will provide a written explanation of any coded information contained in files maintained on you. This written explanation will be provided whenever a file is provided to you for visual inspection. You may be accompanied by one other person of your choosing, who must furnish reasonable identification. An ICRA may require you to furnish a written statement granting permission to the ICRA to discuss your file in such person’s presence.



of 7

Applicant Authorization to Conduct Background Investigation

California Investigative Consumer Reporting Agencies Act

I have carefully read and understand the California Investigative Consumer Reporting Agencies Act Disclosure. By my signature below, I authorize the City of San Diego (City) to proceed with a background investigation of my qualifications to serve on the City’s Redistricting Commission. I further authorize the release of my records to the City by law enforcement agencies, educational institutions (including public and private schools and universities), information service bureaus, courts (federal, state, and local), my past and present employers, and any other individuals, agencies, institutions, and other sources holding information pertinent to me.


Please check this box to receive a free copy of any investigative consumer report obtained by the City from an ICRA.

PART 3: STATEMENT OF ECONOMIC INTERESTS (FORM 700)

The Statement of Economic Interests (Form 700) is a public document which public officials and certain government employees, including consultants and even volunteer board members, use to disclose financial interests.

In order to be considered for appointment to the Redistricting Commission, you will need to file a Statement of Economic Interests (Form 700) and disclose financial interests at the appropriate level of Category 1 set forth in the Redistricting Commission Conflict of Interest Code.

Additional Resources: • Reference Pamphlet• Form 700 FAQs

Forms in alternative formats and accommodations for filing are available upon request. Please call (619) 533-4000 (voice) or (619) 236-7012 (TT) or e-mail [email protected] for assistance from City Clerk staff.

https://www.sandiego.gov/sites/default/files/cic-redistrictingcommisison.pdf

http://www.fppc.ca.gov/content/dam/fppc/NS-Documents/TAD/Form%20700/2019-2020/Ref_Pamphlet_2019.20_FINAL.pdf

http://www.fppc.ca.gov/content/dam/fppc/NS-Documents/TAD/Form%20700/2019-2020/Form_700_FAQs_2019.pdf

mailto:[email protected]

December 2019

2019-2020Statement 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.19 Q & A ........................................................................p.20

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

Sheet for State andLocalOfficials

Quick Start GuideDetailed instructions begin on page 3.

WHEN IS THE ANNUAL STATEMENT DUE?

• March2–ElectedStateOfficers,JudgesandCourtCommissioners,StateBoardandCommissionmembers listed in Government Code Section 87200

• April1–Mostotherfilers

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

ITEMS TO NOTE!• TheForm700isapublicdocument.

• Onlyfilersservinginactivemilitarydutymayreceiveanextensiononthefilingdeadline.

• Youmustalsoreportinterestsheldbyyourspouseorregistereddomesticpartner.

• Youragency’sconflictofinterestcodewillhelpyoutocompletetheForm700.YouareencouragedtogetyourconflictofinterestcodefromthepersonwhoaskedyoutocompletetheForm700.

NOTHING TO REPORT?Markthe“Noreportableinterests”boxonPart4oftheCoverPage,andsubmitonlythesignedCoverPage.Please 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:BusinessEntitites/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].

FPPC Form 700 (2019/2020)[email protected] • 866-275-3772 • www.fppc.ca.gov

Page - 2

What’s NewGift Limit IncreaseThe gift limit increased to $500 for calendar years 2019 and 2020.

Who must file:• Electedandappointedofficialsandcandidateslistedin

Government Code Section 87200• Employees,appointedofficials,andconsultantsfiling

pursuanttoaconflictofinterestcode(“codefilers”).Obtain your disclosure categories, which describethe 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 committee are notrequiredtofiletheForm700.

• Membersofnewlycreatedboardsandcommissionsnotyetcoveredunderaconflictofinterest code

• Employees in newly created positions of existingagencies

Formoreinformation,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”signatureorbedulyauthorizedbyyourfilingofficertofileelectronicallyunder Government Code Section 87500.2.

When to file:Annual Statements

March 2, 2020 - ElectedStateOfficers - JudgesandCourtCommissioners - State Board and StateCommissionMemberslisted

in Government Code Section 87200 April 1, 2020

- MostotherfilersIndividualsfilingunderconflictofinterestcodesincityandcountyjurisdictionsshouldverifytheannualfilingdatewiththeirlocalfilingofficers.

Statementspostmarkedbythefilingdeadlineareconsideredfiledontime.

Statements of 30 pages or less may be emailed or faxed by the deadline as long as the originally signed paper versionissentbyfirstclassmailtothefilingofficialwithin24 hours.

Assuming Office and Leaving Office StatementsMostfilersfilewithin30daysofassumingorleavingofficeorwithin30daysoftheeffectivedateofanewlyadoptedoramendedconflictofinterestcode.

Exception:

IfyouassumedofficebetweenOctober1, 2019,and December31, 2019,andfiledanassumingofficestatement,youarenotrequiredtofileanannualstatementuntilMarch2,2021,orApril1,2021,whichever is applicable. The annual statement will cover thedayafteryouassumedofficethroughDecember31,2020.(SeeReferencePamphlet,page6,foradditionalexceptions.

Candidate StatementsFilenolaterthanthefinalfilingdateforthedeclarationof candidacy or nomination documents. A candidate statementisnotrequiredifyoufiledanassumingofficeorannualstatementforthesamejurisdictionwithin60daysbeforefilingadeclarationofcandidacyorothernominationdocuments.

Late StatementsThereisnoprovisionforfilingdeadlineextensionsunlessthefilerisservinginactivemilitaryduty.(Seepage19forinformationonpenaltiesandfines.)

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


Page - 3

Types of Statements

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

• Report:Investments,interestsinrealproperty,andbusiness positions held on the date you assumed theofficeorpositionmustbereported.Inaddition,income(includingloans,gifts,andtravelpayments)receivedduring the 12 months prior to the date you assumed theofficeorposition.

ForpositionssubjecttoconfirmationbytheStateSenateortheCommissiononJudicialAppointments,yourassumingofficedateisthedateyouwereappointedornominated to the position.

• Example:MariaLopezwasnominatedbytheGovernortoserveonastateagencyboardthatissubjecttostateSenateconfirmation.TheassumingofficedateisthedateMaria’snominationissubmittedtotheSenate.Mariamustreportinvestments,interestsinrealproperty,andbusinesspositionssheholdsonthatdate,andincome(includingloans,gifts,andtravelpayments)received during the 12 months prior to that date.

Ifyourofficeorpositionhasbeenaddedtoanewlyadoptedornewlyamendedconflictofinterestcode,usetheeffectivedateofthecodeoramendment,whicheverisapplicable.

• Report:Investments,interestsinrealproperty,andbusinesspositionsheldontheeffectivedateofthecodeoramendmentmustbereported.Inaddition,income(includingloans,gifts,andtravelpayments)receivedduringthe12monthspriortotheeffectivedateof the code or amendment.

Annual Statement: Generally,theperiodcoveredisJanuary1,2019,throughDecember31,2019.IftheperiodcoveredbythestatementisdifferentthanJanuary1,2019,throughDecember31,2019,(forexample,youassumedofficebetweenOctober1,2018,andDecember31,2018 or you arecombiningstatements),youmustspecifytheperiodcovered.

• Investments,interestsinrealproperty,businesspositionsheld,andincome(includingloans,gifts,andtravelpayments)receivedduringtheperiodcoveredby the statement must be reported. Do not change thepreprinteddatesonSchedulesA-1,A-2,andBunlessyouarerequiredtoreporttheacquisitionordispositionof an interest that did not occur in 2019.

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

Leaving Office Statement: Generally,theperiodcoveredisJanuary1,2019, through the date you stopped performing the duties of yourposition.IftheperiodcovereddiffersfromJanuary1,2019,throughthedateyoustoppedperformingthedutiesofyourposition(forexample,youassumedofficebetween October1,2018,andDecember31,2018,or youarecombiningstatements),theperiodcoveredmustbespecified.Thereportingperiodcancoverpartsoftwocalendar years.

• Report:Investments,interestsinrealproperty,businesspositionsheld,andincome(includingloans,gifts,andtravelpayments)receivedduringtheperiodcoveredbythe statement. Do not change the preprinted dates onSchedulesA-1,A-2,andBunlessyouarerequiredtoreporttheacquisitionordispositionofaninterestthatdid not occur in 2019.

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.

Note: Onceyoufileyourstatement,youmaynotwithdrawit. All changes must be noted on amendment schedules.


Page - 4

Leaving Office: Date Left / /(Check one circle.)

The period covered is January 1, 2019, through the date of leaving office.

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

Annual: The period covered is January 1, 2019, through December 31, 2019.

The period covered is / / , through December 31, 2019.

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, Retired Judge, Pro Tem Judge, or Court Commissioner (Statewide Jurisdiction) (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 InitialFilingReceivedFiling Official 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 EMAiL 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

FPPC Form 700 - Cover Page (2019/2020)[email protected] • 866-275-3772 • www.fppc.ca.gov

Page - 5

• 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 2019 annualstatement,do not change the pre-printeddatestoreflect2020.Yourannualstatementisused for reporting the previous year’s economic interests. EconomicinterestsforyourannualfilingcoveringJanuary1,2020,throughDecember31,2020,willbedisclosedonyourstatementfiledin2021. 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 reportableinterests.

• Enter the total number of completed pages including thecover page and either check the box for each schedule youuse to disclose interests; or if you have nothing to discloseonanyschedule,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.When you sign your statement, you are stating, under penalty of perjury, that it is true and correct.Onlythefilerhas authority to sign the statement. An unsigned statement isnotconsideredfiledandyoumaybesubjecttolatefilingpenalties.

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 nameratherthantheirprivatefirm’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; ChiefCounsel;CityCouncilMember;StaffServicesAnalyst)

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

withwhichyouarerequiredtofileandyourpositiontitle(s)inthespaceprovided.Do not use acronyms.Attach an additional sheet if necessary. Completeonestatementcoveringthedisclosurerequirementsfor all positions. Each copy must contain an originalsignature.Therefore,beforesigningthestatement,make a copy for each agency. Sign each copy with anoriginalsignatureandfilewitheachagency.

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

Example:Brian Bourne is a city council member for the City of Lincoln andaboardmemberfortheCampFarWestIrrigationDistrict–amulti-countyagencythatcoversPlacerandYubacounties.Brian will complete one Form 700 using full disclosure(asrequiredforthecityposition)andcoveringinterestsinbothPlacerandYubacounties(asrequiredforthemulti-countyposition)andlistbothpositionsontheCoverPage.Beforesigningthestatement,Brian will make a copy andsignbothstatements.OnestatementwillbefiledwithCityofLincolnandtheotherwillbefiledwithCampFarWestIrrigationDistrict.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

FPPC Form 700 - Cover Page (2019/2020)[email protected] • 866-275-3772 • www.fppc.ca.gov

Page - 6

IF APPLICABLE,LISTDATE:

/ / / /ACquIRED DISPOSED











19 19 19 19

1919

191919

Name

► NAMEOFBuSINESS ENTITY

GENERALDESCRIPTIONOFTHIS BuSINESS











Comments:

SCHEDULE A-1Investments

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

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


CALIFORNIA FORM

FAIR MARkETvALuE $2,000 -$10,000 $10,001 -$100,000 $100,001 -$1,000,000 Over$1,000,000






19

NATuREOF INvESTMENTStock Other

(Describe)Partnership IncomeReceived of $0 - $499

IncomeReceivedof$500orMore (Report on Schedule C)


(Describe)Partnership IncomeReceivedof$0 -$499














1919

FPPC Form 700 - Schedule A-1 (2019/2020)[email protected] • 866-275-3772 • www.fppc.ca.gov

Page - 7

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 investmentfunds(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 (includingalivingtrust),youmustdiscloseinvestmentsheldbythebusinessentityortrust.(SeeReferencePamphlet,page16,formoreinformationondisclosingtrusts.)

• Business trusts

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

fundssimilartodiversifiedmutualfunds(suchasexchangetradedfunds)andinvestmentsheldincertainretirementaccounts.(SeeReferencePamphlet,page13.)(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 ReferencePamphlet,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 ofyourinvestmentduringthereportingperiod.Ifyouarefilingacandidateoranassumingofficestatement,indicatethefairmarketvalueonthefilingdateorthedateyoutookoffice,respectively.(Seepage20formoreinformation.)

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

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

Examples:Frank Byrdholdsastateagencyposition.Hisconflictofinterestcoderequiresfulldisclosureofinvestments.Frank mustdisclosehisstockholdingsof$2,000ormoreinanycompanythatislocatedinordoesbusinessinCalifornia,as well as those stocks held by his spouse or registered domestic partner and dependent children.

Alice Lanceisacitycouncilmember.Shehasa4%interest,worth$5,000,inalimitedpartnershiplocatedinthecity.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.


Page - 8









19 19

19 1919 19

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)

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

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

GENERALDESCRIPTIONOFTHIS BuSINESS GENERALDESCRIPTIONOFTHIS BuSINESS

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 oneTrust,go to 2 BusinessEntity,complete the box, then go to 2

Check oneTrust,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 RATASHARE OF THE GROSS INCOME TO THE ENTITY/TRUST)

Name

700

Check one box: Check one box:

YOuRBuSINESSPOSITION YOuRBuSINESS POSITION



$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 propertyare attached

Yrs. remaining

NATuREOF INTEREST Property Ownership/Deed of Trust Stock Partnership

Leasehold Other

Check box if additional schedules reporting investments or real propertyare attached

Yrs. remaining

19 19

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.)

FPPC Form 700 - Schedule A-2 (2019/2020)[email protected] • 866-275-3772 • www.fppc.ca.gov

Page - 9

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 theentity.

• Check the box indicating the highest fair market value ofyour 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 loanto the business entity or trustidentifiedinPart1ifyour pro rata share of the gross income (including yourcommunitypropertyinterestinyourspouse’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 sourceofcommissionincomeof$10,000ormoreduringthereportingperiodthroughthebusinessentityidentifiedinPart1.(SeeReferencePamphlet,page8.)

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

Mark“None”ifyoudonothaveanyreportable$10,000sources of income to disclose. Phrasessuchas“variousclients”or“notdisclosingsourcespursuanttoattorney-clientprivilege”arenotadequatedisclosure. (See Reference Pamphlet,page14,forinformationonprocedurestorequest anexemptionfromdisclosingprivilegedinformation.)

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 asreal property or an investment.

• Ifinvestment,providethenameanddescriptionofthebusiness entity.

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

• Check the box indicating the highest fair market valueof your interest in the real property or investment duringthe reporting period. (Report the fair market value of theportion of your residence claimed as a tax deduction if youareutilizingyourresidenceforbusinesspurposes.)

• Identifythenatureofyourinterest.• Enterthedateacquiredordisposedonlyifyouinitially

acquiredorentirelydisposedofyourinterestintheproperty or investment during the reporting period.


Page - 10

NAME OFLENDER*

ADDRESS (Business Address Acceptable)

BuSINESS ACTIvITY, IFANY,OFLENDER





19 1919 19

SCHEDULE BInterests in Real Property

(IncludingRental Income)

Name

► ASSESSOR’SPARCELNuMBERORSTREET ADDRESS ► ASSESSOR’SPARCELNuMBERORSTREET ADDRESS

CITY CITY

INTEREST RATE 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:



IF RENTAL PROPERTY,GROSS INCOMERECEIvED

OvER$100,000

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

$10,001 -$100,000

IF RENTAL PROPERTY,GROSS INCOMERECEIvED

OvER$100,000

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

$10,001 -$100,000

HIGHESTBALANCEDuRING REPORTING PERIOD

Guarantor, ifapplicable

OvER$100,000

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

$10,001 -$100,000


CALIFORNIA FORM

NAME OFLENDER*


BuSINESS ACTIvITY, IFANY,OFLENDER

INTEREST RATE TERM(Months/Years)

% None

Guarantor, ifapplicable

HIGHESTBALANCEDuRING REPORTING PERIOD

OvER$100,000

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

$10,001 -$100,000

* Youarenotrequiredtoreportloansfrom a commerciallendinginstitutionmadeinthelender’sregularcourseofbusinessontermsavailabletomembersofthepublicwithoutregardtoyourofficialstatus.Personalloansandloansreceivednotinalender’sregularcourseofbusinessmustbedisclosedasfollows:

None None

FPPC Form 700 - Schedule B (2019/2020)[email protected] • 866-275-3772 • www.fppc.ca.gov

Page - 11

disclose the number of years remaining on the lease.• Ifyoureceivedrentalincome,checktheboxindicatingthe

gross amount you received.• Ifyouhada10%orgreaterinterestinrealpropertyand

receivedrentalincome,listthenameofthesource(s)ifyour pro rata share of the gross income from any singletenantwas$10,000ormoreduringthereportingperiod.Ifyoureceivedatotalof$10,000ormorefromtwoormoretenantsactinginconcert(inmostcases,thiswillapplytomarriedcouples),disclosethenameofeachtenant.Otherwise,mark“None.”

• Loans from a private lender that total $500 or more andare secured by real property may be reportable. Loansfrom commercial lending institutions made in thelender’s regular course of business on terms availableto members of the public without regard to your officialstatus 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. Forvariableinterestrateloans,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: Allison Gande is a city planning commissioner. Duringthereportingperiod, she received rental income of $12,000,fromasingletenantwho rented property she ownedinthecity’sjurisdiction.IfAllisonreceived$6,000eachfromtwotenants,thetenants’nameswouldnotberequiredbecausenosingletenantpaidher$10,000ormore. A married couple 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 abusinessdeductionmaybereportable.Ifreportable,report the fair market value of the portion claimed as a taxdeduction.)

• Some interests in real property held through a blind trust(SeeReferencePamphlet,page16.)• Please note: A non-reportable property can still

begroundsforaconflictofinterestandmaybedisqualifying.

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 theproperty).

• Enterthedateacquiredordisposedonlyifyouinitiallyacquiredorentirelydisposedofyourinterestintheproperty during the reporting period.

• Identifythenatureofyourinterest.Ifitisaleasehold,


Page - 12

name of lender*

address (Business Address Acceptable)

business activity, if any, of lender

if applicable, list date:

/ / / / acquired disposed


/ / / /acquired disposed

18 1818 18

Schedule BInterests in Real Property

(including rental income)

name

► ASSESSOR’S PARCEL NUMBER OR street address ► 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

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

► ASSESSOR’S PARCEL NUMBER OR street address ► ASSESSOR’S PARCEL NUMBER OR street address

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


BuSINESSACTIvITY, IFANY,OFSOuRCE

YOuRBuSINESSPOSITION

NAMEOFLENDER*


BuSINESSACTIvITY, IFANY,OFLENDER

INTERESTRATE TERM(Months/Years)

% None

HIGHESTBALANCEDuRINGREPORTINGPERIOD

$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 commerciallendinginstitution,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)

CONSIDERATIONFORWHICH INCOMEWASRECEIvED Salary Spouse’sor registereddomesticpartner’s income

(Forself-employeduseScheduleA-2.)

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

Sale of

Other

CONSIDERATIONFORWHICH INCOMEWASRECEIvED 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

FPPC Form 700 - Schedule C (2019/2020)[email protected] • 866-275-3772 • www.fppc.ca.gov

Page - 13

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.)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 theemployer’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.)• Incentivecompensation(SeeReferencePamphlet,page

12.)

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

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

• Stock dividends and income from the sale of stock unlessthesourcecanbeidentified.

• IncomefromaPERSretirementaccount.

(SeeReferencePamphlet,page12.)

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 businessposition.

• Provide a general description of the business activity if thesource is a business entity.

• Check the box indicating the amount of gross incomereceived.

• Identifytheconsiderationforwhichtheincomewasreceived.

• Forincomefromcommissionsales,checktheboxindicating the gross income received and list the name ofeachsourceofcommissionincomeof$10,000ormore.(SeeReferencePamphlet,page8.)Note: If you receivecommission income on a regular basis or have anownership interest of 10% or more, you must disclosethe 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.


Page - 14

SCHEDULE DIncome – Gifts

Comments:

Name


CALIFORNIA FORM

►NAMEOFSOuRCE (Not an Acronym)


BuSINESS ACTIvITY, IFANY,OFSOuRCE

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

/ / $

/ / $

/ / $





/ / $

/ / $

/ / $





/ / $

/ / $

/ / $





/ / $

/ / $

/ / $





/ / $

/ / $

/ / $





/ / $

/ / $

/ / $

FPPC Form 700 - Schedule D (2019/2020)[email protected] • 866-275-3772 • www.fppc.ca.gov

Page - 15

Instructions – Schedule DIncome – Gifts

Reminders• Giftsfromasinglesourcearesubjecttoa$500 limit 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 mobiledevicesthathelpsfilerstrackgiftsandprovidesaquickand 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 aconvention,conference,meeting,socialevent,meal,orlikegathering

• Rebates/discounts not made in the regular course ofbusinesstomembersofthepublicwithoutregardtoofficialstatus

• Weddinggifts(SeeReferencePamphlet,page16)• Anhonorariumreceivedpriortoassumingoffice(Youmay

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

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

You are not required to disclose:• Giftsthatwerenotusedandthat,within30daysafter

receipt,werereturnedtothedonorordeliveredtoacharitable organization or government agency withoutbeing claimed by you as a charitable contribution for taxpurposes

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

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

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

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

• Personalizedplaquesortrophieswithanindividualvalueofless than $250

• Campaign contributions• uptotwotickets,foryourownuse,toattendafundraiser

foracampaigncommitteeorcandidate,ortoafundraiserfor an organization exempt from taxation under Section501(c)(3)oftheInternalRevenueCode.Theticketmustbe received from the organization or committee holding thefundraiser.

• Gifts given to members of your immediate family if thesource has an established relationship with the familymember and there is no evidence to suggest the donor hadapurposetoinfluenceyou.(SeeRegulation18943.)

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

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

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.


Page - 16

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 received from a nonprofit 501(c)(3) organization

or the “Speech” box if you made a speech or participated in a panel. Per Government CodeSection 89506, these payments may not be subject to the gift limit. However, they may resultin a disqualifying conflict of interest.

• For gifts of travel, provide the travel destination.

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




CITYANDSTATE

501(c)(3)orDESCRIBEBuSINESS ACTIvITY,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




FPPC Form 700 - Schedule E (2019/2020)[email protected] • 866-275-3772 • www.fppc.ca.gov

Page - 17

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”to read about travel payments under section 89506(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.

• AtravelpaymentthatwasreceivedfromanonprofitentityexemptfromtaxationunderInternalRevenueCodeSection501(c)(3)forwhichyouprovidedequalorgreaterconsideration,suchasreimbursementfortravelonbusinessfora501(c)(3)organizationforwhichyouareaboard member.Note: Certain travel payments may not be reportable if reported via email 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 MaryClaire Chandler is the chair of a 501(c)(6)tradeassociation,and the association pays for her travel to attend its meetings. Because MaryClaire is deemed tobeprovidingequalorgreaterconsiderationforthetravelpayment by virtue of servingontheboard,thispayment may be reported as income. Payments for MaryClaire to attend other events for which she is not providing services are likely considered gifts. Notethatthesamepaymentfroma501(c)3wouldNOTbereportable.

Example:MayorkimtravelstoChinaonatriporganizedbyChinaSiliconvalleyBusinessDevelopment,aCalifornianonprofit,501(c)(6)organization.TheChengduMunicipalPeople’sGovernmentpaysforMayorkim’sairfareandtravelcosts,aswellashismealsandlodgingduringthetrip.Thetrip’sagendashowsthatthetrip’spurposeistopromotejobcreation and economic activity in China and in Siliconvalley,sothetripis reasonably related to a governmental purpose. Thus,Mayorkimmustreportthegiftoftravel,but the gift is exempt from thegiftlimit.Inthiscase,the travel payments are notsubjecttothegiftlimitbecause the source is a foreign government and because the travel is reasonably relatedtoagovernmentalpurpose.(Section89506(a)(2).)NotethatMayorkimcouldbedisqualifiedfromparticipatinginormakingdecisionsaboutTheChengduMunicipalPeople’sGovernment for 12 months. Also note that if China Silicon valleyBusinessDevelopment(a501(c)(6)organization)paidforthetravelcostsratherthanthegovernmentalorganization,thepaymentswouldbesubjecttothegiftlimits.(SeetheFPPCfactsheet,LimitationsandRestrictionsonGifts,Honoraria,TravelandLoans,atwww.fppc.ca.gov.)

Instructions – Schedule ETravel Payments, Advances,

and Reimbursements


Page - 18

SChEDuLE EIncome – Gifts


Name

Comments:

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


700FAIr POLITICAL PrACTICES COMMISSION

CALIFORNIA FORM


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

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



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

550.00

● 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


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

550.00

● 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

Restrictions and Prohibitions

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

Gift ProhibitionGiftsreceivedbymoststateandlocalofficials,employees,andcandidatesaresubjecttoa limit. In2019-2020,thegiftlimit is $500 from a single source during a calendar year. Additionally,stateofficials,statecandidates,andcertainstateemployeesaresubjecttoa$10limitpercalendarmonthongiftsfromlobbyistsandlobbyingfirmsregisteredwiththeSecretaryofState.SeeReferencePamphlet,page 10.

Stateandlocalofficialsandemployeesshouldcheckwiththeir agency to determine if other restrictions apply.

DisqualificationPublicofficialsare,undercertaincircumstances,requiredtodisqualifythemselvesfrommaking,participatingin,orattemptingtoinfluencegovernmentaldecisionsthatwillaffecttheireconomicinterests.Thismayincludeintereststheyarenotrequiredtodisclose.Forexample,apersonalresidenceisoftennotreportable,butmaybegroundsfordisqualification.Specificdisqualificationrequirementsapplyto87200filers(e.g.,citycouncilmembers,membersofboardsofsupervisors,planningcommissioners,etc.).Theseofficialsmustpubliclyidentifytheeconomicinterestthatcreatesaconflictofinterestandleavetheroombeforea discussion or vote takes place at a public meeting. For moreinformation,consultGovernmentCodeSection87105,Regulation18707,andtheGuidetoRecognizingConflictsofInterestpageatwww.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.


Page - 19

Questions and Answers

GeneralQ. What is the reporting period for disclosing interests

onanassumingofficestatementoracandidatestatement?

A. Onanassumingofficestatement,discloseallreportableinvestments,interestsinrealproperty,andbusiness positions held on the date you assumedoffice.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 onthe Cover Page or an attachment as the agencies forwhichyouwillbefiling.Reportyoureconomicinterestsusingthelargestjurisdictionandhighestdisclosurerequirementsassignedtoyoubythethreeagencies.Maketwocopiesoftheentirestatementbeforesigningit,signeachcopywithanoriginalsignature,and distribute one original to the county and to eachof the two boards. Remember to complete separatestatements for positions that you leave or assumeduring the year.

q. Iamadepartmentheadwhorecentlybeganactingascitymanager.ShouldIfileasthecitymanager?

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

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

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

q. Asadesignatedemployee,Ileftonestateagencytoworkforanotherstateagency.MustIfilealeavingofficestatement?

A. Yes.Youmayalsoneedtofileanassumingofficestatement for the new agency.

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 byabrokeragefirm.MustIdisclosethesestockseventhoughtheyareheldinanIRAandIdidnotdecidewhich stocks to purchase?

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

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

A. Youarerequiredtoreportthehighestvaluethatthestockreachedduringthereportingperiod.Youmayuse your monthly statements to determine the highestvalue.Youmayalsousetheentity’swebsitetodeterminethehighestvalue.Youareencouragedtokeep a record of where you found the reported value.Notethatforanassumingofficestatement,youmustreport the value of the stock on the date you assumedoffice.


Page - 20

Questions and AnswersContinued

q. Iamthesoleownerofmybusiness,anS-Corporation.Ibelievethatthenatureofthebusinessissuchthatitcannotbesaidtohaveany“fairmarketvalue”becauseithasnoassets.Ioperatethecorporationunderanagreementwithalargeinsurancecompany.Mycontract does not have resale value because of itsnatureasapersonalservicescontract.MustIreportthe fair market value for my business on Schedule A-2of 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 adeterminablevalue.TheForm700doesnotrequireaprecise fair market value; it is only necessary to checka box indicating the broad range within which the valuefalls.

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 moneyforourson’scollegeeducation.Isthisreportable?

A. IftheSection529accountcontainsreportableinterests(e.g.,commonstockvaluedat$2,000ormore),thoseinterests are reportable (not the actual Section 529account).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 alegally recognized privilege under California or Federallaw. This regulation may be obtained from our websiteat 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 forinformationalpurposesonly;itisnotarequirement.


Page - 21


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

A. Sources of income to a business in which you have anownershipinterestof10%orgreateraredisclosedonScheduleA-2.(SeeReferencePamphlet,page8.)

q. Myhusbandisapartnerinafour-personfirmwhereall of his business is based on his own billings andcollectionsfromvariousclients.HowdoIreportmycommunity property interest in this business and theincome 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 incomeon Schedule C.

q. Iamadoctor.Forpurposesofreporting$10,000sourcesofincomeonScheduleA-2,Part3,arethepatients or their insurance carriers considered sourcesof income?

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

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 wasused exclusively as your residence. This would be forinformationalpurposesonly;itisnotarequirement.

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

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

q. MustIreportahomethatIownasapersonalresidencefor my daughter?

A. Youarenotrequiredtodiscloseahomeusedasapersonal residence for a family member unless youreceiveincomefromit,suchasrentalincome.

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

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

Gift DisclosureQ. IfIreceivedareportablegiftoftwoticketstoaconcert

valuedat$100each,butgavetheticketstoafriendbecauseIcouldnotattendtheconcert,doIhaveanyreporting obligations?

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


Page - 22

Q. Julia and JaredBenson,amarriedcouple,wanttogiveapieceofartworktoacountysupervisor.Iseachspouse considered a separate source for purposes ofthe gift limit and disclosure?

A. Yes,eachspousemaymakeagiftvaluedatthegiftlimit duringacalendaryear.Forexample,during2019thegiftlimitwas$500,sotheBensonsmayhavegiventhe supervisor artwork valued at no more than $1,000.The supervisor must identify Jared and Julia Benson asthe sources of the gift.

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

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

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

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

q. Ireceivedfreeadmissiontoaneducationalconferencerelatedtomyofficialduties.Partoftheconferencefeesincludedaroundofgolf.Isthevalueofthegolfconsidered informational material?

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



Page - 23