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 statements with each agency.
To simplify your ﬁling obligations, you may complete an
• To do this, enter the name of the other agency(ies) with
which you are required to ﬁle and your position title(s) in
the space provided. Do not use acronyms. Attach an
additional sheet if necessary. Complete one statement
covering the disclosure requirements for all positions.
Each copy must contain an original signature. Therefore,
before signing the statement, make a copy for each
agency. Sign each copy with an original signature and ﬁle
with each agency.
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 1 annual ﬁling deadline must ﬁle
a separate assuming ofﬁce statement. In subsequent years,
the city council member may expand his or her annual ﬁling to
include both positions.
Scott Baker 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 Placer and
Yuba counties. Scott will complete one Form 700 using full
disclosure (as required for the city position) and covering
interests in both Placer and Yuba counties (as required for
the multi-county position) and list both positions on the Cover
Page. Before signing the statement, Scott will make a copy
and sign both statements. One statement will be ﬁled with
City of Lincoln and the other will be ﬁled with Camp Far West
Irrigation District. Both will contain an original signature.
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.
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 2015 annual statement, do not change the
pre-printed dates to reﬂect 2016. Your annual statement is
used for reporting the previous year’s economic interests.
Economic interests for your annual ﬁling covering January 1,
2016, through December 31, 2016, will be disclosed on your
statement ﬁled in 2017. See Reference Pamphlet, page 4.
Combining Statements: Certain types of statements 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
Part 4. Schedule Summary
• Complete the Schedule Summary after you have reviewed
each schedule to determine if you have reportable
• 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. All statements must have an original
“wet” signature or be duly authorized by your ﬁling ofﬁcer to
ﬁle electronically under Government Code Section 87500.2.
Instructions, examples, FAQs, and a reference pamphlet are
available to help answer your questions. 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.
FPPC Form 700 (2015/2016)
FPPC Advice Email: email@example.com
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
Instruc瑩ons – 1
Judge or Court Commissioner (Statewide Jurisdiction)
2. Jurisdiction of Ofﬁce
(Check at least one box)
Agency Name (Do not use acronyms)
Division, Board, Department, District, if applicable
1. Ofﬁce, Agency, or Court
If ﬁling for multiple positions, list below or on an attachment. (Do not use acronyms)
Yuba & Sutter Counties
Feather River Irrigation District