13-B — Bellflower City Council, August 28, 2023

13-B
TO: Honorable Mayor and Members of the City Council

FROM: Jeffrey L. Stewart, City Manager

SUBJECT: Consideration and possible action to provide direction to staff regarding the City Council vacancy.

DATE: August 28, 2023

EXECUTIVE SUMMARY

On August 11, 2023, Mayor Pro Tem Raymond Y. Hamada submitted a letter resigning his position on the Bellflower City Council (District 1), effective August 14, 2023. His seat on the City Council is now vacant pursuant to Government Code §§ 1750(f) and 1770(c). Pursuant to Government Code § 36512, the City Council has the following options: 1) call a special election to be held at the next regularly established election date (March 5, 2024) to fill the vacant seat; or 2) appoint a qualified resident of District 1 to fill the unexpired term created by Mr. Hamada’s resignation until the results of the next regularly scheduled City Council election (November 5, 2024). Should the City Council take action to appoint a member of the community residing in District 1 to fill the open seat, staff is recommending a process that includes the requirements detailed in the Application Process (Exhibit A) and the Application Packet (Exhibit B). However, the City Council is not obligated to make an appointment.

RECOMMENDATION TO CITY COUNCIL

Provide direction to staff to do one of the following:

1) Prepare the necessary documents to call a special election on March 5, 2024, to fill the vacant seat; or

2) Establish a process to appoint a resident from Council District 1 of the City to serve as Council Member for a term ending in December 2024 (at the declaration of the results of the next regularly scheduled Municipal Election on November 5, 2024), as follows:

a) Approve the Application Process (Exhibit A) and Application Packet for Appointment to the Bellflower City Council (Exhibit B);

b) Authorize the City Clerk to make the Application Packet available beginning August 29, 2023 and follow the Application Process to accept applications from qualified residents until 5:00 p.m., on September 5, 2023, to fill the District 1 City Council seat; or

3) Alternatively, discuss and take other action related to this item.

Page 1 of 2 ends

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Staff Report – Vacant Council Seat
August 28, 2023

Page 2 of 2 ends

FISCAL IMPACT

A special election for Council Member District 1 on March 5, 2024, is estimated at $51,586.81 and would require a budget amendment. A special election for Council Member District 1 combined with the next regularly scheduled Municipal Election on November 5, 2024, is estimated at $35,012.91 and sufficient allocation exists in the budgeted 2024-25 election cost (Account No. 010-43600-1210).

PUBLIC NOTICE

No additional public notice required.

DISCUSSION

Based upon the timing of Mr. Hamada’s resignation, the City may take any of the following actions: 1) call a special election to be held at the next regularly established election date (March 5, 2024) to fill the vacant seat; or 2) appoint a qualified resident of District 1 to fill the unexpired term created by Mr. Hamada’s resignation until the results of the next regularly scheduled City Council election (November 5, 2024). Should the City Council take action to appoint a member of the community residing in District 1 to fill the open seat, staff is recommending a process that includes the requirements detailed in the Application Process (Exhibit A) and the Application Packet (Exhibit B).

However, the City Council is not obligated to make an appointment.

ATTACHMENTS

Exhibit A – Application Process to Fill the Anticipated Vacancy on the City Council Exhibit B – Application Packet for Appointment to the Bellflower City Council

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EXHIBIT A

CITY OF BELLFLOWER

APPLICATION PROCESS TO FILL THE VACANCY ON THE CITY COUNCIL (COUNCIL MEMBER DISTRICT 1)

1) To be appointed to the City Council you must be a registered voter residing in District 1 in the City of Bellflower at the time of submitting the Application Packet and must remain an elector and resident of District 1 in the City while serving on the Council.

2) Interested parties will be required to complete an application packet that will considered by the full City Council.

3) The Application Packet will require a completed Application with a Statement of Qualifications attached and a Statement of Economic Interest (FPPC Form 700).

4) The City Clerk will review all application packets received to ensure that the packet is complete. All required forms must be submitted at the same time. Incomplete or electronically submitted application packets will not be considered by the City Council. All submitted application packets will be kept confidential for the duration of the application period.

5) The City Council will have full discretion on how to conduct its review of the candidate applications. No additional written materials will be accepted, except materials required as part of the application packet. The Council Members will not discuss the candidates prior to the City Council meeting at which the City Council Appointment is placed on the agenda for.

6) At a City Council Meeting, the City Council at its discretion may appoint a candidate if it reaches consensus.

7) If necessary, finalists will be invited for an interview with the City Council at a Special City Council meeting to be scheduled at a future date, if needed. Upon completion of interviews, the City Council may appoint a qualified candidate to fill the vacant seat; OR subsequently meet at a Regular or Special City Council meeting not later than October 13, 2023, to either appoint a candidate to fill the vacant seat or schedule a special municipal election for March 5, 2024.
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EXHIBIT B

APPLICATION PACKET

FOR CITY COUNCIL VACANCY
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APPLICATION FOR APPOINTMENT TO THE BELLFLOWER CITY COUNCIL (PUBLIC DOCUMENT)

COMPLETED AND SIGNED APPLICATION PACKETS MUST BE FILED IN PERSON WITH THE CITY CLERK’S OFFICE BY
TUESDAY, SEPTEMBER 5, 2023, AT 5:00 P.M.

This application is to fill a vacancy on the Bellflower City Council with the term expiring in December 2024. This application is a public document. It may be reviewed by any member of the public upon request after the close of the application period. Only Bellflower registered voters who have submitted a complete Application Packet by the deadline will be considered for appointment.

Name

Name as listed on voter registration

Residence Address

Mailing Address (if different)

Home Phone Daytime Phone

Occupation & Employer

Are you currently a registered voter and a resident of District 1 in the City of Bellflower?

Years of Residence in the City Years of Residence in District 1

Are you able to commit the time required to serve on the City Council? Yes No

Have you ever served on any Boards, Committees, Commissions, Task Forces, etc. (City of Bellflower or otherwise), in the past? Yes No

If yes, please list:

STATEMENT OF QUALIFICATIONS:

On a separate sheet of paper using only ARIAL 12 POINT FONT, please answer the following question in a MAXIMUM of 200 WORDS: Why are you the best candidate to fill the vacancy on the Bellflower City Council?

Page 1 of 2 ends

DATE/TIME RECEIVED:

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Application for Appointment to the Bellflower City Council

Page 2 of 2 ends

To be appointed to the City Council you must be a registered voter residing in District 1 in the City of Bellflower at the time of submitting this Application and must remain an elector of District 1 in the City while serving on the Council.

To be considered for appointment you must submit a completed and signed Application Packet in person which includes:

1. The Application with Statement of Qualifications attached; and

2. The FPPC Form 700 (Statement of Economic Interests).

Return Application Packet to:

City of Bellflower - City Clerk’s Office
16600 Civic Center Drive
Bellflower, CA 90706
(562) 804-1424, ext. 2220

Incomplete or electronically submitted Application Packets will not be accepted. All signatures on all required forms must be original wet signatures.

FILING DEADLINE: TUESDAY, SEPTEMBER 5, 2023, AT 5:00 P.M.

I, _______________________________, declare under penalty of perjury, under the laws of the State of California, that all information stated in this application and all attached pages are true, correct, and complete. I further declare that I am a resident of the City of Bellflower and reside and am registered to vote in District 1 the City of Bellflower.

Applicant’s Signature Date

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December 2022
2022-2023
Statement of
Economic Interests
Form 700
California Fair Political Practices Commission
1102 Q Street, Suite 3000 • Sacramento, CA 95811
Email Advice: [email protected]
Toll-free advice line: 1 (866) ASK-FPPC • 1 (866) 275-3772 Telephone: (916) 322-5660 • Website: www.fppc.ca.gov
A Public Document
Table of Contents
Quick Start Guide .................................................... p.2 Who? Where? How? When? ....................................p.3 Types of Statements .................................................p.4 Cover Page and Schedules
Cover Page ........................................................p.5 Schedule A-1 (Investments) ...............................p.7 Schedule A-2 (Business Entities/Trusts) ............p.9 Schedule B (Real Property) ...............................p.11 Schedule C (Income) .........................................p.13 Schedule D (Gifts) ..............................................p.15 Schedule 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 and
Local Officials
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Quick Start Guide
Detailed instructions begin on page 3.

WHEN IS THE ANNUAL STATEMENT DUE?
• March 1 – Elected State Officers, Judges and Court Commissioners, State Board and Commission members listed in Government Code Section 87200
• April 1 – Most other filers
WHERE DO I FILE?
Most people file the Form 700 with their agency. If you’re not sure where to file your Form 700, contact your filing officer or the person who asked you to complete it.

ITEMS TO NOTE!
• The Form 700 is a public document.
• Only filers serving in active military duty may receive an extension on the filing deadline. • You must also report interests held by your spouse or registered domestic partner. • Your agency’s conflict of interest code will help you to complete the Form 700. You are encouraged to get your conflict of interest code from the person who asked you to complete the Form 700.

NOTHING TO REPORT?
Mark the “No reportable interests” box on Part 4 of the Cover Page, and submit only the signed Cover Page.

Please review each schedule carefully!
Schedule
Common
Reportable Interests
Common
Non-Reportable Interests
A-1:

Investments
Stocks, including those held in an IRA
or 401K. Each stock must be listed.

Insurance policies, government bonds, diversified
mutual funds, funds similar to diversified mutual
funds.

A-2:

Business
Entitites/Trusts
Business entities, sole proprietorships,
partnerships, LLCs, corporations and
trusts. (e.g., Form 1099 filers).

Savings and checking accounts, cryptocurrency,
and annuities.

Real Property
Rental property in filer’s jurisdiction, or
within two miles of the boundaries of
the jurisdiction.

A residence used exclusively as a personal
residence (such as a home or vacation property).

Income
Non-governmental salaries. Note that
filers are required to report only half of
their spouse’s or partner’s salary.

Governmental salary (from school district, for
example).

Gifts
Gifts from businesses, vendors, or
other contractors (meals, tickets, etc.).

Gifts from family members.

Travel
Payments
Travel payments from third parties (not
your employer).

Travel paid by your government agency.

Note: Like reportable interests, non-reportable interests may also create conflicts of interest and could be grounds for disqualification from certain decisions.

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

E-FILING ISSUES?
• If using your agency’s system, please contact technical support at your agency. • If using FPPC’s e-filing system, write to [email protected].

FPPC Form 700 (2022/2023)
[email protected] • 866-275-3772 • www. .ca.gov
Page - 2-8-

How to file:

The Form 700 is available at www.fppc.ca.gov . Form 700 schedules are also available in Excel format. Each Statement must have a handwritten “wet” signature or “secure electronic signature,” meaning either (1) a signature submitted using an approved electronic filing system or (2) if permitted by the filing officer, a digital signature submitted via the filer’s agency email address. (See Regulations 18104 and 18757.) Companies such as Adobe and DocuSign offer digital signature services. All statements are signed under the penalty of perjury and must be verified by the filer. See Regulation 18723.1(c) for filing instructions for copies of expanded statements.

When to file:

Annual Statements
Â March 1, 2023
-Elected State Officers
-Judges and Court Commissioners
-State Board and State Commission Members listed in
Government Code Section 87200
Â April 3, 2023
-Most other filers
Individuals filing under conflict of interest codes in city and county jurisdictions should verify the annual filing date with their filing official or filing officer.

Statements postmarked by the filing deadline are considered filed on time.

Statements of 30 pages or less may be emailed or faxed by the deadline as long as the originally signed paper version is sent by first class mail to the filing official within 24 hours.

Assuming Office and Leaving Office Statements
Most filers file within 30 days of assuming or leaving office or within 30 days of the effective date of a newly adopted or amended conflict of interest code.

Exception:

If you assumed office between October 1,2022, and
December 31, 2022, and filed an assuming office statement, you are not required to file an annual statement until March 1, , 2024, or April 1, 2024, whichever is applicable. The annual statement will cover the day after you assumed office through December 31, 2023. (See Reference Pamphlet, page 6, for additional exceptions.

Candidate Statements
File no later than the final filing date for the declaration of candidacy or nomination documents. A candidate statement is not required if you filed an assuming office or annual statement for the same jurisdiction within 60 days before filing a declaration of candidacy or other nomination documents.

Late Statements
There is no provision for filing deadline extensions unless the filer is serving in active military duty. (See page 19 for information on penalties and fines.)
Amendments
Statements may be amended at any time. You are only
required to amend the schedule that needs to be revised. It is not necessary to amend the entire filed form. The amended schedule(s) is attached to your original filed statement. Obtain amendment schedules at www.fppc.ca.gov .

FPPC Form 700 (2022/2023)
[email protected] • 866-275-3772 • www.fppc.ca.gov
Page - 3
What’s New
Gift Limit Increase
The gift limit increased to $520 for calendar years 2021 and 2022.

Who must file:
• Elected and appointed officials and candidates listed in Government Code Section 87200
• Employees, appointed officials, and consultants filing pursuant to a conflict of interest code (“code filers”). Obtain your disclosure categories, which describe the interests you must report, from your agency; they are not part of the Form 700
• Candidates running for local elective offices that are designated in a conflict of interest code (e.g., county sheriffs, city clerks, school board trustees, and water board members) Exception:
• Candidates for a county central committee are not
required to file the Form 700
• Employees in newly created positions of existing
agencies
For more information, see Reference Pamphlet, page 3, at www. fppc.ca.gov.

Where to file:
87200 Filers
State offices Â Your agency
Judicial offices Â The clerk of your court
Retired Judges Â Directly with FPPC
County offices Â Your county filing official
City offices Â Your city clerk
Multi-County offices Â Your agency
Code Filers — State and Local Officials, Employees, and Consultants Designated in a Conflict of Interest
Code: File with your agency, board, or commission unless otherwise specified in your agency’s code (e.g., Legislative staff files directly with FPPC). In most cases, the agency, board, or commission will retain the statements.

Members of Newly Created Boards and Commissions: File
with your agency or with your agency’s code reviewing body pursuant to Regulation 18754.

Employees in Newly Created Positions of Existing Agencies:

File with your agency or with your agency’s code reviewing body. (See Reference Pamphlet, page 3.)
Candidates file as follow:

State offices, Judicial County elections official with offices and whom you file your
multi-county offices Â declaration of candidacy
County offices Â County elections official
City offices Â City Clerk
Public Employee’s
Retirement System
(CalPERS) Â CalPERS
State Teacher’s
Retirement Board
(CalSTRS) Â CalSTRS
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Types of Statements
Assuming Office Statement:

If you are a newly appointed official or are newly employed in a position designated, or that will be designated, in a state or local agency’s conflict of interest code, your assuming office date is the date you were sworn in or
otherwise authorized to serve in the position. If you are a newly elected official, your assuming office date is the date you were sworn in.
• Report: Investments, interests in real property, and
business positions held on the date you assumed the
office or position must be reported. In addition, income (including loans, gifts, and travel payments) received
during the 12 months prior to the date you assumed the
office or position.

For positions subject to confirmation by the State Senate or the Commission on Judicial Appointments, your
assuming office date is the date you were appointed or
nominated to the position.
• Example: Maria Lopez was nominated by the Governor
to serve on a state agency board that is subject to
state Senate confirmation. The assuming office date
is the date Maria’s nomination is submitted to the
Senate. Maria must report investments, interests in
real property, and business positions Maria holds on
that date, and income (including loans, gifts, and travel payments) received during the 12 months prior to that
date.

If your office or position has been added to a newly
adopted or newly amended conflict of interest code, use the effective date of the code or amendment, whichever is applicable.
• Report: Investments, interests in real property, and
business positions held on the effective date of the
code or amendment must be reported. In addition,
income (including loans, gifts, and travel payments)
received during the 12 months prior to the effective date of the code or amendment.

Annual Statement:

Generally, the period covered is January 1, 2022,
through December 31, 2022. If the period covered by
the statement is different than January 1, 2022, through December 31, 2022, (for example, you assumed office
between October 1, 2021, and December 31, 2021 or you
are combining statements), you must specify the period
covered.
• Investments, interests in real property, business
positions held, and income (including loans, gifts, and travel payments) received during the period covered
by the statement must be reported. Do not change the
preprinted dates on Schedules A-1, A-2, and B unless
you are required to report the acquisition or disposition of an interest that did not occur in 2022.
• If your disclosure category changes during a reporting period, disclose under the old category until the effective date of the conflict of interest code amendment and
disclose under the new disclosure category through the
end of the reporting period.

Leaving Office Statement:

Generally, the period covered is January 1, 2022, through the date you stopped performing the duties of your position.

If the period covered differs from January 1, 2022, through the date you stopped performing the duties of your position (for example, you assumed office between October 1, 2021, and December 31, 2021, or you are combining statements), the period covered must be specified. The reporting period can cover parts of two calendar years.
• Report: Investments, interests in real property, business positions held, and income (including loans, gifts, and travel payments) received during the period covered by
the statement. Do not change the preprinted dates on
Schedules A-1, A-2, and B unless you are required to
report the acquisition or disposition of an interest that did not occur in 2022.

Candidate Statement:

If you are filing a statement in connection with your
candidacy for state or local office, investments, interests in real property, and business positions held on the date of filing your declaration of candidacy must be reported. In addition, income (including loans, gifts, and travel payments) received during the 12 months prior to the date of filing your declaration of candidacy is reportable. Do not change the preprinted dates on Schedules A-1, A-2, and B.

Candidates running for local elective offices (e.g., county sheriffs, city clerks, school board trustees, or water district board members) must file candidate statements, as required by the conflict of interest code for the elected position.

The code may be obtained from the agency of the elected position.

Amendments:

If you discover errors or omissions on any statement, file an amendment as soon as possible. You are only required to amend the schedule that needs to be revised; it is not necessary to refile the entire form. Obtain amendment
schedules from the FPPC website at www.fppc.ca.gov .

Note: Once you file your statement, you may not withdraw it.

All changes must be noted on amendment schedules.

Expanded Statement:

If you hold multiple positions subject to reporting
requirements, you may be able to file an expanded
statement for each position, rather than a separate and distinct statement for each position. The expanded statement must cover all reportable interests for all jurisdictions and list all positions on the Form 700 or on an attachment for which it is filed. The rules and processes governing the filing of an expanded statement are set forth in Regulation 18723.1.

FPPC Form 700 (2022/2023)
[email protected] • 866-275-3772 • www.fppc.ca.gov
Page - 4
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Schedule C - Income, Loans, & Business Positions – schedule attached Schedule D - Income – Gifts – schedule attached
Schedule E - Income – Gifts – Travel Payments – schedule attached Leaving Office: Date Left //
(Check one circle.)
The period covered is January 1, 20222022, through the date of leaving office.

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

Annual: The period covered is January 1, 2022,2022, through December 31, 20222022.

The period covered is //, through
December 31, 20222022.

STATEMENT OF ECONOMIC INTERESTS

COVER PAGE

A 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 Initial Filing Received
Filing Official Use Only
Please type or print in ink.
700

FAIR 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 (required)
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-
FPPC Form 700 - Cover Page (2022/2023)
[email protected] • 866-275-3772 • www.fppc.ca.gov
Page - 5-11-

• If your agency is not a state office, court, county office, city office, or multi-county office (e.g., school districts, special districts and JPAs), check the “other” box and enter the county or city in which the agency has jurisdiction.

Example:

This filer is a member of a water district board with jurisdiction in portions of Yuba and Sutter Counties.

Part 3. Type of Statement
Check at least one box. The period covered by a statement is determined by the type of statement you are filing. If you are completing a 2022 annual statement, do not change the pre-printed dates to reflect 2023. Your annual statement is used for reporting the previous year’s economic interests.

Economic interests for your annual filing covering January 1, 2023, through December 31, 2023, will be disclosed on your statement filed in 2024. See Reference Pamphlet, page 4.

Combining Statements: Certain types of statements for the same position may be combined. For example, if you leave office after January 1, but before the deadline for filing your annual statement, you may combine your annual and leaving office statements. File by the earliest deadline. Consult your filing officer or the FPPC.

Part 4. Schedule Summary
• Complete the Schedule Summary after you have reviewed each schedule to determine if you have reportable
interests.
• Enter the total number of completed pages including the cover page and either check the box for each schedule you use to disclose interests; or if you have nothing to disclose on any schedule, check the “No reportable interests” box.

Please do not attach any blank schedules.

Part 5. Verification
Complete the verification by signing the statement and
entering the date signed. Each statement must have an
original “wet” signature unless filed with a secure electronic signature. (See page 3 above.) All statements must be signed under penalty of perjury and be verified by the filer pursuant to Government Code Section 81004. See Regulation 18723.1(c) for filing instructions for copies of expanded statements.

When you sign your statement, you are stating, under
penalty of perjury, that it is true and correct. Only the filer has authority to sign the statement. An unsigned statement is not considered filed and you may be subject to late filing penalties.

Instructions
Cover Page
Enter your name, mailing address, and daytime telephone number in the spaces provided. Because the Form 700 is a public document, you may list your business/office address instead of your home address.

Part 1. Office, Agency, or Court
• Enter the name of the office sought or held, or the agency or court. Consultants must enter the public agency name rather than their private firm’s name. (Examples: State Assembly; Board of Supervisors; Office of the Mayor; Department of Finance; Hope County Superior Court).
• Indicate the name of your division, board, or district, if applicable. (Examples: Division of Waste Management;
Board of Accountancy; District 45). Do not use acronyms. • Enter your position title. (Examples: Director; Chief Counsel; City Council Member; Staff Services Analyst).
• If you hold multiple positions (i.e., a city council member who also is a member of a county board or commission) you may be required to file separate and distinct statements with each agency. To simplify your filing obligations, in some cases you may instead complete a single expanded statement and file it with each agency.
• The rules and processes governing the filing of an
expanded statement are set forth in Regulation 18723.1.

To file an expanded statement for multiple positions,
enter the name of each agency with which you are
required to file and your position title with each agency in the space provided. Do not use acronyms. Attach an additional sheet if necessary. Complete one statement
disclosing all reportable interests for all jurisdictions.

Then file the expanded statement with each agency as
directed by Regulation 18723.1(c).

If you assume or leave a position after a filing deadline, you must complete a separate statement. For example, a city council member who assumes a position with a county special district after the April annual filing deadline must file a separate assuming office statement. In subsequent years, the city council member may expand their annual filing to include both positions.

Example:

Brian Bourne is a city council member for the City of Lincoln and a board member for the Camp Far West Irrigation District – a multi-county agency that covers the Counties of Placer and Yuba. The City is located within Placer County. Brian may complete one expanded statement to disclose all reportable interests for both offices and list both positions on the Cover Page. Brian will file the expanded statement with each the City and the District as directed by Regulation 18723.1(c).

Part 2. Jurisdiction of Office
• Check the box indicating the jurisdiction of your agency and, if applicable, identify the jurisdiction. Judges, judicial candidates, and court commissioners have statewide
jurisdiction. All other filers should review the Reference Pamphlet, page 13, to determine their jurisdiction.
• If your agency is a multi-county office, list each county in which your agency has jurisdiction.

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:

Yuba & Sutter Counties
Board MemberN/A
N/A
Feather River Irrigation District
FPPC Form 700 - Cover Page (2022/2023)
[email protected] • 866-275-3772 • www.fppc.ca.gov
Page - 6
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SCHEDULE A-1
Investments
Stocks, Bonds, and Other Interests
(Ownership Interest is Less Than 10%)
Investments must be itemized.

Do not attach brokerage or financial statements.

IF APPLICABLE, LIST DATE:
////

ACQUIRED DISPOSED
IF APPLICABLE, LIST DATE:
////

ACQUIRED DISPOSED
22 22 22 22
2222
222222
Name
► NAME OF BUSINESS ENTITY

GENERAL DESCRIPTION OF THIS BUSINESS
► NAME OF BUSINESS ENTITY

GENERAL DESCRIPTION OF THIS BUSINESS
Comments:
700

FAIR POLITICAL PRACTICES COMMISSION

CALIFORNIA FORM

FAIR MARKET VALUE
$2,000 - $10,000 $10,001 - $100,000
$100,001 - $1,000,000 Over $1,000,000

FAIR MARKET VALUE
$2,000 - $10,000 $10,001 - $100,000
$100,001 - $1,000,000 Over $1,000,000
22 NATURE OF INVESTMENT
Stock Other
(Describe)
Partnership Income Received of $0 - $499
Income Received of $500 or More (Report on Schedule C)

NATURE OF INVESTMENT
Stock Other
(Describe)
Partnership Income Received of $0 - $499
Income Received of $500 or More (Report on Schedule C)

NATURE OF INVESTMENT
Stock Other
(Describe)
Partnership Income Received of $0 - $499
Income Received of $500 or More (Report on Schedule C)
2222
FPPC Form 700 - Schedule A-1 (2022/2023)
[email protected] • 866-275-3772 • www.fppc.ca.gov
Page - 7-13-

Instructions – Schedules A-1 and A-2
Investments
“Investment” means a financial interest in any business entity (including a consulting business or other
independent contracting business) that is located in, doing business in, planning to do business in, or that has done business during the previous two years in your agency’s jurisdiction in which you, your spouse or registered
domestic partner, or your dependent children had a direct, indirect, or beneficial interest totaling $2,000 or more at any time during the reporting period. (See Reference
Pamphlet, page 13.)
Reportable investments include:
• Stocks, bonds, warrants, and options, including those held in margin or brokerage accounts and managed
investment funds (See Reference Pamphlet, page 13.)
• Sole proprietorships
• Your own business or your spouse’s or registered
domestic partner’s business (See Reference Pamphlet,
page 8, for the definition of “business entity.”)
• Your spouse’s or registered domestic partner’s
investments even if they are legally separate property
• Partnerships (e.g., a law firm or family farm)
• Investments in reportable business entities held in a retirement account (See Reference Pamphlet, page 15.)
• If you, your spouse or registered domestic partner,
and dependent children together had a 10% or
greater ownership interest in a business entity or trust (including a living trust), you must disclose investments held by the business entity or trust. (See Reference
Pamphlet, page 16, for more information on disclosing
trusts.)
• Business trusts
You are not required to disclose:
• Government bonds, diversified mutual funds, certain
funds similar to diversified mutual funds (such as
exchange traded funds) and investments held in certain
retirement accounts. (See Reference Pamphlet, page

13.) (Regulation 18237)
• Bank accounts, savings accounts, money market
accounts and certificates of deposits
• Cryptocurrency
• Insurance policies
• Annuities
• Commodities
• Shares in a credit union
• Government bonds (including municipal bonds)
• Retirement accounts invested in non-reportable interests (e.g., insurance policies, mutual funds, or government
bonds) (See Reference Pamphlet, page 15.)
• Government defined-benefit pension plans (such as
CalPERS and CalSTRS plans)
• Certain interests held in a blind trust (See Reference Pamphlet, page 16.)
Use Schedule A-1 to report ownership of less than 10%
(e.g., stock). Schedule C (Income) may also be required if the investment is not a stock or corporate bond. (See second example below.)
Use Schedule A-2 to report ownership of 10% or greater
(e.g., a sole proprietorship).

To Complete Schedule A-1:

Do not attach brokerage or financial statements.
• Disclose the name of the business entity. Do not use
acronyms for the name of the business entity.
• Provide a general description of the business activity of the entity (e.g., pharmaceuticals, computers,
automobile manufacturing, or communications).
• Check the box indicating the highest fair market value of your investment during the reporting period. If you are filing a candidate or an assuming office statement, indicate the fair market value on the filing date or the date you took office, respectively. (See page 20 for
more information.)
• Identify the nature of your investment (e.g., stocks, warrants, options, or bonds).
• An acquired or disposed of date is only required if you initially acquired or entirely disposed of the investment interest during the reporting period. The date of a stock dividend reinvestment or partial disposal is not required.

Generally, these dates will not apply if you are filing a candidate or an assuming office statement.

Examples:

Frank Byrd holds a state agency position. Frank's conflict of interest code requires full disclosure of investments.

Frank must disclose stock holdings of $2,000 or more
in any company that is located in or does business in
California, as well as those stocks held by Franks's spouse or registered domestic partner and dependent children.

Alice Lance is a city council member. Alice has a 4%
interest, worth $5,000, in a limited partnership located in the city. Alice must disclose the partnership on Schedule A-1 and income of $500 or more received from the
partnership on Schedule C.Reminders
• Do you know your agency’s jurisdiction?
• Did you hold investments at any time during the period covered by this statement?
• Code filers – your disclosure categories may only
require disclosure of specific investments.

FPPC Form 700 (2022/2023)
[email protected] • 866-275-3772 • www.fppc.ca.gov
Page - 8-14-

SCHEDULE A-2
Investments, Income, and Assets
of Business Entities/Trusts
(Ownership Interest is 10% or Greater)

NATURE OF INTEREST
Property Ownership/Deed of Trust Stock Partnership
Leasehold Other

Check box if additional schedules reporting investments or real property are attached
Yrs. remaining
Other

NATURE OF INVESTMENT
Partnership Sole Proprietorship
IF APPLICABLE, LIST DATE:
// //

ACQUIRED DISPOSED
IF APPLICABLE, LIST DATE:
// //

ACQUIRED DISPOSED
22 22
22 2222 22
Comments:

Name
Address (Business Address Acceptable)
Name
Address (Business Address Acceptable)

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

GENERAL DESCRIPTION OF THIS BUSINESS

INVESTMENT REAL PROPERTY
Name of Business Entity, if Investment, or
Assessor’s Parcel Number or Street Address of Real Property Description of Business Activity or
City or Other Precise Location of Real Property

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

LEASED BY THE BUSINESS ENTITY OR TRUST
Check one
Trust, go to 2 Business Entity, complete the box, then go to 2 Check one
Trust, go to 2 Business Entity, complete the box, then go to 2 ► 2. IDENTIFY THE GROSS INCOME RECEIVED (INCLUDE YOUR PRO RATA

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

SHARE OF THE GROSS INCOME TO THE ENTITY/TRUST)
Name
700
Check one box:Check one box:

YOUR BUSINESS POSITION YOUR BUSINESS POSITION

FAIR MARKET VALUE
$2,000 - $10,000
$10,001 - $100,000
$100,001 - $1,000,000
Over $1,000,000

FAIR MARKET VALUE
$2,000 - $10,000
$10,001 - $100,000
$100,001 - $1,000,000
Over $1,000,000
$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

NATURE OF INTEREST
Property Ownership/Deed of Trust Stock Partnership
Leasehold Other

Check box if additional schedules reporting investments or real property are attached
Yrs. remaining
22 22
Other

NATURE OF INVESTMENT
Partnership Sole Proprietorship
or
► 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 (2022/2023)
[email protected] • 866-275-3772 • www.fppc.ca.gov
Page - 9
None Names listed below None or Names listed below
-15-

Instructions – Schedule A-2
Investments, Income, and Assets of Business Entities/Trusts Use Schedule A-2 to report investments in a business
entity (including a consulting business or other
independent contracting business) or trust (including
a living trust) in which you, your spouse or registered domestic partner, and your dependent children, together or separately, had a 10% or greater interest, totaling $2,000 or more, during the reporting period and which is located in, doing business in, planning to do business in, or which has done business during the previous two years in your agency’s jurisdiction. (See Reference Pamphlet, page

13.) A trust located outside your agency’s jurisdiction is reportable if it holds assets that are located in or doing business in the jurisdiction. Do not report a trust that contains non-reportable interests. For example, a trust containing only your personal residence not used in whole or in part as a business, your savings account, and some municipal bonds, is not reportable.

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

To Complete Schedule A-2:

Part 1. Disclose the name and address of the business
entity or trust. If you are reporting an interest in a business entity, check “Business Entity” and complete the box as follows:
• Provide a general description of the business activity of the entity.
• Check the box indicating the highest fair market value of your investment during the reporting period.
• If you initially acquired or entirely disposed of this interest during the reporting period, enter the date
acquired or disposed.
• Identify the nature of your investment.
• Disclose the job title or business position you held with the entity, if any (i.e., if you were a director, officer, partner, trustee, employee, or held any position of
management). A business position held by your spouse
is not reportable.

Part 2. Check the box indicating your pro rata share
of the gross income received by the business entity or
trust. This amount includes your pro rata share of the gross income from the business entity or trust, as well as your community property interest in your spouse’s or registered domestic partner’s share. Gross income is the total amount of income before deducting expenses, losses, or taxes.

Part 3. Disclose the name of each source of income that is located in, doing business in, planning to do business in, or that has done business during the previous two years in your agency’s jurisdiction, as follows:
• Disclose each source of income and outstanding loan
to the business entity or trust identified in Part 1 if your pro rata share of the gross income (including
your community property interest in your spouse’s or
registered domestic partner’s share) to the business
entity or trust from that source was $10,000 or more
during the reporting period. (See Reference Pamphlet,
page 11, for examples.) Income from governmental
sources may be reportable if not considered salary.

See Regulation 18232. Loans from commercial lending
institutions made in the lender’s regular course of
business on terms available to members of the public
without regard to your official status are not reportable. • Disclose each individual or entity that was a source
of commission income of $10,000 or more during the
reporting period through the business entity identified in Part 1. (See Reference Pamphlet, page 8.)
You may be required to disclose sources of income located outside your jurisdiction. For example, you may have
a client who resides outside your jurisdiction who does business on a regular basis with you. Such a client, if a reportable source of $10,000 or more, must be disclosed.

Mark “None” if you do not have any reportable $10,000
sources of income to disclose. Phrases such as
“various clients” or “not disclosing sources pursuant to attorney-client privilege” are not adequate disclosure. (See Reference Pamphlet, page 14, for information on
procedures to request an exemption from disclosing
privileged information.)
Part 4. Report any investments or interests in real
property held or leased by the entity or trust identified in Part 1 if your pro rata share of the interest held was $2,000 or more during the reporting period. Attach additional schedules or use FPPC’s Form 700 Excel spreadsheet if
needed.
• Check the applicable box identifying the interest held as real property or an investment.
• If investment, provide the name and description of the business entity.
• If real property, report the precise location (e.g., an assessor’s parcel number or address).
• Check the box indicating the highest fair market value of your interest in the real property or investment during the reporting period. (Report the fair market value of the portion of your residence claimed as a tax deduction if you are utilizing your residence for business purposes.) • Identify the nature of your interest.
• Enter the date acquired or disposed only if you initially acquired or entirely disposed of your interest in the
property or investment during the reporting period.

FPPC Form 700 (2022/2023)
[email protected] • 866-275-3772 • www.fppc.ca.gov
Page - 10-16-

NAME OF LENDER*

ADDRESS (Business Address Acceptable)

BUSINESS ACTIVITY, IF ANY, OF LENDER

IF APPLICABLE, LIST DATE:
// //

ACQUIRED DISPOSED
IF APPLICABLE, LIST DATE:
// //

ACQUIRED DISPOSED
22 2222 22

SCHEDULE B
Interests in Real Property
(Including Rental Income)
► 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.

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
Ownership/Deed of Trust Easement
Leasehold
Yrs. remaining Other
Comments:

FAIR MARKET VALUE
$2,000 - $10,000
$10,001 - $100,000
$100,001 - $1,000,000
Over $1,000,000

IF RENTAL PROPERTY, GROSS INCOME RECEIVED
OVER $100,000
$500 - $1,000 $0 - $499 $1,001 - $10,000
$10,001 - $100,000

HIGHEST BALANCE DURING REPORTING PERIOD
Guarantor, if applicable
OVER $100,000
$500 - $1,000 $1,001 - $10,000
$10,001 - $100,000
700

FAIR POLITICAL PRACTICES COMMISSION

CALIFORNIA FORM
NAME OF LENDER*

ADDRESS (Business Address Acceptable)

BUSINESS ACTIVITY, IF ANY, OF LENDER

INTEREST RATE TERM (Months/Years)
% None
Guarantor, if applicable

HIGHEST BALANCE DURING REPORTING PERIOD
OVER $100,000
$500 - $1,000 $1,001 - $10,000
$10,001 - $100,000
* You are not required to report loans from a commercial lending institution 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
FPPC Form 700 - Schedule B (2022/2023)
[email protected] • 866-275-3772 • www.fppc.ca.gov
Page - 11
Name
-17-

disclose the number of years remaining on the lease.
• If you received rental income, check the box indicating the gross amount you received.
• If you had a 10% or greater interest in real property and received rental income, list the name of the source(s) if your pro rata share of the gross income from any single tenant was $10,000 or more during the reporting period. If you received a total of $10,000 or more from two or more tenants acting in concert (in most cases, this will apply to married couples), disclose the name of each tenant.

Otherwise, mark “None.”
• Loans from a private lender that total $500 or more and are secured by real property may be reportable. Loans
from commercial lending institutions made in the
lender’s regular course of business on terms available
to members of the public without regard to your official status are not reportable.

When reporting a loan:
-Provide the name and address of the lender.
-Describe the lender’s business activity.
-Disclose the interest rate and term of the loan. For
variable interest rate loans, disclose the conditions
of the loan (e.g., Prime + 2) or the average interest
rate paid during the reporting period. The term of
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.
-Identify a guarantor, if
applicable.

If you have more than one
reportable loan on a single
piece of real property, report
the additional loan(s) on
Schedule C.

Example:

Allison Gande is a city
planning commissioner.

During the reporting period,
Allison received rental income
of $12,000, from a single
tenant who rented property
owned in the city’s jurisdiction.

If Allison received $6,000
each from two tenants, the
tenants’ names would not be
required because no single
tenant paid her $10,000 or
more. A married couple is
considered a single tenant.

Instructions – Schedule B
Interests in Real Property
Reminders
• Income and loans already reported on Schedule B are
not also required to be reported on Schedule C.
• Real property already reported on Schedule A-2, Part 4 is not also required to be reported on Schedule B.
• Code filers – do your disclosure categories require
disclosure of real property?
Report interests in real property located in your agency’s jurisdiction in which you, your spouse or registered domestic partner, or your dependent children had a direct, indirect, or beneficial interest totaling $2,000 or more any time during the reporting period. Real property is also considered to be “within the jurisdiction” of a local government agency if the property or any part of it is located within two miles outside the boundaries of the jurisdiction or within two miles of any land owned or used by the local government agency. (See Reference Pamphlet, page 13.)
Interests in real property include:
• An ownership interest (including a beneficial ownership interest)
• A deed of trust, easement, or option to acquire property • A leasehold interest (See Reference Pamphlet, page 14.) • A mining lease
• An interest in real property held in a retirement account (See Reference Pamphlet, page 15.)
• An interest in real property held by a business entity or trust in which you, your spouse or registered domestic
partner, and your dependent children together had a 10% or greater ownership interest (Report on Schedule A-2.) • Your spouse’s or registered domestic partner’s interests in real property that are legally held separately by him or her You are not required to report:
• A residence, such as a home or vacation cabin, used
exclusively as a personal residence (However, a residence in which you rent out a room or for which you claim a
business deduction may be reportable. If reportable,
report the fair market value of the portion claimed as a tax deduction.)
• Some interests in real property held through a blind trust (See Reference Pamphlet, page 16.)
• Please note: A non-reportable property can still
be grounds for a conflict of interest and may be
disqualifying.

To Complete Schedule B:
• Report the precise location (e.g., an assessor’s parcel number or address) of the real property.
• Check the box indicating the fair market value of your interest in the property (regardless of what you owe on the property).
• Enter the date acquired or disposed only if you initially acquired or entirely disposed of your interest in the
property during the reporting period.
• Identify the nature of your interest. If it is a leasehold, FPPC Form 700 (2022/2023)
[email protected] • 866-275-3772 • www.fppc.ca.gov
Page - 12-18-

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

SCHEDULE C
Income, Loans, & Business
Positions
(Other than Gifts and Travel Payments)
GROSS INCOME RECEIVED No Income - Business Position Only No Income - Business Position OnlyGROSS INCOME RECEIVED 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
700

FAIR POLITICAL PRACTICES COMMISSION

CALIFORNIA FORM
►1. INCOME RECEIVED

NAME OF SOURCE OF INCOME
ADDRESS (Business Address Acceptable)

BUSINESS ACTIVITY, IF ANY, OF SOURCE

YOUR BUSINESS POSITION
►1. INCOME RECEIVED

NAME OF SOURCE OF INCOME
ADDRESS (Business Address Acceptable)

BUSINESS ACTIVITY, IF ANY, OF SOURCE

YOUR BUSINESS POSITION
NAME OF LENDER*
ADDRESS (Business Address Acceptable)

BUSINESS ACTIVITY, IF ANY, OF LENDER
INTEREST RATE TERM (Months/Years)
% None

HIGHEST BALANCE DURING REPORTING PERIOD
$500 - $1,000
$1,001 - $10,000
$10,001 - $100,000
OVER $100,000
Comments:
►2. LOANS RECEIVED OR OUTSTANDING DURING THE REPORTING PERIOD *You are not required to report loans from a commercial lending institution, or any indebtedness created as part of a retail installment or credit card transaction, made in the lender ’s regular course of business on terms available to members of the public without regard to your official status. Personal loans and loans received not in a lender’s regular course of business must be disclosed as follows:

SECURITY FOR LOAN
None Personal residence
Real Property
Guarantor
Other
Street address
City
(Describe)

CONSIDERATION FOR WHICH INCOME WAS RECEIVED
Salary Spouse’s or registered domestic partner’s income (For self-employed use Schedule A-2.)
Partnership (Less than 10% ownership. For 10% or greater use Schedule A-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 (2022/2023)
[email protected] • 866-275-3772 • www.fppc.ca.gov
Page - 13-19-

Instructions – Schedule C
Income, Loans, & Business Positions
(Income Other Than Gifts and Travel Payments)
Reporting Income:

Report the source and amount of gross income of $500
or more you received during the reporting period. Gross income is the total amount of income before deducting
expenses, losses, or taxes and includes loans other
than loans from a commercial lending institution. (See Reference Pamphlet, page 11.) You must also report the source of income to your spouse or registered domestic
partner if your community property share was $500 or
more during the reporting period.

The source and income must be reported only if the source is located in, doing business in, planning to do business in, or has done business during the previous two years in your agency’s jurisdiction. (See Reference Pamphlet, page 13.) Reportable sources of income may be further limited by
your disclosure category located in your agency’s conflict of interest code.

Reporting Business Positions:

You must report your job title with each reportable
business entity even if you received no income during the reporting period. Use the comments section to indicate that no income was received.

Commonly reportable income and loans include:
• Salary/wages, per diem, and reimbursement for
expenses including travel payments provided by your
employer
• Community property interest (50%) in your spouse’s
or registered domestic partner’s income - report the
employer’s name and all other required information
• Income from investment interests, such as partnerships, reported on Schedule A-1
• Commission income not required to be reported on
Schedule A-2 (See Reference Pamphlet, page 8.)
• Gross income from any sale, including the sale of a
house or car (Report your pro rata share of the total sale price.)
• Rental income not required to be reported on Schedule B • Prizes or awards not disclosed as gifts
• Payments received on loans you made to others
• An honorarium received prior to becoming a public official (See Reference Pamphlet, page 10.)
• Incentive compensation (See Reference Pamphlet, page

12.)
You are not required to report:
• Salary, reimbursement for expenses or per diem,
or social security, disability, or other similar benefit payments received by you or your spouse or registered
domestic partner from a federal, state, or local
government agency.
• Stock dividends and income from the sale of stock
unless the source can be identified.
• Income from a PERS retirement account.
(See Reference Pamphlet, page 12.)
To Complete Schedule C:

Part 1. Income Received/Business Position Disclosure
• Disclose the name and address of each source of
income or each business entity with which you held a
business position.
• Provide a general description of the business activity if the source is a business entity.
• Check the box indicating the amount of gross income
received.
• Identify the consideration for which the income was
received.
• For income from commission sales, check the box
indicating the gross income received and list the name
of each source of commission income of $10,000 or
more. (See Reference Pamphlet, page 8.) Note: If
you receive commission income on a regular basis
or have an ownership interest of 10% or more, you
must disclose the business entity and the income
on Schedule A-2.
• Disclose the job title or business position, if any, that you held with the business entity, even if you did not receive income during the reporting period.

Part 2. Loans Received or Outstanding During the
Reporting Period
• Provide the name and address of the lender.
• Provide a general description of the business activity if the lender is a business entity.
• Check the box indicating the highest balance of the loan during the reporting period.
• Disclose the interest rate and the term of the loan.
-For variable interest rate loans, disclose the
conditions of the loan (e.g., Prime + 2) or the
average interest rate paid during the reporting
period.
-The term of the loan is the total number of months or
years given for repayment of the loan at the time the
loan was entered into.
• Identify the security, if any, for the loan.

Reminders
• Code filers – your disclosure categories may not require disclosure of all sources of income.
• If you or your spouse or registered domestic partner are self-employed, report the business entity on Schedule A-2. • Do not disclose on Schedule C income, loans, or business positions already reported on Schedules A-2 or B.FPPC Form 700 (2022/2023) [email protected] • 866-275-3772 • www.fppc.ca.gov
Page - 14-20-

SCHEDULE D
Income – Gifts
Comments:

Name
700

FAIR POLITICAL PRACTICES COMMISSION

CALIFORNIA FORM
► NAME OF SOURCE (Not an Acronym)

ADDRESS (Business Address Acceptable)

BUSINESS ACTIVITY, IF ANY, OF SOURCE

DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
// $
// $
// $
► NAME OF SOURCE (Not an Acronym)

ADDRESS (Business Address Acceptable)

BUSINESS ACTIVITY, IF ANY, OF SOURCE

DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
// $
// $
// $
► NAME OF SOURCE (Not an Acronym)

ADDRESS (Business Address Acceptable)

BUSINESS ACTIVITY, IF ANY, OF SOURCE

DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
// $
// $
// $
► NAME OF SOURCE (Not an Acronym)

ADDRESS (Business Address Acceptable)

BUSINESS ACTIVITY, IF ANY, OF SOURCE

DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
// $
// $
// $
► NAME OF SOURCE (Not an Acronym)

ADDRESS (Business Address Acceptable)

BUSINESS ACTIVITY, IF ANY, OF SOURCE

DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
// $
// $
// $
► NAME OF SOURCE (Not an Acronym)

ADDRESS (Business Address Acceptable)

BUSINESS ACTIVITY, IF ANY, OF SOURCE

DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
// $
// $
// $
FPPC Form 700 - Schedule D (2022/2023)
[email protected] • 866-275-3772 • www.fppc.ca.gov
Page - 15-21-

Instructions – Schedule D
Income – Gifts
Reminders
• Gifts from a single source are subject to a $520 limit in 20222022. (See Reference Pamphlet, page 10.)
• Code filers – you only need to report gifts from
reportable sources.

Gift Tracking Mobile Application
• FPPC has created a gift tracking app for mobile
devices that helps filers track gifts and provides a quick and easy way to upload the information to the Form
700. Visit FPPC’s website to download the app.

A gift is anything of value for which you have not provided equal or greater consideration to the donor. A gift is reportable if its fair market value is $50 or more. In addition, multiple gifts totaling $50 or more received during the reporting period from a single source must be reported.

It is the acceptance of a gift, not the ultimate use to which it is put, that imposes your reporting obligation. Except as noted below, you must report a gift even if you never used it or if you gave it away to another person.

If the exact amount of a gift is unknown, you must make a good faith estimate of the item’s fair market value. Listing the value of a gift as “over $50” or “value unknown” is not adequate disclosure. In addition, if you received a gift through an intermediary, you must disclose the name, address, and business activity of both the donor and the intermediary. You may indicate an intermediary either in the “source” field after the name or in the “comments” section at the bottom of Schedule D.

Commonly reportable gifts include:
• Tickets/passes to sporting or entertainment events
• Tickets/passes to amusement parks
• Parking passes not used for official agency business
• Food, beverages, and accommodations, including those
provided in direct connection with your attendance at a convention, conference, meeting, social event, meal, or like gathering
• Rebates/discounts not made in the regular course of
business to members of the public without regard to official status
• Wedding gifts (See Reference Pamphlet, page 16)
• An honorarium received prior to assuming office (You may report an honorarium as income on Schedule C, rather
than as a gift on Schedule D, if you provided services of equal or greater value than the payment received. See
Reference Pamphlet, page 10.)
• Transportation and lodging (See Schedule E.)
• Forgiveness of a loan received by you
You are not required to disclose:
• Gifts that were not used and that, within 30 days after receipt, were returned to the donor or delivered to a
charitable organization or government agency without
being claimed by you as a charitable contribution for tax purposes
• Gifts from your spouse or registered domestic partner, child, parent, grandparent, grandchild, brother, sister, and certain other family members (See Regulation 18942 for a complete list.). The exception does not apply if the donor was acting as an agent or intermediary for a reportable source who was the true donor.
• Gifts of similar value exchanged between you and an
individual, other than a lobbyist registered to lobby your state agency, on holidays, birthdays, or similar occasions • Gifts of informational material provided to assist you in the performance of your official duties (e.g., books, pamphlets, reports, calendars, periodicals, or educational seminars) • A monetary bequest or inheritance (However, inherited investments or real property may be reportable on other schedules.)
• Personalized plaques or trophies with an individual value of less than $250
• Campaign contributions
• Up to two tickets, for your own use, to attend a fundraiser for a campaign committee or candidate, or to a fundraiser for an organization exempt from taxation under Section
501(c)(3) of the Internal Revenue Code. The ticket must be received from the organization or committee holding the fundraiser.
• Gifts given to members of your immediate family if the source has an established relationship with the family
member and there is no evidence to suggest the donor had a purpose to influence you. (See Regulation 18943.)
• Free admission, food, and nominal items (such as a pen, pencil, mouse pad, note pad or similar item) available to all attendees, at the event at which the official makes a speech (as defined in Regulation 18950(b)(2)), so long as the admission is provided by the person who organizes the event.
• Any other payment not identified above, that would
otherwise meet the definition of gift, where the payment is made by an individual who is not a lobbyist registered to lobby the official’s state agency, where it is clear that the gift was made because of an existing personal or business relationship unrelated to the official’s position and there is no evidence whatsoever at the time the gift is made to suggest the donor had a purpose to influence you.

To Complete Schedule D:
• Disclose the full name (not an acronym), address, and, if a business entity, the business activity of the source.
• Provide the date (month, day, and year) of receipt, and disclose the fair market value and description of the gift.

FPPC Form 700 (2022/2023)
[email protected] • 866-275-3772 • www.fppc.ca.gov
Page - 16-22-

SCHEDULE E
Income – Gifts
Travel Payments, Advances,
and Reimbursements
Name
Comments:
700

FAIR POLITICAL PRACTICES COMMISSION

CALIFORNIA FORM
• Mark either the gift or income box.
• Mark the “501(c)(3)” box for a travel payment received from a nonprofit 501(c)(3) organization or the “Speech” box if you made a speech or participated in a panel. Per Government Code Section 89506, these payments may not be subject to the gift limit. However, they may result in a disqualifying conflict of interest.
• For gifts of travel, provide the travel destination.

DATE(S): // - // AMT: $
(If gift)
DATE(S): // - // AMT: $
(If gift)
► NAME OF SOURCE (Not an Acronym)

ADDRESS (Business Address Acceptable)

CITY AND STATE

501 (c)(3) or DESCRIBE BUSINESS ACTIVITY, IF ANY, OF SOURCE ► NAME OF SOURCE (Not an Acronym)

ADDRESS (Business Address Acceptable)

CITY AND STATE

501 (c)(3) or DESCRIBE BUSINESS ACTIVITY, IF ANY, OF SOURCE ► NAME OF SOURCE (Not an Acronym)

ADDRESS (Business Address Acceptable)

CITY AND STATE

501 (c)(3) or DESCRIBE BUSINESS ACTIVITY, IF ANY, OF SOURCE ► NAME OF SOURCE (Not an Acronym)

ADDRESS (Business Address Acceptable)

CITY AND STATE

501 (c)(3) or DESCRIBE BUSINESS ACTIVITY, IF ANY, OF SOURCE ► MUST CHECK ONE:

Made a Speech/Participated in a Panel
Other - Provide Description
Gift -or- Income
► If Gift, Provide Travel Destination
► MUST CHECK ONE:

Made a Speech/Participated in a Panel
Other - Provide Description
Gift -or- Income
► If Gift, Provide Travel Destination
DATE(S): // - // AMT: $
(If gift)
DATE(S): // - // AMT: $
(If gift)
FPPC Form 700 - Schedule E (2022/2023)
[email protected] • 866-275-3772 • www.fppc.ca.gov
Page - 17-23-

Travel payments reportable on Schedule E include advances and reimbursements for travel and related expenses,
including lodging and meals.

Gifts of travel may be subject to the gift limit. In addition, certain travel payments are reportable gifts, but are not subject to the gift limit. To avoid possible misinterpretation or the perception that you have received a gift in excess of the gift limit, you may wish to provide a specific description of the purpose of your travel. (See the FPPC fact sheet entitled “Limitations and Restrictions on Gifts, Honoraria, Travel, and Loans” to read about travel payments under section
89506(a).)
You are not required to disclose:
• Travel payments received from any state, local, or federal government agency for which you provided services equal or greater in value than the payments received, such as reimbursement for travel on agency business from your
government agency employer.
• A payment for travel from another local, state, or federal government agency and related per diem expenses when
the travel is for education, training or other inter-agency programs or purposes.
• Travel payments received from your employer in the
normal course of your employment that are included in the income reported on Schedule C.
• A travel payment that was received from a nonprofit
entity exempt from taxation under Internal Revenue
Code Section 501(c)(3) for which you provided equal or
greater consideration, such as reimbursement for travel on business for a 501(c)(3) organization for which you are a board member.

Note: Certain travel payments may not be reportable
if reported via email on Form 801 by your agency.

To Complete Schedule E:
• Disclose the full name (not an acronym) and address of the source of the travel payment.
• Identify the business activity if the source is a business entity.
• Check the box to identify the payment as a gift or income, report the amount, and disclose the date(s).
• Travel payments are gifts if you did not provide
services that were equal to or greater in value than the payments received. You must disclose gifts totaling $50 or more from a single source during the period covered
by the statement.

When reporting travel payments that are gifts, you must provide a description of the gift, the date(s) received, and the travel destination.
• Travel payments are income if you provided services
that were equal to or greater in value than the
payments received. You must disclose income totaling
$500 or more from a single source during the period
covered by the statement. You have the burden of
proving the payments are income rather than gifts.

When reporting travel payments as income, you must
describe the services you provided in exchange for the
payment. You are not required to disclose the date(s)
for travel payments that are income.

Example:

City council member MaryClaire Chandler is the chair of a 501(c)(6) trade association, and the association pays for MaryClaire's travel to attend its meetings. Because MaryClaire is deemed
to be providing equal or
greater consideration for
the travel payment by
virtue of serving on the
board, this payment may
be reported as income.

Payments for MaryClaire
to attend other events
for which they are not
providing services are
likely considered gifts.

Note that the same payment from a 501(c)(3) would NOT be reportable.

Example:

Mayor Kim travels to China on a trip organized by China Silicon Valley Business Development, a California nonprofit, 501(c)(6) organization. The Chengdu Municipal People’s
Government pays for
Mayor Kim’s airfare and
travel costs, as well as
meals and lodging during
the trip. The trip’s agenda
shows that the trip’s
purpose is to promote job
creation and economic
activity in China and in
Silicon Valley, so the trip
is reasonably related to
a governmental purpose.

Thus, Mayor Kim must report the gift of travel, but the gift is exempt from the gift limit. In this case, the travel payments are not subject to the gift limit because the source is a foreign government and because the travel is reasonably related to a governmental purpose. (Section 89506(a)(2).) Note
that Mayor Kim could be disqualified from participating in or making decisions about The Chengdu Municipal People’s
Government for 12 months. Also note that if China Silicon Valley Business Development (a 501(c)(6) organization) paid for the travel costs rather than the governmental organization, the payments would be subject to the gift limits. (See the FPPC fact sheet, Limitations and Restrictions on Gifts, Honoraria, Travel and Loans, at www.fppc.ca.gov.)
Instructions – Schedule E
Travel Payments, Advances,
and Reimbursements
FPPC Form 700 (2022/2023)
[email protected] • 866-275-3772 • www.fppc.ca.gov
Page - 18-24-

Restrictions and Prohibitions
The Political Reform Act (Gov. Code Sections 81000-
91014) requires most state and local government officials and employees to publicly disclose their economic
interests including personal assets and income. The
Act’s conflict of interest provisions also disqualify a public official from taking part in a governmental decision if it is reasonably foreseeable that the decision will have
a material financial effect on these economic interests as well as the official’s personal finances and those
of immediate family. (Gov. Code Sections 87100 and
87103.) The Fair Political Practices Commission (FPPC) is the state agency responsible for issuing the attached Statement of Economic Interests, Form 700, and for
interpreting the Act’s provisions.

Gift Prohibition
Gifts received by most state and local officials, employees, and candidates are subject to a limit. In 2021-2022, the gift limit increased to $520 from a single source during a calendar year.

Additionally, state officials, state candidates, and certain state employees are subject to a $10 limit per calendar month on gifts from lobbyists and lobbying firms registered with the Secretary of State. See Reference Pamphlet,
page 10.

State and local officials and employees should check with their agency to determine if other restrictions apply.

Disqualification
Public officials are, under certain circumstances, required to disqualify themselves from making, participating in, or attempting to influence governmental decisions that will affect their economic interests. This may include interests they are not required to disclose. For example, a personal residence is often not reportable, but may be grounds for disqualification. Specific disqualification requirements apply to 87200 filers (e.g., city councilmembers, members of boards of supervisors, planning commissioners, etc.).

These officials must publicly identify the economic interest that creates a conflict of interest and leave the room before a discussion or vote takes place at a public meeting. For more information, consult Government Code Section
87105, Regulation 18707, and the Guide to Recognizing
Conflicts of Interest page at www.fppc.ca.gov .

Honorarium Ban
Most state and local officials, employees, and candidates are prohibited from accepting an honorarium for any
speech given, article published, or attendance at a
conference, convention, meeting, or like gathering. (See Reference Pamphlet, page 10.)
Loan Restrictions
Certain state and local officials are subject to restrictions on loans. (See Reference Pamphlet, page 14.)
Post-Governmental Employment
There are restrictions on representing clients or employers before former agencies. The provisions apply to elected state officials, most state employees, local elected officials, county chief administrative officers, city managers,
including the chief administrator of a city, and general managers or chief administrators of local special districts and JPAs. The FPPC website has fact sheets explaining
the provisions.

Late Filing
The filing officer who retains originally-signed or
electronically filed statements of economic interests may impose on an individual a fine for any statement that is filed late. The fine is $10 per day up to a maximum of $100.

Late filing penalties may be reduced or waived under certain circumstances.

Persons who fail to timely file their Form 700 may be
referred to the FPPC’s Enforcement Division (and, in some cases, to the Attorney General or district attorney) for investigation and possible prosecution. In addition to the late filing penalties, a fine of up to $5,000 per violation may be imposed.

For assistance concerning reporting, prohibitions, and
restrictions under the Act:
• Email questions to [email protected].
• Call the FPPC toll-free at (866) 275-3772.

Form 700 is a Public Document
Public Access Must Be Provided
Statements of Economic Interests are public
documents. The filing officer must permit any
member of the public to inspect and receive a copy
of any statement.
• Statements must be available as soon as possible
during the agency's regular business hours, but
in any event not later than the second business
day after the statement is received. Access to the
Form 700 is not subject to the Public Records Act
procedures.
• No conditions may be placed on persons seeking
access to the forms.
• No information or identification may be required
from persons seeking access.
• Reproduction fees of no more than 10 cents per
page may be charged.

FPPC Form 700 (2022/2023)
[email protected] • 866-275-3772 • www.fppc.ca.gov
Page - 19-25-

Questions and Answers
General
Q. What is the reporting period for disclosing interests on an assuming office statement or a candidate
statement?
A. On an assuming office statement, disclose all
reportable investments, interests in real property, and business positions held on the date you assumed
office. In addition, you must disclose income (including loans, gifts and travel payments) received during the 12 months prior to the date you assumed office.

On a candidate statement, disclose all reportable
investments, interests in real property, and business
positions held on the date you file your declaration of candidacy. You must also disclose income (including
loans, gifts and travel payments) received during the
12 months prior to the date you file your declaration of candidacy.

Q. I hold two other board positions in addition to my
position with the county. Must I file three statements of economic interests?
A. Yes, three are required. However, you may instead
complete an expanded statement listing the county and
the two boards on the Cover Page or an attachment as
the agencies for which you will be filing. Disclose all reportable economic interests in all three jurisdictions on the expanded statement. File the expanded
statement for your primary position providing an original “wet” signature unless filed with a secure electronic
signature. (See page 3 above.) File copies of the
expanded statement with the other two agencies as
required by Regulation 18723.1(c). Remember to
complete separate statements for positions that you
leave or assume during the year.

Q. I am a department head who recently began acting as
city manager. Should I file as the city manager?
A. Yes. File an assuming office statement as city
manager. Persons serving as “acting,” “interim,” or
“alternate” must file as if they hold the position because they are or may be performing the duties of the
position.

Q. My spouse and I are currently separated and in the
process of obtaining a divorce. Must I still report my spouse’s income, investments, and interests in real
property?
A. Yes. A public official must continue to report a spouse’s economic interests until such time as dissolution of
marriage proceedings is final. However, if a separate
property agreement has been reached prior to that
time, your estranged spouse’s income may not have to
be reported. Contact the FPPC for more information.

Q. As a designated employee, I left one state agency to work for another state agency. Must I file a leaving
office statement?
A. Yes. You may also need to file an assuming office
statement for the new agency.

Investment Disclosure
Q. I have an investment interest in shares of stock in a company that does not have an office in my jurisdiction.

Must I still disclose my investment interest in this
company?
A. Probably. The definition of “doing business in the
jurisdiction” is not limited to whether the business has an office or physical location in your jurisdiction. (See Reference Pamphlet, page 13.)
Q. My spouse and I have a living trust. The trust holds rental property in my jurisdiction, our primary residence, and investments in diversified mutual funds. I have full disclosure. How is this trust disclosed?
A. Disclose the name of the trust, the rental property and its income on Schedule A-2. Your primary residence
and investments in diversified mutual funds registered
with the SEC are not reportable.

Q. I am required to report all investments. I have an IRA that contains stocks through an account managed by
a brokerage firm. Must I disclose these stocks even
though they are held in an IRA and I did not decide
which stocks to purchase?
A. Yes. Disclose on Schedule A-1 or A-2 any stock worth $2,000 or more in a business entity located in or doing business in your jurisdiction.

FPPC Form 700 (2022/2023)
[email protected] • 866-275-3772 • www.fppc.ca.gov
Page - 20-26-

Questions and Answers
Continued
Q. The value of my stock changed during the reporting
period. How do I report the value of the stock?
A. You are required to report the highest value that the stock reached during the reporting period. You may
use your monthly statements to determine the highest
value. You may also use the entity’s website to
determine the highest value. You are encouraged to
keep a record of where you found the reported value.

Note that for an assuming office statement, you must
report the value of the stock on the date you assumed
office.

Q. I am the sole owner of my business, an S-Corporation.

I believe that the nature of the business is such that it cannot be said to have any “fair market value” because
it has no assets. I operate the corporation under
an agreement with a large insurance company. My
contract does not have resale value because of its
nature as a personal services contract. Must I report
the fair market value for my business on Schedule A-2
of the Form 700?
A. Yes. Even if there are no tangible assets, intangible assets, such as relationships with companies and
clients are commonly sold to qualified professionals.

The “fair market value” is often quantified for other
purposes, such as marital dissolutions or estate
planning. In addition, the IRS presumes that “personal services corporations” have a fair market value. A
professional “book of business” and the associated
goodwill that generates income are not without a
determinable value. The Form 700 does not require a
precise fair market value; it is only necessary to check a box indicating the broad range within which the value falls.

Q. I own stock in IBM and must report this investment
on Schedule A-1. I initially purchased this stock in
the early 1990s; however, I am constantly buying
and selling shares. Must I note these dates in the
“Acquired” and “Disposed” fields?
A. No. You must only report dates in the “Acquired” or “Disposed” fields when, during the reporting period, you initially purchase a reportable investment worth $2,000 or more or when you dispose of the entire investment.

You are not required to track the partial trading of an investment.

Q. On last year’s filing I reported stock in Encoe valued at $2,000 - $10,000. Late last year the value of this stock fell below and remains at less than $2,000. How should this be reported on this year’s statement?
A. You are not required to report an investment if the value was less than $2,000 during the entire reporting period.

However, because a disposed date is not required for
stocks that fall below $2,000, you may want to report
the stock and note in the “comments” section that the
value fell below $2,000. This would be for informational purposes only; it is not a requirement.

Q. We have a Section 529 account set up to save money
for our son’s college education. Is this reportable?
A. If the Section 529 account contains reportable interests (e.g., common stock valued at $2,000 or more), those
interests are reportable (not the actual Section 529
account). If the account contains solely mutual funds,
then nothing is reported.

Income Disclosure
Q. I reported a business entity on Schedule A-2. Clients of my business are located in several states. Must I report all clients from whom my pro rata share of income is
$10,000 or more on Schedule A-2, Part 3?
A. No, only the clients located in or doing business on a regular basis in your jurisdiction must be disclosed.

Q. I believe I am not required to disclose the names of clients from whom my pro rata share of income is
$10,000 or more on Schedule A-2 because of their right
to privacy. Is there an exception for reporting clients’ names?
A. Regulation 18740 provides a procedure for requesting an exemption to allow a client’s name not to be
disclosed if disclosure of the name would violate a
legally recognized privilege under California or Federal law. This regulation may be obtained from our website
at www.fppc.ca.gov . (See Reference Pamphlet, page

14.)
FPPC Form 700 (2022/2023)
[email protected] • 866-275-3772 • www.fppc.ca.gov
Page - 21-27-

Questions and Answers
Continued
Q. I am sole owner of a private law practice that is not reportable based on my limited disclosure category.

However, some of the sources of income to my law
practice are from reportable sources. Do I have to
disclose this income?
A. Yes, even though the law practice is not reportable, reportable sources of income to the law practice of
$10,000 or more must be disclosed. This information
would be disclosed on Schedule C with a note in the
“comments” section indicating that the business entity
is not a reportable investment. The note would be for
informational purposes only; it is not a requirement.

Q. I am the sole owner of my business. Where do I
disclose my income - on Schedule A-2 or Schedule C?
A. Sources of income to a business in which you have an ownership interest of 10% or greater are disclosed on
Schedule A-2. (See Reference Pamphlet, page 8.)
Q. My spouse is a partner in a four-person firm where
all of their business is based on their own billings and collections from various clients. How do I report my
community property interest in this business and the
income generated in this manner?
A. If your spouse's investment in the firm is 10% or
greater, disclose 100% of your spouse's share of the
business on Schedule A-2, Part 1 and 50% of your
spouse's income on Schedule A-2, Parts 2 and 3. For
example, a client of your spouse’s must be a source of
at least $20,000 during the reporting period before the client’s name is reported.

Q. How do I disclose my spouse’s or registered domestic partner’s salary?
A. Report the name of the employer as a source of income on Schedule C.

Q. I am a doctor. For purposes of reporting $10,000
sources of income on Schedule A-2, Part 3, are the
patients or their insurance carriers considered sources of income?
A. If your patients exercise sufficient control by selecting you instead of other doctors, then your patients, rather than their insurance carriers, are sources of income to you. (See Reference Pamphlet, page 14.)
Q. I received a loan from my grandfather to purchase my home. Is this loan reportable?
A. No. Loans received from family members are not
reportable.

Q. Many years ago, I loaned my parents several thousand dollars, which they paid back this year. Do I need to
report this loan repayment on my Form 700?
A. No. Payments received on a loan made to a family
member are not reportable.

Real Property Disclosure
Q. During this reporting period we switched our principal place of residence into a rental. I have full disclosure and the property is located in my agency’s jurisdiction, so it is now reportable. Because I have not reported
this property before, do I need to show an “acquired”
date?
A. No, you are not required to show an “acquired” date
because you previously owned the property. However,
you may want to note in the “comments” section that
the property was not previously reported because it was used exclusively as your residence. This would be for
informational purposes only; it is not a requirement.

Q. I am a city manager, and I own a rental property located in an adjacent city, but one mile from the city limit. Do I need to report this property interest?
A. Yes. You are required to report this property because it is located within 2 miles of the boundaries of the city you manage.

Q. Must I report a home that I own as a personal residence for my daughter?
A. You are not required to disclose a home used as a
personal residence for a family member unless you
receive income from it, such as rental income.

Q. I am a co-signer on a loan for a rental property owned by a friend. Since I am listed on the deed of trust, do I need to report my friend’s property as an interest in real property on my Form 700?
A. No. Simply being a co-signer on a loan for property
does not create a reportable interest in that real
property.

FPPC Form 700 (2022/2023)
[email protected] • 866-275-3772 • www.fppc.ca.gov
Page - 22-28-

Gift Disclosure
Q. If I received a reportable gift of two tickets to a concert valued at $100 each, but gave the tickets to a friend
because I could not attend the concert, do I have any
reporting obligations?
A. Yes. Since you accepted the gift and exercised
discretion and control of the use of the tickets, you must disclose the gift on Schedule D.

Q. Julia and Jared Benson, a married couple, want to
give a piece of artwork to a county supervisor. Is each spouse considered a separate source for purposes of
the gift limit and disclosure?
A. Yes, each spouse may make a gift valued at the gift
limit during a calendar year. For example, during 2022 the gift limit was $520, so the Bensons may have given
the supervisor artwork valued at no more than $1,040.

The supervisor must identify Jared and Julia Benson as
the sources of the gift.

Q. I am a Form 700 filer with full disclosure. Our agency holds a holiday raffle to raise funds for a local charity.

I bought $10 worth of raffle tickets and won a gift
basket valued at $120. The gift basket was donated by
Doug Brewer, a citizen in our city. At the same event, I bought raffle tickets for, and won a quilt valued at
$70. The quilt was donated by a coworker. Are these
reportable gifts?
A. Because the gift basket was donated by an outside
source (not an agency employee), you have received a
reportable gift valued at $110 (the value of the basket less the consideration paid). The source of the gift
is Doug Brewer and the agency is disclosed as the
intermediary. Because the quilt was donated by an
employee of your agency, it is not a reportable gift.

Q. My agency is responsible for disbursing grants. An
applicant (501(c)(3) organization) met with agency
employees to present its application. At this meeting, the applicant provided food and beverages. Would
the food and beverages be considered gifts to the
employees? These employees are designated in our
agency’s conflict of interest code and the applicant is a reportable source of income under the code.

A. Yes. If the value of the food and beverages consumed by any one filer, plus any other gifts received from the same source during the reporting period total $50 or
more, the food and beverages would be reported using
the fair market value and would be subject to the gift
limit.

Q. I received free admission to an educational conference related to my official duties. Part of the conference
fees included a round of golf. Is the value of the golf considered informational material?
A. No. The value of personal benefits, such as golf,
attendance at a concert, or sporting event, are gifts
subject to reporting and limits.

Questions and Answers
Continued
FPPC Form 700 (2022/2023)
[email protected] • 866-275-3772 • www.fppc.ca.gov
Page - 23-29-

Bellflower City CouncilAugust 28, 2023

Bellflower City Council
August 28, 2023