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

California Form 700 (2013-2014) Fair Political Practices Commission
FPPC Toll-Free Helpline: 1 (866) ASK-FPPC - (866) 275-3772

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 $440 gift limit, but may result in a disqualifying conflict of interest.

Name of Source (Not an Acronym):

Address (Business Address Acceptable):

City and State:

Business Activity, If Any, Of Source:

501 (c)(3)

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

Name of Source (Not an Acronym):

Address (Business Address Acceptable):

City and State:

Business Activity, If Any, Of Source:

501 (c)(3)

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

Name of Source (Not an Acronym):

Address (Business Address Acceptable):

City and State:

Business Activity, If Any, Of Source:

501 (c)(3)

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

Name of Source (Not an Acronym):

Address (Business Address Acceptable):

City and State:

Business Activity, If Any, Of Source:

501 (c)(3)

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

Comments:

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