Name of Outside Organization(include address and description)C.Describe the public purpose made pursuant to the agency’s policyIdentify one of the following:
CaliforniaForm1. Agency NameDesignated Agency Contact (Name,Title)Date StampE-mailDivision, Department, or Region (If Applicable)2. Function or Event Information Comment:FPPC Form 802 (4/12)FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-7772) 802(Month, Day, Year)For Offi cial Use OnlyArea Code/Phone Number Date of Original Filing: A Public DocumentAmendment(Must provide explanation in Part 3.)Was ticket distribution made at the behest of agency offi cial?Ticket(s)/Pass(es) provided by agency?Event DescriptionFace Value of Each Ticket/Pass $ Date(s)////Name of Agency, Department or UnitNumber of Ticket(s)/Pass(es)Number of Ticket(s)/Pass(es)Number of Ticket(s)/Pass(es) Offi cial’s Name (Last, First) If no: Describe the public purpose made pursuant to the agency’s policy Agency Report of:Ceremonial Role Events and Ticket/Pass Distributions
3. RecipientsYesNoYesNoName of Individual(Last, First) Use Section A to identify the agency’s department or unit. Use Section B to identify an individual. Use Section C to identify an outside organization.Does the agency have a ticket policy?YesNoProvide Title/ExplanationA.B.If yes: Name of SourceCeremonial RoleCeremonial RoleOtherOtherIncomeIncomeIf checking “Ceremonial Role” or “Other” describe below:If checking “Ceremonial Role” or “Other” describe below:4. Verifi cationI have read and understand FPPC Regulations 18944.1 and 18942. I have verifi ed that the distribution set forth above, is in accordance with the requirements.Signature of Agency Head or DesigneePrint NameTitle(Month, Day, Year) This form is for use by all state and local government agencies. The form identifi es persons that receive admission tickets and passes and describes the public purpose for the distribution. This form was prepared by the Fair Political Practices Commission (FPPC) and is available at www.fppc.ca.gov.General InformationFPPC Regulation 18944.1 sets out the circumstances under which an agency’s distribution of tickets to entertainment events, sporting events, and like occasions would not result in a gift to individuals that attend the function. In general, the agency must adopt a policy which identifi es the public purpose served in distributing the admissions. The Form 802 serves to detail each event and the public purpose of each ticket distribution. FPPC Regulation 18942 lists exceptions to reportable gifts, including ceremonial events, when listed on this form.When the regulation procedures are followed, persons, organizations, or agencies who receive admissions are listed on a Form 802. Agency offi cials do not report the admissions on the offi cial’s Statement of Economic Interests, Form 700, and the value of the admission is not subject to the gift limit. The Form 802 also informs the public as to whether the admissions were made at the behest of an agency offi cial and whether the behested tickets were provided to an organization or to specifi c individuals. ExceptionThis form is not required for admission provided to a school or university district offi cial, coach, athletic director, or employee to attend an amateur event performed by students of that school or university.Public PostingThis form must be maintained as a public document. A copy of all forms must be forwarded to the FPPC for posting on its website. E-mail delivery is preferred.E-mail: [email protected]; Fax: 916.322.0886; 428 J Street, Suite 620, Sacramento, CA 95814.Forms must be sent to the FPPC as soon as possible.General business practice is no later than 45 days from the distribution.A local agency may also also post the forms on its wesbite, but it is not required to do so.Privacy Information NoticeInformation requested by the FPPC is used to administer and enforce the Political Reform Act. Failure to provide information may be a violation subject to administrative, criminal, or civil penalties. All reports are public records available for inspection and reproduction. Direct questions to FPPC’s General Counsel.InstructionsPart 1. Agency Identifi cation:List the agency’s name. Provide a designated agency contact person, their phone number, and e-mail address. Mark the amendment box if changing any information on a previously fi led form and include the date of the original fi ling.Part 2. Function or Event Information:Confi rm that your agency has a policy for ticket distribution. Unless the the ceremonial role or income box in Part 3, Section B, is marked, this form is only applicable if your agency has a policy. Complete all of the other required fi elds that identify the ticket value, description of event, date(s) and whether the ticket was provided by the agency or an outside source. If an agency offi cial behests the tickets, the offi cial’s name is also required. Use the comment fi eld or an attachment to explain in full.Part 3. Ticket Recipients:This part identifi es who uses the tickets. The identifi cation requirements vary depending upon who received the tickets and are categorized into three sections. Each section must list the number of tickets received. Use the commentfi eld or an attachment to explain in full.Section A. Report tickets distributed to agency staff, other than an elected offi cial or governing board member, pursuant to the agency’s policy. It is not necessary to list each employee’s name, but identify the unit/department for which the employee works. The agency must describe the public purpose associated with the ticket distribution. A reference to the policy is permissible.Section B. Report: 1) any agency offi cial who performs a ceremonial role; 2) any agency offi cial who reports the value as income; or 3) tickets used by elected offi cals and governing board members (including those distributed pursuant to the agency’s policy).Section C. Report tickets provided to an organization.The organization’s name, an address (website url is permissible), and a brief description of the public purpose are required.FPPC Form 802 (4/12)FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) CaliforniaForm802A Public DocumentAgency Report of:Ceremonial Role Events and Ticket/Pass Distributions Name of Outside Organization(include address and description)C.Describe the public purpose made pursuant to the agency’s policyIdentify one of the following:
FPPC Form 802 (4/12)FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-7772) A Public DocumentName of Agency, Department or UnitNumber of Ticket(s)/Pass(es)Number of Ticket(s)/Pass(es)Number of Ticket(s)/Pass(es) Describe the public purpose made pursuant to the agency’s policyAgency Report of:Ceremonial Role Events and Ticket/Pass DistributionsContinuation Sheet3. Recipients Name of Individual(Last, First) Use Section A to identify the agency’s department or unit. Use Section B to identify an individual. Use Section C to identify an outside organization.A.B.Ceremonial RoleCeremonial RoleCeremonial RoleCeremonial RoleOtherOtherOtherOtherIncomeIncomeIncomeIncomeIf checking “Ceremonial Role” or “Other” describe below:If checking “Ceremonial Role” or “Other” describe below:If checking “Ceremonial Role” or “Other” describe below:If checking “Ceremonial Role” or “Other” describe below:
CaliforniaForm802Agency Name