Schedule E: Income - Gifts - Travel Payments, Advances, and Reimbursements

California Form 700 (2015-2016) Fair Political Practices Commission
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Name:
  • 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. These payments are not subject to the $460 gift limit, but may result in a disqualifying conflict of interest.
  • For gifts of travel that occurred on or after January 1, 2016, provide the travel destination.

Name of Source (Not an Acronym):

Address (Business Address Acceptable):

City and State:

501 (c)(3) or DESCRIBE business activity, if any, of source

Business Activity, If Any, Of Source:

Date(s) (month, day, year):   To (if applicable) (month, day, year)

Amount in dollars $:

Type of Payment: (must check one)

Gift Income

Made a Speech/Participated in a Panel

Other, Provide Description:

If Gift, Provide Travel Destination

Name of Source (Not an Acronym):

Address (Business Address Acceptable):

City and State:

501 (c)(3) or DESCRIBE business activity, if any, of source

Business Activity, If Any, Of Source:

Date(s) (month, day, year):   To (if applicable) (month, day, year)

Amount in dollars $:

Type of Payment: (must check one)

Gift Income

Made a Speech/Participated in a Panel

Other, Provide Description:

If Gift, Provide Travel Destination

Name of Source (Not an Acronym):

Address (Business Address Acceptable):

City and State:

501 (c)(3) or DESCRIBE business activity, if any, of source

Business Activity, If Any, Of Source:

Date(s) (month, day, year):   To (if applicable) (month, day, year)

Amount in dollars $:

Type of Payment: (must check one)

Gift Income

Made a Speech/Participated in a Panel

Other, Provide Description:

If Gift, Provide Travel Destination

Name of Source (Not an Acronym):

Address (Business Address Acceptable):

City and State:

501 (c)(3) or DESCRIBE business activity, if any, of source

Business Activity, If Any, Of Source:

Date(s) (month, day, year):   To (if applicable) (month, day, year)

Amount in dollars $:

Type of Payment: (must check one)

Gift Income

Made a Speech/Participated in a Panel

Other, Provide Description:

If Gift, Provide Travel Destination

Comments:

[End of SCHEDULE E: Income - Gifts - Travel Payments, Advances, and Reimbursements]