CC Resolution No. 4243 t .
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RESOLUTION NO. 4243
A RESOLUTION ADOPTING CONFLICT OF INTEREST CODE
RESOLVED, by the City Council of the City of
Cupertino, as follows:
1. That the Code entitled ",Conflict of Interest
Code, of the City Council, City of Cupertino," a copy of
which is attached hereto and by reference incorporated
herein, be, and is hereby, approved and adopted for the
City Council, subject to the approval thereof by the Fair
Political Practices Commission of the State of California.
2. That the Clerk of this City be, and is,hereby,
authorized and instructed to submit a copy of such Code
to the Fair Political Practices Commission of the State of
California, and to request said Commission to approve said
Code in accordance with Government Code Section 87303.
PASSED AND ADOPTED at a regular meeting of the City
Council of the City of Cupertino this 16th day of
August , 1976, by the following vote:
Vote: Members of the City Council
AYES : Frolich, Jackson, 0' Keef e
NOES : None
ABSENT: Nellis ~
ABSTAIN : None ,
DISSENTING: Meyers APPROVED:
/s/ Robert W. Meyers
Mayor, City of Cupertino
ATTEST:
/s/ Wm. E. Rvder
City Clerk
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CONFLICT OF INTEREST CODE
OF THE CITY COUNCIL
CITY OF CUPERTIIJO
ARTICLE I--GENERAL PROVISIONS
Section 1.1. Authority. This Code is adopted pursuant
to and in implementation of, Article 3(commencing with Section
~ , 87300) of Cahpter 7, Title 9 of the Government Code of the State
of California. Source: Government Code §87300.•
Section 1.2. Effect. This Code is in addition to State
and local laws pertaining to conflicts of interest of City Council
persons and is not intended to abridge or otherwise modify such
laws.
Section 1.3. Severability. If any article, section,
subsection, paragraph, subparagraph, sentence, clause or phrase
of this Code is for any reason held to be invalid, unconstitutional
or unenforceable, such decision shall not affect the validity of
the remaining portions of this Code. The City declares that it
would have adopted this Code and each article, section, subsection,
paragraph, subparagraph, sentence, clause and phrase thereof irrespec-
tive of the fact any one or more of such portions of this Code be
declared invalid, unconstitutional or unenforceable.
Section 1.4. Effective Date. This Code shall take effect
30 days after its approval by the Fair Political Practices Comr,iission
of the State of California. Source: Government Code §87303.
Section 1.5. Definitions. As used in this Code, unless
the context otherwise clearly implies, the following words and
terms shall have the meanings set forth herein.
(a) Business entity. "Business entity" means any
organization or enterprise operated for profit, including but not
, limited to a proprietorship, partnership, firm, business trust,
joint venture, syndicate, corporation or association. Source:
Government Code §82005.
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(b) City. "City" means the City of Cupertino.
(c) Clerk. "Clerk" means the Clerk of the City of
. Cupertino.
(d) Council Person. "Council person" means any member
of the City Council of the City of Cupertino.
(e) CountY. "County" means the County of Santa Clara.
(f) Disclosure statements. "Disclosure statements" mean
statements disclosing reportable interests required, by Section 2.1,
to be filed by council persons. Source: Government Code §87302(b).
(g) Reportable interests. "Reportable interests" mean
investments, interests in real property and income required to be
disclosed by a council person. "Reportable.interests" as to any
particular council person are deemed to be affected forseeably and
materiaTly by any decision made or participated in by the council
person by virtue of his or her position. Source: Government Code
§87302(b). .
ARTICLE II--DISCLOSURE •
Section 2.1. Disclosure Statements. Each council person
shall file an initial statement and annual statements disclosing
those reportable interests in the category or categories of
reportable interests, more particularly described in Section 2.5.
In the event a council person does not have any reportable interests,
such statements need not be filed. Such statements shall be filed
at the place specified in Section 2.2 and at the times specified in
Section 2.3 and Section 2.4, shall contain the infoimation specified
in Section 2.6 through Section 2.8, and shall be in the form specified
in Section 2.9. Source: Government Code §87302(b).
Section 2.2. Place of Filin . Disclosure statements
shall be filed, in the original, with the Clerk, who shall receive
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such statements on behalf of the City. The Clerk shall make and
retain a copy of each disclosure statement so filed and shall
forward the original thereof to the Fair Political Practices
Commission. Source: Regulations of the Fair Political Practices
Commission.
Section 2.3. Time of Filing Initial Statenents. (a) In
General. Each council person having reportable interests shall
file an initial disclosure statement within thirty (30) days after
the effective date of this Code.
(b) New council persons. Each council person, who
assumes a his or her office more than thirty (30) days after the
effective date of this Code, and who has reportable interests at
the time of assuming such position shall file an initial disclosure
statement not less than ten (10) days before assuming such office,
unless an earlier assumption of such position is required, in which
event, the initial disclosure statement shall be filed within 30
days of assuming the office. Source: Government Code §87302(b).
Section 2.4. Time of Filing Annual Statements. An annual
disclosure statement shall be filed in the month of February of
each year by each council person who acquired, received or held a
reportable interest during the,preceding calendar year whether or
not such reportable interest was disposed of during such calendar
year and whether or not the council person filed an initial
statement pursuant to Section 2.3. Source: Government Code $87302(b).
Section 2.5. Categories of Reportable Interests. Reportable
interests are divided into the following categories:
(a) Category I: Interests in Real Property. Interests
in real property are reportable interests if:
(1) the real property to which the interest pertains
is located in part or in whole, (A) within the boundaries of the
City, (B) within the "sphere of influence" of the City, as defined
by the Local Agency Formation Commission, or (C) within two miles
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of land located outside the boundaries of the City which is owned
or used by the Cityt or
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' (2) the fair market value of the interest of the
' council person or his or her spouse is greater than One Thousand
Dollars ($1,000); and
(3) the interest is either: (A) a leasehold,
beneficial or ownership interest held by the council person or
his or her spouse, (B) an option held by the council person or his
or her spouse to acquire such an interest, or (C) an interest or
option held by a business entity or trust in which the council
person or his or her spouse owns directly, indirectly or benefi-
cially, a ten percent (108) interest or greater; provided, however,
that in the event that the ownership interest of the council person
or his or her spouse in such business entity or trust is less than
fifty percent (50&), the value, for the purpose of paragraph (2),
of the real property interest or option relates to the value of
the pro rata share of the council person or his or her spouse
in the real property interest or option held by the business
entity or trust; and provided further, that in the event that the
ownership interest of the council person or his or her spouse in
such business entity or trust is fifty percent (50$) or more, the
va.lue,.for the purpose of paragraph (2), of the real property
interest or option relates to the entire value of the real property
interest or option held by the business entity or trust. Sources:
Government Code §87302(b), 82035, 82033, and 87206(e).
(b), Category II: Investments. Investments in business
entities are reportable if:
(:1) the business entity, including parent corpora-
tions, subsidiary corporations or otherwise related business
entities, (A) has an interest in real property located in part or
in whole within the boundaries oE the City, within the "sphere of
influence" of the City as defined by the Local Agency Formation
Commission, or within two miles of land owned or used by the City,
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(B) does business or plans to do business within the City, or ~
(C1 has done business within the City at any time during the '
two years prior to ~ie time that the disclosure statement of the ~
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council person is filed; and
(2) the fair market value of the investment of
the council person or his or her spouse is greater than One
Thousand Dollars ($1,000); and
(3) the investment either (A) is held by the
council person or his or her spouse and constitutes a financial '
interest in, or security issued by, the business entity, including
but not limited to common stock, preferred stock, rights, warrants,
options, debt instruments and any partnership or other ownership
interest; or (B) is held by any business entity or trust in which
the designated employee or his or her spouse owns, directly,
indirectly or beneficially, a ten percent (10$) interest or
greater, and constitutes~a financial interest in, or security
issued by, a business entity qualifying under paragraph (2) above,
provided, however, that in the event that the ownership interest
of the council person or his or her spouse in such business entity
or trust is less than fifty percent (508), the value, for the
purpose of paragraph (2), of the investment relates to the value
of the pro rata share of the council person or hi§ or her spouse
in the investment held by the business entity or trust; and
provided further, that in the event that the ownership interest
of the council person or his or her spouse in such business entity
or trust is fifty percent (50$) or more, the value, for the purpose
of paragraph (2), of the investment relates to the entire value of
the investment held by the business entity or trust.
An investment is not reportable if it constitutes a time
or demand deposit in a financial institution, a share in a credit
union, an insurance policy, or a bond or other debt instrument
issued by any government or government agency. Sources:
Government Code §87302(b), 82034, 82035, and 87206(e).
(c) Category II2: Sources of Income. Sources of income
are reportable if:
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(1) the source of income was either (A) a business
entity located or doing business as described in subsection (b)(1),
. (B) an individual residing within the City, or (C) a non-profit
association or corporation having its principal place of business
within the City; or
(2) either (A) the aggregate amount of income
received by the council person or his or her spouse from the
source during the period covered by the disclosure statement was
Two Hundred Fifty Dollars (5250) or more in value, or (B) if the
income was a gift received by the council person or his or her
spouse from the source during the period covered by the disclosure ,
statement, the value of the gift was Twenty-Five Dollars (S25) or
more; or
(3). the income was either received by (A) the
council person or his or her spouse, or (B) received by any
business entity or trust in which the designated employee or his
or her spouse owns, directly, indirectly or beneficially, a ten
percent (108) interest or greater, provided, however, that in the
event that the income is received by a business entity described
in this paragraph (B), the value, for the purpose of paragraph (2),
of the income relates to the pro rata share of the council person
or his or her spouse in the income of the business entity or trust.
Income includes, except to the extent excluded by
this subsection, income of any nature from any source, including
but not limited to any salary, wage, advance, payment, dividend
interest, rent, capital gain, return of capital, gift (including
any gift o£ food or beverage), loan, forgiveness or payment of
indebtedness, discount in the price of anything of value unless
the discount is available to members of the public without regard
to official status, rebate, reimbursement of expenses, per diem,
or contribution to an insurance or pension program paid by any
person other than an employer.
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• Income does not include: (1) campaign contributions
required to be reported under Chapter 4(commencing with Section
84100 of Title 9 of the Government Code; (2) salary and reimburse-
ment for expenses or per diem received from any
government agency and reimbursement for travel expenses and per
diem received from a bona fide educational, academic or charitable
organization; (3) gifts of informational material, such as books,
pamphlets, reports, calendars or periodicals; (4) gifts which are
not used and which, within thirty days after receipt, are returned
to the donor or delivered to a charitable organization without
being claimed as a charitable contribution for tax purposes;
(5) gifts from an individual's spouse, child, parent, grandparent,
grandchild, brother, sister, parent-in-law, brother-in-law, sister-
in-la~v, aunt, uncle, or first cousin or the spouse of any such
~ person; provided that a gift from any such person shall be
considered income if the donor is acting as an agent or intermediary
for any person not covered by this paragraph (5); (6) any devise or
inheritance; (7) interest, dividends or premiums on a time or
demand deposit in a financial institution, shares in a credit union
or any insurance policy, payments received under any insurance policy,
or any bond or other debt instrument issued by any government or
government agency; and (.8) dividends, interest or any other return
on a security which is registered with the Securities and Exchange
Commission of the United States Government. Sources: Government
Code §87302(b), 87207(a)(1), 82030(a), 82030 and 82030(b). •
Section 2.6. Content of Disclosure Statements; Category I.
Disclosure statements required to be filed for reportable interests
specified in Category I shall contain the following information:
(a) The address or other precise location of the
real property;
(b) A statement of the nature of the interest in
the real property;
(c) When the real property is not used principally
at the residence of the council person making the filing, a statement
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of whetfier the fair market value of the interest exceeds Ten
Thousand Dollars (.$10,000) and whether it exceeds One Hundred
Thousand Dollars (.5100,000~; and
(d) In the case of an interest in real property
wholly or partially acquired during the period covered by an
annual disclosure statement, the date of acquisition and, if
such interest in such property was disposed of during such period,
the date of disposition. Sources: Government Code §87302(b),
87206(c), 87206(a), 87206(d) and 87206(f).
Section 2.7. Content of Disclosure Statements; Category ZI
~ and Related Categories. Disclosure statements required to be filed
for reportable interests specified in Category ii shall contain the
following information:
(a) The name and address of the business entity in
which each investment is held;
(b) A general description of the business activity
in which the business entity is engaged;
(c) A statement of the nature of the investlnent;
(d) A statement of whether the fair market value of
the investment exceeds Ten Thousand Dollars ($10,000) and
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whether it exceeds One Hundred Thousand Dollars (5100,000);
and '
(e) In the case of investments wholly or partially
acquired during the period covered by an annual disclosure
statement, the date of acquisition and, if such interest
in such property was disposed of during such period, the
date of disposition. Sources: Government Code §87302(b),
87206(b), 87206(a), 87206(d), and 87206(f).
Section 2.8. Content of Disclosure Statement;
Category III. Except as to an initial disclosure state-
ment for ~ahich income sources need not be reported,
disclosure statements required to be filed for reportable
interests specified in Category III shall contain the
following information:
(a) The name and address of each source of
income;
(b) A general description of the business
activity, if any, of each source;
(c) A statement whether the aggregate value of
income from each source was greater than One Thousand Dollars
($1,~00), and whether it was greater than ien Thousand Dollars
($10,000);
(d1 A description oP the consideration, if any, for
which the income was received;
(e) In the case of income constituting a gift, the
amount and the date on which the gift was received;•
(f) In the case of income of a business entity, in
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which the council person or his or her spouse owns a ten percent
(108) interest or more:
(1) name and address and a general description of
the business activity of the business entity;
(2) if such business entity provides legal or
brokerage services, the name of every natural person, non-profit
association or corporation and business entity who paid fees to
such business entity if the pro rata share of the council person
employee or his or her spouse of such fees was One Thousand Dollars,
($1,000) or more; and
(3) if such business entity does not provide
legal or brokerage services, the name of every natural person,
non-profit association or corporation, and business entity from
whom such business entity received payments if the pro rata share
of the council person or his or her spouse of gross receipts from
such person, non-profit association or corporation, or business .
entity was Ten Thousand Dollars ($10,000) or more during any
calendar year partially or wholly covered by the disclosure statement
being filed. Sources: Government Code §87302(b), 87207(a)(1),
87207(a)(2). 87207(a)(3). 87207(a)(4), 87207(b)(1). 87207(b)(2)
and 87207 (b) (3 ) .
, Section 2.9. Form of Disclosure Statements. Disclosure
~ statements required to be filed hereunder for any category of
reportable interests shall be substantially in the form set forth
for such category in Exhibit "A~~ attached hereto. Sources:
Government Code §87206 and 87207.
ARTICLE III--DISQUALIFICATION ~
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Section 3.1. General Rule. Council.persons shall disqualify
themselves from making or participating in the making of any govern-
mental decision when it is reasonably forseeable that a financial
interest of the council person may be materially affected by the
decision. A council person shall not be required to disqualify
himsel£ with respect to any matter which could not be legally
acted upon or decided without his participation. Source: Government
Code §87302(c). -10-
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Section 3.2. Making Governmental Decisions; Actions
Included. A council person makes a governmental decision within the
meaning of this Article, when he or she, acting within the authority
of his or her position:
(a) Votes on a matter;
(b) Appoints a person;
(c) Obligates or commits the City to any course of
action;
(d) Enters into any contractual agreement on behalf
of the City; or
(e) Determines not to act, within the meaning of '
subsection (a) through subsection (d), unless such determination
is made because of his or her financial interest.
When the determination not to act occurs because of his
or her financial interest, the council person's determination must
be accompanied by disclosure of the financial interest made part
of the City's official records. Source: Regulations of the Fair
Political Practices Commission 18700(b).
Section 3.3. Participating in Decisions; Actions
Included. A council person participates in the making of a govern-
mental decision within the meaning of this Article, when he or she,
acting within the authority of his or her position:
(a) Negotiates in any manner with a governmental entity
or private person regarding the decision; '
(b) Conducts research or investigations regarding the
decision;
(c) Prepares any report, analysis, or opinion regarding
the decision;
(d) Participates in any governmental discussions or
debates regardinq the decision; or
(e) Advises or makes recommendations to the decision-
maker. Source: Regulations of the Fair Political Practices Commission
18700(c).
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• Section 3.4. Making or Participating in Decisions;
" Actions Excluded. Making or participating in the making of a
• governmental decision as used in this Article shall not include:
(a) Actions of a council person which are solely
ministerial, secretarial, manual, or clerical;
(b) Appearances by a council person as a member
of the general public before an agency in the course of its
prescribed governmental function to represent himself or herself
on matters related solely to his or her personal interests; or
(c) Actions by a designated employee relating to his
or her compensation as a member of the City Council. Source:
Regulations of the Fair Political Practices Conmiission 18700(d).
Section 3.5. Financial Interest. A financial interest
as used in this Article means:
(a) A direct or indirect interest in real property
as described in Section 2.5(a) if such interest is worth more than
~ One Thousand Dollars ($1,000);
(b) A direct or indirect investment as described in
Section 2.5(b) if such investment is worth more than One Thousand
Dollars ($1,000);
(c) A source of income as described in Section 2.5(c),
other than a loan by a commercial lending institution in the.regular
course of business, if such income aggregates Two Hundred Fifty
Dollars ($250) or more in value received by or promised to the
council person within twelve (12) months prior to the time when
the decision referred to in Section 3.1 is made; or '
(d) A business entity if the council person is a
director, officer, partner, trustee or employee or holds any
position of management therein.
For the purpose of this Section, indirect investment or
interest means any investment or interest owned by the soouse or
dependent child of a council person, by an agent on behalf of a
designated employee, by any business entity controlled by the
council person or by a trust in which he has a substantial interest.
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A business entity is controlled by a council person if the council
person, his agent, spouse and dependent children hold more than
fifty percent (508) of the ownership interest in the entity. A
council person has a substantial interest in a trust when the
employee, his spouse and dependent children have a present or
future interest worth more than One Thousand Dollars ($1,000).
Sources: Government Code §87302(c) and 87103.
~ Section 3.6. Affected Materially. (a) Standard of
Determination. The financial effect of a governmental decision
on~a financial interest of a council person is material if, at
the time the council person makes or participates in the making
of~a decision, in light of all the circumstances and facts known
at the time of the decision, the council person knows or has reason
to know that the existence of the financial interest might inter-
fere with the council person's performance of his or her duties
in an impartial manner free from bias. Source: Regulations of
the Fair Political Practices Commission 18702(a).
(b) Circumstances to be Considered. in determining
the existence of a material effect upon a financial interest, the
council person shall consider relevant factors, including but not ~
limited to the following:
(1) in the case of any real property in which
the council person has a direct or indirect interest worth more
than One Thousand Dollars ($1,000): (A) whether the effect of
the decision will be to increase the income-producing potential
of the real property by One Hundred Dollars ($100) or a five percent
(58) per month, whichever is less; and (B) whether the effect of
the decision will be to increase the fair market value of the real
property by One Thousand Dollars ($1,000) or more or by five percent
(5$) whichever is greater.
(2) In the case of a business entity in which the
council person has a direct or indirect investment worth more than
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One Thousand Dollars (51,000), or in the case of a council person
who is a director, officer, partner, trustee, employee or holds
any position of management in a business entity: (A) whether
the effect will be to increase or decrease the annualized gross
revenue of the business entity by one percent (18) or more or the
annual net income of the business entity by five percent (58) or
more; and (B) whether the effect of the decision will be to increase
or decrease the assets or liabilities of the business entity by
Fifty Thousand Dollars ($50,000) or more, or by five percent (58)
of its current assets or liabilities, whichever is less.
(3) In the case of a source of income of a
council person (other than a loan by a commercial lending institu-
tion in the regular course of business) aggregating Two Hundred
Fifty Dollars ($250) or more in value received by or promised to
the council person within twelve (12) months prior to the time
when the decision is made: (A) whether, if the source of income
is a business entity, the decision will affect such business '
entity in the manner described in subsection (2) above; (B) whether
the governmental decision will directly affect the amount of income
to be received by the council person; and (C) whether there is a
nexus between the qovernmental decision and the purpose for which
the council person receives income.
The specific dollar or percentage amounts set forth in
this subsection do not constitute either absolute maximum or
minimum levels, but are merely intended to provide guidance and
should be considered along with other relevant factors in determining
whether a financial interest may interfere with the council person's
exercise of his or her duties in rendering a decision. Source:
Regulations of the Fair Political Practices Commission 18702(b).
Section 3.7. Notice of Action Taken. (a) Mandatory I
Posting of Notice of Action Taken. If a council person disqualifies j
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himself or herself from the making of a decision, or participation ~
in a decision, upon a particular subject, and if the City '
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subsequently commits itself to a definite course of action with
regard to said subject, then the Clerk shall post a Notice of
Action taken as soon as is practicable following such commitment.
(b) Request for Reconsideration: Time of Filing;
Effect of Failure to File. In the event that a Notice has been
posted pursuant to subsection (a), a written request for reconsid-
eration or disapproval of any City commitment on the ground of
existence of a conflict of interest of a council person shall
be filed with the Clerk within thirty (30) days of the posting
of said Notice. In the event that such a request is not filed,
said commitment and all decision made with regard thereto shall
be final and conclusive.
(c) Reconsideration Upon Filing of Request Therefor.
In the event that a request is filed with the Clerk pursuant to
subsection (b) hereof, the Clerk shall direct said request to the
City Council, and said body shall cause said commitment to be
reconsidered.
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~STATE~ ~~1' OF~ ECO~IC~~I~ ~1~~'~~~~~'~
~ F O R~Ji 7 21 ~
(Government Code Sections 87200 • 87207)
FOR INCUMBENTS RE-ELECTED TO THE SAME OFFlCE
OR OFFICE OF THE SAME JURISDICTION .
OFFICEHOLDERS FILING ANNIVERSARY STATEN9ENTS
.
PERSOIVS WHO HAVE LEFT OFFICE
~ ~ Table of Contents
WHAT IS A STATEMENT OF ECONOMIC INTERESTS? . . . . . . . . . . . . . . . . 1
WHO MUST FILE STATEMENTS? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
WHEN MUST STATEMENTS BE FI LED? . . . . . . . . . . . . . . . . . . . . . . . . 1
WHAT PERIOD SHOULD THE STATEMENT COVER? . . . . . . . . . . . . . . . . . 2
WHERE MUST STATEMENTS BE FI 'LED? . . . . . . . . . . . . . . . : . . . . . . . . 2
HOW TO COMPLETE FORM 721 . . . . . . . . . . . . . . . . . . . . . . . . . . 2•9
~ Schedule 721•A - Investments Over 51,000 . . . . . . . . . . . . . . . . . . . . . 2•3
Sample, Schedule 721-A . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Schedule 721•B - Interests in Real Property Over ~1,000 . . . . . . . . . . . . . 4
Sample, Schedule 721 •B . . . . . . . . . . . . ~ . . . . . . . . . . . . . . . . 5
Schedule 721•C - Investments and Interests in Real Property
Held by Business Entities You Control . . . . . . . . . . . . . . . . . . . . 5
' Sample, Schedule 721-C . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Schedule 721-0 Income Aggregating 5250 or More . . . . . . . . . . . . . . . . 6-7
Sample, Schedule 721 •D . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Schedule 721-E - Gifts Aggregating 525. or More . . . . . . . . . . . . . . . . . . 7-8
Sample, Schedule 721-E ~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Schedule 721-F - Income of Business Entities Which
Provide Legal or Brokerage Services . . . . . . . . . . . . . . . . . . . . . . 8
~ Sample,Schedule721•F . . . . . . . . . . . . . . . . . . . . . . . . . 9
Schedule 721-G -Income of Business Entities Which Oo Not
Provide Legal or Brokerage Services . . . . . . . . . . . . . . . . . . . . . . 9
Sample, Schedule 721 •G . . . . . . . . . . . . . . . . . . . . . . . . . 9
Candidates, newly-elected officeholders who were non•incumbent candidates and appointees who have not
yet assumed office must file Form 720. See "Instruction Manual for Statement of Economic Interests -
Form 720." "
Fair Political Pracrices Commissron ~
P.O. Box 807
. Sacramenro, Califomia 95804
Phone: (916) 322•5660
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INSTRUCTION MANUAL FOR STATEMENT OF ECONOMIC INTERESTS - FORM 721 ~
These instructions are intended to assist the following persbns to comply with the financial disclosure '
requirements of the Political Reform Act (Government Code 87100 et seq.): ~
- Incumbents who have been re~lected to the same office or elected to an office of the same
jurisdiction.
- Officeholders filing anniversary statements.
- Persons who have left office.
WHAT IS A STATEMENT OF ECONOMIC INTERESTS?
A Statement of Economic Interests is a form, available for inspection by the public, which discloses certain
financial interests.
Form 721 is for incumbents who have been re-elected to the same office or office of the same jurisdiction,
officeholders filing anniversary statements and persons who have left office, all of whom must disclose their
investments, interests in real property, income and gifts.
WHO MUST FILE STATEMENTS? .
State Offices - Governor
Lieutenant Governor ~
Attorney General : ,
Controller
Secretary of State
Treasurer
Superintendent of Public Instruction
Member of the Legislature
Member of the State Board of Equalization
Member of the Public Utilities Commission
Member of the State Energy Resources Conservation
~ and Development Commission
Member of the State or Regional Coastal Zone ` .
Conservation Commission
Member of the Fair Political Practices Commission
County Offices - ~iember of the Board of Supervisors
Chief Administrative Officer
City Offices - Mayor
Member of the City Council
City Manager
WHEN MUST STATEMENTS BE FiLED?
Incumbent Re-elected to Same Office or Office of Same Jurisdiction = Within 30 days after tfie date your
new term be~ns.
Officeholder Filin; Anniversary Statement - Within 30 days after the anniversary* of the date your term
began.
~
Pecson Who Has Left Office - Within 30 days after leaving office.
.+The anniversary date is determined by the date on which the term of office began and is not necessarily the date you took
office.
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WHAT PERIOD SHOULD THE STATEMENT COVERI
Incumbent Re-elected to Same Office or Office of Same •Jurisdiction - Investments, interests in real
property, income and gifts acquired since your last anniversary* Statement of Economic Interests to the
date your new term of office began.
Officehoider Filin; Anniversary Statement - Investments, interests in rea* property, income and ~fts
acquired from the day following the day your term began to your anniversary date.
Person Who Has Left Office - Investments, interests in real property, income and gifts acquired since your
last anniversary Statement of Economic Interests to the day you left office.
WHERE MUST STATEMENTS BE FiLED?
State Office - With your agency (e.g., Senators file with the Secretary of the Senate• the Treasurer files
with the Treasurer's Office). ' ,
County Office - With your county clerk.
~ City Office - With your city clerk.
HOW TO COMPLETE FORM 721 •
~ SCHEDULE 721•A
• INVESTMENTS OVER $1,000 .
You must report each of your investments (any financial interest in or security issued by a business entity,
including but not limited to common stock, preferred stock, ri;hts, wanants, options, debt instruments and
any partnership or other ownership interest) valued over $1,000 if the business entity or any parent,
subsidiary or otherwise related business entity owns real property in your jurisdiction** or does business,
plans to do business or has done business in the past two years in your jurisdiction. .
Any investments held by your spouse or dependent children must be reported as though held by you
personally. .
In addition, if you or your spouse owns ciirectly, ind'uectly or beneficially a ten per cent or greater interest
in a business entity or trust which holds investments in other business entities which do business, plan to do
business or have done business in the last two years in your jurisdiction, you must report your pro rata
share of such investments if your share is worth over ~ 1,000.
EXAMPLE: You own 20 per cent of the common stock of X Corporation. X Corporation
holds an investment in Y Corpo~ation worth $10,000. Y Corporation does business in you~
jurisdiction. Your pro rata share of the investment in Y Corporation is worth ~2,000. Since
you have an ownership interest of 10 per cent or greater in X Corporation, and since your
pro rata share of the investment in Y Corporation is over $1,000, you must report a$2,000
investment in Y Corporation as though you owned it directly.
'The anniversary date is determined by the date on which the term of office began and is not necessarily the date you took
office. .
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EXCEPTIONS: You need not list the following types of financial interests as investments:
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- Time or demand deposits in financial institutions (e.g., bank accounts, savings accounts). :
- Shares in a credit union. ~
- Insurance policies.
- Bonds and other debt instruments issued by any government a;ency.
For each reportable investment you must report the following information:
- Nature of the investment (e.g., common stock, partnership interest).
- Name of the business entity and a general description of the business activity.
- Date you acquired or disposed of the investment if you did so during the period covered by the .
Statement.
- Value of your investment. For purposes of determining whether or not the value of an
investment exceeds $1,000, ~ 10,000 or ~ 100,000, you should consider the highest value of the
asset during the period covered. .
SAMPLE, SCHEDULE 721-A
On February 1 you purchased $800 worth of stock in XYZ Corporation, a corporation doing business in
your jurisdiction. On March 1 the stock had a market value of $1,200. On ~Iay 1, you sold the stock for
$900. (You must list the stock because for part of the period covered by the Statement your investment
was worth more than $1,000.) In addition, you have a partnership interest worth ~40,000 in your insurance
firm which owns stock in General Utilities Company, your pro rata share being ~ 1,500. Both your
insurance firm and General Utilities Company do business in your jurisdiction. Schedule 721-A should be
completed as follows: ,
. Check One
XYZ Corporation
(x~ Value does not exceed $10,000
(Name of Company)
Common StoCk [ J Value.exceeds ~10,000 but does not
, .
(Nature ot ~ntarests, e.q., Common Stock, Partnerst+ip tnterest, ett.) exce8d $100 000
Manufactures wid~etS . Acquired Value exceeds 5100,000
°
(General Description of Buslnass Activity) ' ~isposed ~
Check One .
Smith & Black Value does not exceed $10,000
(Name oi Company)
Partnersh.tp [XJ Value exceeds $10,000 but does not
.(Nature ot Interests, e.g. Common Stock, Partnership Interest; ei~.i exceed 5100,~0~
Insurance brokers A4_y„i.~A_______. Value excseds 5100,000
(General Description of Buslness Activity) Dlsposed
General Utilities Check One
[~tl Value does not exceed $10,000
(Name ot Company)
COmInon StoCk • Value excaeds 510,000 but does not
(tvature oi ~nterasts, e.9., Common Stocsc, Partnership I~tarest, etc.) exceed 5100,000
Serves electric power _ A4q,,,,e~
( ] Value exceeds $100,000
(Ge~eral DesCriptio~ ot Susineu Activity) ~ Oisposed
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SCHEDULE 721-B
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INTERESTS IN REAL PROPERTY OVER 51,000
You must report each interest in real property (including any leasehold, beneficial or ownership interest or ~
an option to acquire such an interest in real property) located in your jurisdiction* if the fair market value
of your interest is more than ~ 1,000. •
Any interests in real property held by your spouse or dependent children must be reported as though held
by you personally.
In addition, if you or your spouse owns d'uectly, indirectly or beneficially a 10 per cent or greater interest
in any business entity or trust which holds real property in your jurisdiction*, you must report your pro
rata share of the interest if your share is worth over ~ 1,000.
EXAMPLE: Your spouse inherited a one-fifth interest in the XYZ trust. The trust owns an
80 per cent interest in Parcel A, a commercial property in downtown Chicago worth $3
million; a 10 per cent interest in Parcel B, which is located in you~ jurisdiction and worth
$20,000; and a 100 per cent interest in Parcel C, which is located within your jurisdiction
and worth $10,000. You need not report the interest in Parcel A because it is not located
within your jurisdiction. You need not repon the interest in Parcei B because the value of
the trust's interest is ~2,000, and your pro rata share is one-fifth, or $400, which is below
the $1,000 threshold. You must report Parcel C because the value of the trust's interest is
$10,000, a~d your pro rata share is one-fifth, or $2,000, which exceeds the $1,000
threshold.
For each reportable interest in real property you must show the following:
- Street address or precise location: You must state the street address or the lot number and
subdivision of the real property. If there is no street address or subdivision, you must indicate the
approximate location of the property and cite the book and page number at which the deed to
your property is recorded in the County Recorder's office.
- Nature of your interest (e.g., ownership, option). ~
- Date you acquired or disposed of the real property if you did so during the period covered by the
Statement. ,
- ~/alue of your interest. To determine the value of your-•interest, you should.only consider your
equity interest. For example, if you own property worth $25,000 in which you have an $8,000
equity (with $17,000 still owed to the mortgager), your reportable interest is ~8,000. You need
not indicate the value of real property which is used principally as your residence.
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SAMPLE, SCHEDULE 721-8 . • • ,
You are purchasing a home in your jurisdiction and you also have an equity interest worth ~4,500 in a lot '
~ in your jurisdiction. In addition, Smith and Jones, the business in which you have a 20 per cent interest ~
recently purchased a commercial building in Mudville, having a fair market value of $125,000. Schedule
721-B should be completed as follows:
Check One
1345 Third Street, Mudville ( l Value does not exceed ~10,000
~(Street~Addreis or Fr@CiSe~l.oGtion of PrOpetty) Value excaeds $10,000 but does not
exceed ~100,000
Equity Oate Acquired ~ l Value exceeds $100,000
~~TSiure o"t"in'teieit, e:---~quft ~'8'~tiori-
~ e•~ y~ p ~ ~ ~ate Oisposed Property is used principally as my resid'ence
Check One
Lot 212, Idylwilde Subdivision, Mudville [Y~ Vaiue does not exceed $10,000
............._._..-----------------------------.....---------------------...._......w-------
( Straet Address or P?e<ise locatlon of Property) Vaiue excaeds ~10,000 but does not
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~~ty Oate Acquired t ,
Value exceeds ~100,000
(Nature of Interest, e.g., Equlty, Optlo~) Oate Oisposed
i . CJ~eck One
555 Main Street, Mudville Va1ue does not exceed $10,000 .
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(Stre~t Addross o? Precise Locatlon of Property) ~
Value exceeds 510,000 but does not
EQuitY oate AeQu~red 9~S~7S excesd $100,000
Value exceeds $100,000
(Nature of Interesi, e.g., Equity, Option) Date Oisposed
SCHEDUIE 721-C
INVESTMENTS AND INTERESTS IN REAL PROPERTY
HELO BY BUSlNESS ENTITIES YOU CONTROL
If you, your spouse or dependent children hold an ownership interest of 50 per cent or more of a business
entity listed on Schedule 721-A, you must report all investments of that entity in business entities which do
business, plan to do business or have done business in the last two years in your jurisdiction worth over
$1,000 and all interests in real property worth over $1,000 held by that entity within your jurisdiction.* A
separate Schedule 721-C must be completed for each business entity.
For each investment held by such a business entity you must disclose the name, the nature of the
investment, a general description of the business activity, the date the interest was acquired or disposed of
if it falls within the period covered by your report, and the value. For purposes of determining the value,
you should consider the highest value of the asset during the period covered.
For real property within your jurisdiction* held by such a business entity, you must disclose the street
address or precise location, the nature of the interest held, the date of acquisition or disposal if it falls ~
within the period covered by the report, and the value.
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~ SAMPtE,~SCHE~ULE 721-C
`On September 6, 1975 4ietro Properties, Inc., in which Councilman Jones owns a 75 per cent interest,
' purchased an apartment complex, The Parkside, located in his jurisdiction and valued at 5280,000. ~fetro
Properties also purchased at the same time the undeveloped lot worth ~25,000 adjacent to the complex.
Schedule 721-C should be completed as~follows: .
Name of Business Entity 1~letro Properties, Inc.
INVESTMENTS OVER ~1,000 HELD BY~8USINESS ENTITY
The Parkside Check One
(~ame~oTZ~ompany) ( l Value does not exceed ~10,000
P3rtnetshi» Interest ( l Value exceeds ~10,000 but does not
(i~Tatuie
o~Tnvestmeni, e.g-Common
stoCk~artneishirp T~~terest, etc.) 2XCEed ~100,000
Apartment Complex Acqulred_ 9I6I75 ~ Value exceeds 5100,000
~ene?al escrfption ot~Business
Activityj « Ofsposed ~ -
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INTERESTS IN REAL PROPERTY OVER S1 000 HELD BY BUSINESS ENTITY
Check One
Lot 1014, Briarwood S~~bdivision, Mudville ( l Value does not exceed 510,000
(Street Add?ess or Precise LACetion of Property) ~ ~ ~ '(xj Value exceeds $10,000 but does not
exceed $100,000
Equ1tY A,cqu~~ee_9/6/75
Nature of Interest, e.y., Equlty Optlon) oisaosea Value exceeds S100,000
SCHEDULE 721•D
. INCOME AGGREGATING ~2500R MORE '
You must disclose income agoregating ~250 or more from any one source during the reporting period.
, Reportable income includes any salary, wage, advance, payment, dividend, interest, rent, capital gain, ,
return of capital, ~ift, loan, forgiveness or payrnent of indebtedness, discount in the price of anything of
value unless the discount is available to members of the public without regard to your official status, rebate,
any reimbursement for expenses, per diem or contribution to an insurance or pension program paid by any
person other than your employ~r (see exception below). If the income consists of gifts, it must be reported
on Schedule 721-E.
Unlike investments and interests in real property which need to be reported only if located in your
jurisdiction, income must be disclosed whether or not the income or its source is connected to your
jurisdiction.
You must report as income any community prbperty interest you have in income of your spouse.
Otherwise, you are not required to report income of your spouse or your children.
Your reportable income includes your pro rata share of any income of a business entity or trust in which
you or your spouse owns directly; indirectly or beneficially a 10 per cent or greater interest. For special
instructions on reporting income of such a business entity, see the discussion of Schedules F and G below.
EXCEPTIONS: you are not required to disclose the following:
- Salary or reimbursements for expenses and per diem received from a state or local government
agency.
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- Reimbursement for travet expenses and per diem received from a bona fide educational, acadertuc ~
or charitable organization. • ~ ~
- Campaign contributions.
- Devise or inheritance. .
- Dividends, interest or other return on a security which is registered with the Securities and
Exchange Commission of the U. S. Government.
- Interest, dividends or premiums on a time or demand deposit in a financial institution, shares in a
credit union or insurance policy, payments received under an insurance policy, bond or other
debt instrument issued by a government or government agency.
_ SAMPLE, SCHEDULE 721•D
Supervisor Smith owns stock in California Widget Corporation, a large publicly owned company listed on
the New York Stock Exchange and doing business in his jurisdiction. He received ~2,000 during the period
in dividends on his stock. He also received $15,000 salary income from his insurance business, ~ 1,500
interest income from a plumbing business and $1,200 as his supervisor's salary. Both the insurance business ~
and the plumbing business operate in his jurisdiction. He need not report the dividend as income since his
stock is registered with the Securities and Exchange Commission, nor his salary of $1,200 since it was
received from a local government agency. Schedule 721-D should be completed as follows:
Smith and Jones Insurance Co. Che+ck One
Amount or value received was not greater •
'jfvame oi'etie Source ofTncome) than $1 000
I 10 Main Street
Amount or value received was greater than 51,000
Mudville, California • and was not greater tt,an S70,oo0
.
(Address of tne Souree ot ~ncome . Amount or value received was greatet than
Insurance brokerage ~X1 $~o,ooo
(Business Actlvity ot tne Souree of Income)
Personal Services .
(Description of the co~siCeration, if any, fo~ the Income)
I Hank's Plumbing Supply Check One .
Amount or value received was not greater
~Name of the Sou?ce ot Income) than $1,000
104 Main Street Amount or value received was greater than $1,000
a~d was not greater than 510,000
Mudville, California
Amount or value received was greater than
(Address of the Source ot Income) $10,000
Plumbing supply
(Business Arlivity of the Source of Income)
Return on Investment ~
(Oescrlption of the Co~sideratlon, lf any, tor the Income)
SCHEDULE 721-E
GIFTS AGGREGATING,S25 OR MORE ~
Gifts from one source which total $25 or more durino the reporting period must be disclosed. The name,
address and business activity of the donor must be reported along with a description of each o ft, dates of
receipt and values. Gifts include any payment to the extent"that consideration of equal or greater value is
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' not'received. An honorarium ~ven you for a speaking engagement or similar service must be reported as a
~ ~gift, unless it is clear from the surrounding circumstances that the services provided represented equal or
greater consideration than the payment received. If the services are of equal or greater value than the
payment received, the payment may be reportable as income on Schedule D.
Gifts include food and drink received by you, except ~fts of hospitality which have been reciprocated
during the reporting period. Do not include ~fts of information material, such as books, pamphlets,
reports, calendazs or periodicals or gifts from your spouse, child, parent, grandparent, ~anchild, brother,
sister, parent-in-law; brother-in-law, sister-in-law, aunt, uncle or fust cousin or the spouse of any such
person. Gifts are not reported if they are returned within 30 days or are Q.,iven to a charitable organization
without being claimed as a charitable contribution for tax purposes.
SAMPLE, SCHEDULE 721-E
0
You received complimentary season tickets worth ~100 from your local professional. football team. You ~
also received a complimentary dinner worth ~75 for a party of four from a local restaurant. Schedule 721 •E
should be completed as follows: ~
~ Hangtown Hornets 3/ 1 /74
(Name ot Oonor) (Oate(s) oi G~tt(s) )
?00 Main Street, Mudville ~ 100
(Address) (Value of Gitt) ~
Football Team Season Tickets
(Buslness Activity, tf any, of the donor) (Oescription of Glit)
Le Connoisseur Restaurant 9/15/75
(Nnme o~ on r ~ (Oate(s)~O~~Itt(s) >
. ~l 18d Fifth Street, Mudville
(Addiesij . (Vaiue of Gi/tj
Restaurant ~ Food and Drink
(Buslness Activity, if any, of the Donor) (DesCriptio~ of Gift)
SCHEDULE 721-F . ~
~ INCOME OF BUSINESS ENTITIES
~ ~ WHICN PROVIDE LEGAL OR BROKERAGE SERVICES
You must complete Schedule 721-F if you or your spouse owns a 10 per cent or oreater interest in a
business entity which provides legal or brokerage services, such as an insurance brokerage, a real estate ~
brokerage or a stock brokerage. You must disclose the name, address and business activity of the entity and
~ list all persons who paid fees to the business entity of which your pro rata share ~vas ~1,000 or more.
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~ SAMPLE, SCHEDULE 721-F ~ : ' .
Smith and Jones, an insurance firm in which you, have a 50 per cent interest, received a commission of
$2,000 from Brown, a commission of ~5,000 from Green and a commission of $1,500 from Black. (You
need not list Black's name because your share was only $750, less than ~1,000.) Schedule 721-F should be
compteted as follows:
Smith and Jones
(Nama of Busfness Entit )
110 Main S~treet, Mudville, California
(Address ot Business Entity)
Insurance brokers
(Oescription of its Business Activity
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List the name of eaCh individuai or entity wno paid tees to the above busf~ess entity It your pro rata share of the fees was S1,000 or mo~e.
James Alan Brown ~
Paul Everett Green
SCHEDULE 721-G
INCOME OF BUSINESS ENTITIES WHICH
DO NOT PROVIDE IEGAL OR BROKERAGE SERVICES
You must complete Schedule 721-G if you or your spouse owns a 10 per cent or greater interest in a
business antity which does not provide legal or brokerage services. You must disclose the name of the
entity, its address and a description of its activity as well as the name of each person from whom the entity
received payments of which your pro rata share of gross receipts was ~ 10,000 or more.
' SAMPLE, SCHEDULE 721-G ' ~
~ You own one-third of Hank's Plumbing Supply which sold ~30,000 worth of equipment to Super Hotel
Corporation. You own five per cent of California Lumber Company which sold $200,000 worth of lumber
to the Mudville Construction Company. You need not report information concerning the California
Lumber Company since you own less than a 10 per cent interest in the business, but you must list Super
Hotel Corporation since you own more than 10 per cent of Hank's Plumbing Supply and your pro rata
share of gross receipts from Super Hotel Corporation was ~10,000. Schedule 721-G should be completed as
follows:
_ Hank's Plumbing Supply
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(Name of Busineu Entlty)
104 l~Iain Street, Mudville, California '
(Address of 8usiness Entity)
._._..-----.Plumbing supplY
(Description of its Business Activity)
~ist the name of each individual or entity from whom the above business entity received payments if your pro rata share of gross receipts f~om
the Individual o~ entity was 510,000 or more: _ .
Super Hotel Corv.
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• ~ FO RM 721
Statement of Economic Interests
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• (Government Code Sections 87200 et seq.)
This form is for incumbents re-elected to the same office o~ office
of the same jurisdiction, officeholders filing annivetsary
statements and persons who have left office.
Ses "Instruction Manual for Statement of Economic Interest - Form 721."
1. Name:
- 2. Address:
3. Office:
State of County of City of .
Califo~nia
4. Check the appropriate box:
[ J I have been re-elected to the same office or office of the same jurisdiction. (File within 30 days
after your new term begins.)
This is my anniversary statement. (File within 30 days after the anniversary of the date your term
bega n. )
I left the above-named office as of
(File within 30 days of leaving office.) coace? .
5. Period covered by the Statement:
to ~
VERIFICATION
I understand ihat investments or interests in real property owned by my spouse or dependent child in
which they have an interest of greater than $1,000 must be reported, and I have included all such
investments or interests in real property in this statement.
I declare under penalty of perjury that I have used all reasonable diligence in preparing this statement and
to the best of my knowledge it is true and complete.
Executed on . 19 _ at , California.
' (Signature)
Note to filing officers: Make and retain copies of alt statements filed with you and forward the originals within five days of
their receipt to: The Fair Political Practices Commission, Attention Conflicts of Interest Division, P.O. Box 807, Sacramento,
California 95804.
1/7R Fai~ Pn/itir_al Practices Commisrion - - 1 -
~CH EDULE 721-A ~ ~ ~
Investments
(Government Code Sections 82034 & 87206) . . .
Ses "Instruction Manual for Statement of Economic interests - Form 721," Pages 2 and 3.
Check One
[ J Value does not excaed $10,000
((vame of Company) Value exceeds 510,000 but does not
exceed ~100,000
•
(IVature of Interests, e.g., ~ommon Stock, Partnarship Interest, etc.)
Oate Acquired [ ] Value exrxeds $100,000
Date OfsPOSed
(General OesCription of 8usiness Activity) Ch~'Ck ~ne
[ J Vaiue does not exceed ~10,000
((Vame of Company)~~~~~~'M......~.__~-------- --w. Value exceeds 510,000 but does not
exceed ~100,000
(Nature of Intnrests, e.g., Common Stock, PartnershiD Intarest etc.) ~
Oate Acquired ( ~ Value exceeds $100,000
..-~-----""'--.~.r.°-----•_...
.M.__°----•------------ Oate Olsposed
(Gene~al DesaiOtion of Business Activlty) ~~k ~~e
[ J Value does not exceed ~10,000
(Name of Company) Value exceeds $10,000 but does not
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" exceed ~100,00
(Nature of Interests, e.g.. Commo~ Stock, PartnersMp Interest, etc.)
Cate Acquired ~ ~ Value excaeds $100,000
(General Oescriptio~ of Business Activity) Date Disposed
Check One
[ ] Value does not exceed $10,000
(Name ot Company) Value exceeds ~10,000 but does not
exceed $100.000
(Nature ot~l~terests, a.g., Common Stock, Dartnership Interest, etc.)
Oate AcQulred [ ] Value exceeds $100,000
,(General DesCriptlon of Business Activity) Date DlsposeC
~ Check One~
[ J Value does not exceed 510,000
~Na'"° or ~°'"°a"y~ Value exceeds S10,000 but does not
` ] ~ exceed $100,000
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(Nature of Interests, e.g., Common Stock, Partnarship Interest,.ete.)
Oate Acqulred [ ] Value exceeds ~100,000
(General Descriptlon of Busi~ess Activity) Oate Oisposed
Check One
~ l Value does not excsed 510,000
(Name oi Company) Value exceeds $10,000 but does not
exceed $100,000
(Nature of I~terests, a.g., Common Stoek, Pa~tnership Interest, etc.
Date Acqulred [ ] Value exceeds. ~100,000
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(General Oescrfptlon of Business Activity) Oate Disposed
Check One
( J Value does not excsed S10,000
(Name of Company) Value exceeds 510,000 but does not
exceed $100,000
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(Nature of Interests, e.g., Common Stock, Partnership Interest, etc.)
Date Acquired ( J Value exceeds $100,000
(General Description ot Business Activity) Oate Oisposed
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' . " SCHEDULE 721-B
. ~ Interests in Reai Property
~ ' . (Government Code Sections 82033 & 87206)
See "Instruction Manual for Statement of Economic Interests - Form 721," Pages 4 and 5.
Check One
Value does not exceed S10,000
( J Value excseds 510,000 but does not
(St~eet Address or Predse Location ot Prooerty) exCeed 5100,000
( ~ Value exceeds ~100,000
Date Acquired ( J Property is used principally as my
(Nature of Interest, e.g., Equity, ODtlon) Date OisDOSed residence ~
Check One
( J Value does not exceed S10,000
(Street Address or o+ec~se ~owcio~ oi a.ooercy~ Value exceeds S10,000 but does not
exceed ~100,000
. Oate Acc,uired ( ~ Value exceeds ~100,000
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(Nature of Interost, e.g., Equity, Optto~) Date Olsposed ~
Check One
[ j Value does not exceed 510,000
.
(Street AdCress or Pretise l_otatlon of Property) ~ Value exceeds ~10,000 but does not
~ excesd S100,000
Oate AcQuired Value exceeds S100,000
(Nature of Interest, e.g., Equfty, Optlon) Date Oisposed
Check One
Value does not exceed 510,000
(Street Address or Precisa Locatfon ot P?operty) Value exceeds S10,000 but does not
exceed S100,000 '
Oata Acquired [ ] Value exceeds ~100,000
(Nature of Interest, e.g., Equity, Option) Oate OisposeO
Check One
[ J Value does not exceed 510,000 1
(Street Adtlresi or Pretisa Lot2tion o~ Property) Value exceeds 510,000 but does not
exceed S100,000
Date Acquired ( j Value exceeds S1Q0,000
(Nature ot Interest, e.g., Equity, Option) Date Oisposed
. Check One
( J Value does not exceed S10,000
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(Streat Atldress or P?ec~so Location of P?operty) Value exceeds ~10,000 but does not
exceed S100,000
Oate acqu~rea ( j Value exceeds S100,000
(Nature of Interest, e.g., Equity. Option) Date Oisposed ~
Check One
Value does not exceed 510,000
(St?eet Adtlress or Pretise Location of Property) Value exceeds S10,000 but does not
. exceed 5100,000
Oate AcQuired
[ ] Value exceeds S100,000
(Nature ot Interest, e.g., Equity, Option) Oate Oisposed
-3-
~ SCHEDUlE721-C.`;
Investments and Interests in Reaf Property Held by ~
Business Entities You Controi ' ,
(Government Code Sections 82033, 82034 & 87206) ;
See "Instruction Manual for Statement of Economic Interests - Form 721," Pages 5 and 6.
Name of Business Entity
INVESTMENTS HELD BY BUSINESS ENTITY
Check One
[ j Value does not exceed $10,000
'jfJSme of"~ompanyj"
Value exceeds $10,000 but does not
-
(Nature of Investment, e.g.. Common Stock, Partnership Interest, etc.) exceed 1
. Date Atquired [ ] Value exceeds ~100,000
(C3eneral DescripLO~ ot Business Activity) Date Oisposed
Check One
( l Value does not excasd ~10,000
(iVame ot Company)
, ( J Value exceeds ~10,000 but does.not
exceed $100,000
(Nature of Investment, e.g., Common StoGk, Partnership Interest, etc.)
Data Acqui~ed [ ] Value exceeds $100,000
(Gene~al~0escription of 8usiness Actfvlty) Oate Disposed
~ Check One
~ l Value does not exceed ~10,000
(Name of Company)
[ j Value exceeds ~10,000 but does not
(Nature ot investment, e.g., Common 5tock, Partnership Interest, etc.) exCeed $100,000
Oate AcqulreC i] Value excesds ~100,000
(General Dexription ot Buslness Activity) ' Oate Disposed
Attach additional information on appropriately labeled continuation sheets.
INTERESTS IN REAL PROPERTY HELD BY BUSINESS ENTITY
_ . • Check One
[ J Value does not exceed 510,000
.~_W..~_._..._____~.------------------------------------------------------------------ Value exceeds 510,000 but does not
(Street Address or Precise l.ocation ot Property)
. exceed $100,000
Date Aequired ~ ~ Value exceeds $100,000
(Nature of Inte?est, e.g., Equlty, Optfon) Oate Oisposed
Check One
[ J Va~ue does not exceed $10,000
~ I Value exceeds $10,000 but does not
(Street Atldress or Precise Lowtion of Property)
exceed $100,000
Data Acquired ( ~ Value exceeds $100,000
(Nature of Interest, e.g., Equity, ODtfon) Data OisposeC
Check One
( J Value does not exceed S10,000 .
Value exceeds ~10,000 but does not
(Street Address or Precise Location of Property)
exceed 5100,000
Date Acquired
[ 1 Value exceeds ~100,000
(Nature of Interesi, e.g., Equity, O~•ion) Oate Oisposed
Atrach addifional informar;'on on appropriately labeled conrinuation sheets.
-4-
1l76 Fai~ Politica! Practices Commissron
` • SCHEDULE 721-D
~ Income (Other than Gifts)
, ~ . ~ (Government Code Sections 82030 & 87207(a) )
See "Instruction Manual for Statement of Economic Interests - Form 721," Pages 6 and 7.
Check One
tFlame o~'fti'e Sourc'e"o'r iric'omej"'"""'"""'"""'""""~'~"'~~'~'~~""~"-~~'--~~~~~"~~' Amount or value received was not
• greater than 51,000
Amount or value received was greater than
~ ~1,000 and was not greater than $10,000
(AtlCress of the Source ot Income)
Amount or value received was greater
than ~10,000
(Businesi Activity of the Source of Income)
- ^ •
(Oescription of the consideration, if any, for the Income)
Check One
• [ l Amount or value received was not
(Name of the.SOUrce of Income).
greater than 51,000
' ( J Amount or value recaived was greater than
51,000 and was not greater than 510,000
(Address of the Sourta ot Income
Amount or value received was greater
than $10,000
(Buslness Actlvity of the Source ot Income
^
(Descriptlon of the Consitlaration, it any, fo~ the Income)
Check One
Amount or value received was not
(Name of the Source of Income)
greater than 51,000
Amount or value received was greater than
$1,000 and was, not greater than S10,000
- .
(Address of the Source of Income)
( J Amount or value received was greater
' than $10,000
(Business Activity of the Source ot Income)
° • ° • • • •
(Descriptlon of tAe Conslderatlon, i} any, for the Income)
• Check One
j Amount or value received was not
(Name of the Source of Income) greater than 51,000 '
Amount or value received was greater than
$1,000 and was not greater than S10,000
• •
(Address of the Source ot Income) ~
Amount~or value received was greater
than 510,000
(Business Activity of the Sourcfl of Income)
°
Oescription ot the Consideration, it any, tor the InCOme)
-5-
~
SCHEDULE 721-E ~ ~
G ifts ' ~ ~
(Government Code Sections 82028 & 87207(a) ) ,
See "Instruction Manual for Statement of Economic Interests - Form 721," Pages 7 and 8. '
(Name of ~ono?) Date(s) ot Giit(s)
(Address) va~ue ot Giit(s)
(Busineu Attivity, if any, of the ~ono~~ Oespiption of Gift(s)
(Name ot Oo~or) Date(s) ot Gtft(s) -
(Address) value o~ Gift(s)
(BUSiness Activity, i1 any, ot the Donor) Description of Gift(s)
(Name ot Do~or) Date(s) ol Gitt(s)
(Atld~ess) • Value of Gitt(s)
(Business Activity, if any, of the Oono~) Oescription of Gitt(s)
(Name ot Oonor) Oate(s) ot Gift~s)
(Atldress) Value ot Gtft(s)
---------------------------------------»__...._.__._....__.-------.........-----.._._r.--°.--°
(Business Activity, if any, ot the Oonor) Oescription of Gift(s)
(Name ot Donor) oate(s? o~ Gitt(s)
(Address) Value of Gitt(s)
(Busf~ess Activity, i( a~y, of the Oono~) Descriptio~ of Gitt(s)
-6-
1/76 Fair Political Praciices Commission
~ 1
~ ~ ' ~ SCHEDULE 721-F ~
_
lncome of Business Entity which
' Provides Legal or Broke~rxa±ge Services
,
(Government Code Sections 82030 & 87207(b) )
See "I nstruction Manual for Statement of Economic I nteresis - Form 721," Pages 8 and 9.
(Name of Business Entity)
(Adtlress of Business Entity)
(OesCriptio~ of its BuSiness Attivity)
list the name of each individual or entity who paid fees to the above business entity if your pro rata share of the fees
was $1,000 0~ more: ~
. ~
~
• \ . .
SCHEDULE 721-G '
Income of Business Entities which .
. .
do not Provide Legal or Brokerage Services ~
,
(Government Code Sections 82030 & 87207(b) 1
See "I nstruction Manual for Statement of Economic I nterests - Form 721," Page 9.
(Name of Business Entity) '
(Address of Business Entity) ~
(Destription of its Business ACtivity
List the name of each individual or entity from whom the above business entity received payments if your pro rata share of
gross receipts from the individual or entitY was 510,000 or more.
.
(Name of Business Entity)
(Address o( Business Entity)
(~escriptlon of its Business Entity)
List the name of each individual or entity from whom the above business entity received payments if your pro rata share of
gross receipts from the individual or entity was $10,000 or more. ~
\ ~
' -8-