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 maycomplete one expanded statement to disclose all reportableinterests for both offices and list both positions on the CoverPage. Brian will file the expanded statement with each the Cityand 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.
• 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.

The image shows that the filer entered Feather River Irrigation District in the agency name field, N/A in the division, board, department, district field, board member in the position field. The filer then entered N/A in the agency field to indicate he is not filing for multiple positions. The filer checked on Multi County and entered Yuba & Sutter Counties on Part 2, under Jurisdiction of Office.

Part 3. Type of Statement

StatementCheck 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 2021 annual statement, do not change the pre-printed dates to reflect 2022. Your annual statement is used for reporting the previous year’s economic interests. Economic interests for your annual filing covering January 1, 2022, through December 31, 2022, will be disclosed on your statement filed in 2023. 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.

End of Title Page, Cover Page Instructions, HTML text-only version of Form 700, Years 2021 and 2022