Schedules A-1 Investments and A-2 Business Entities

Sat May 07, 2022 6:46 pm

SCHEDULES A-1 AND A-2 STATEMENTS OF ECONOMIC INTERESTS

Schedule A-1 and A-2 Investments Instructions

Reportable investments include

Stocks, bonds, warrants, and options, including those held in margin or brokerage accounts and managed investment funds
Sole proprietorships
Your own business or your spouse's or registered domestic partner's business
Your spouse's or registered domestic partner's investments even if they are legally separate property
Partnerships (e.g., a law firm or family farm)
Investments in reportable business entities held in a retirement account
If you, your spouse or registered domestic partner, and dependent children together had a 10% or greater ownership interest in a business entity, you must disclose investments held by the business entity

You are not required to disclose

Government bonds, diversified mutual funds, certain funds similar to diversified mutual funds (such as exchange traded funds) and investments held in certain retirement accounts
Bank accounts, savings accounts, money market accounts and certificates of deposits
Insurance policies
Annuities
Commodities
Shares in a credit union
Government bonds (including municipal bonds)
Retirement accounts invested in non-reportable interests (e.g., insurance policies, mutual funds, or government bonds)
Government defined-benefit pension plans

Use Schedule A-1 to report ownership of less than 10% (e.g., stock). Schedule B (Income) may also be required if the investment is not a stock or a corporate bond. (See second example below)

Use Schedule A-2 to report ownership of 10% or greater (e.g., a sole proprietorship).

To Complete Schedule A-1

Do not attach brokerage or financial statements.

Disclose the name of the business entity
Provide a general description of the business activity of the entity (e.g., pharmaceuticals, computers, automobile manufacturing, or communications)
Check the box indicating the highest fair market value of your investment during the reporting period. if you are filing a candidate or an assuming office statement, indicate a fair market value on the filing date or the date you took office, respectively
Identify the nature of your investments (e.g., stocks, warrants, options, or bonds)
An acquired or disposed of date is only required if you initially acquired or entirely disposed of the investment interest during the reporting period. The date of a stock dividend reinvestment or partial disposal is not required. Generally, these dates will not apply if you are filing a candidate or an assuming office statement

Example 1: Frank Byrd holds a state agency position. His conflict of interest code requires full disclosure of investments. Frank must disclose his stock holdings of $2,000 or more in any company that is located in or does business in San Andreas, as well as those stocks held by his spouse or registered domestic partner and dependent children.

Example 2: Alice Lance is a city council member. She has a 4% interest, worth $50,000, in a limited partnership located in the city. Alice must disclose the partnership on Schedule A-1 and income of $4,001 or more received from the partnership on Schedule B.

Use Schedule A-2 to report investments in a business entity (including a consulting business or other independent contracting business) in which you, your spouse or registered domestic partner, and your dependent children, together or separately, had a 10% or greater interest, totaling $100,000 or more, during the reporting period and which is located in, doing business in, planning to do business in, or which has done business during the previous two years.

Also report on Schedule A-2 investments and real property held by that entity if your pro rata share of the investment or real property interest was $100,000 or more during the reporting period.

Form 700, Schedule A-1, Investments: Stocks, Bonds, and Other Interests (Ownership Interest is Less than 10 Percent) Form

Investments must be itemized. Do not attach brokerage or financial statements. Mark your response with an X.

Filer's name:

Investment 1

Name of Business Identity:

General Description of this Business Activity:

Fair Market Value:
[-] $10,000 to $50,000
[-] $50,001 to $100,000
[-] $100,001 to $1,000,000
[-] Over $1,000,000

Nature of Investment:
[-] Stock
[-] Partnership
[-] Other

If other checked, describe other:

Income Received:
[-] Income Received of $0 to $4,000
[-] Income Received of $4,001 or More (Report on Schedule B)

If Applicable, Acquired Date:
If Applicable, Disposed Date:

Investment 2 (If Another is Applicable)

Name of Business Identity:

General Description of this Business Activity:

Fair Market Value:
[-] $10,000 to $50,000
[-] $50,001 to $100,000
[-] $100,001 to $1,000,000
[-] Over $1,000,000

Nature of Investment:
[-] Stock
[-] Partnership
[-] Other

If other checked, describe other:

Income Received:
[-] Income Received of $0 to $4,000
[-] Income Received of $4,001 or More (Report on Schedule B)

If Applicable, Acquired Date:
If Applicable, Disposed Date:

Investment 3 (If Another is Applicable)

Name of Business Identity:

General Description of this Business Activity:

Fair Market Value:
[-] $10,000 to $50,000
[-] $50,001 to $100,000
[-] $100,001 to $1,000,000
[-] Over $1,000,000

Nature of Investment:
[-] Stock
[-] Partnership
[-] Other

If other checked, describe other:

Income Received:
[-] Income Received of $0 to $4,000
[-] Income Received of $4,001 or More (Report on Schedule B)

If Applicable, Acquired Date:
If Applicable, Disposed Date:

Form 700, Schedule A-2, Investments, Income, and Assets of Business Entities (Ownership Interest is 10 percent or greater) Form

Mark your response with an X.

Filer's name:

1. BUSINESS ENTITY

Name of business entity:
Address of business entity:

General Description of this Business Activity:

Fair Market Value:
[-] $10,000 to $50,000
[-] $50,001 to $100,000
[-] $100,001 to $1,000,000
[-] Over $1,000,000

Nature of Investment:
[-] Partnership
[-] Sole Proprietorship
[-] Other

If other checked, describe other:

If Applicable, Acquired Date:
If Applicable, Disposed Date:

2. IDENTIFY THE GROSS INCOME RECEIVED (INCLUDE YOUR PRO RATA SHARE OF THE GROSS INCOME TO THE ENTITY)

Gross income received (include your pro rata share of the gross income to the entity):
[-] $0 to $4,000
[-] $4,001 to $20,000
[-] $20,001 to $40,000
[-] Over $40,000

3. LIST THE NAME OF EACH REPORTABLE SINGLE SOURCE OF INCOME OF $100,000

[-] None
[-] Names listed below

If names listed below checked, list the name of each reportable single source of income of $100,000 or more:

4. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD OR LEASED BY THE BUSINESS ENTITY

Investments or Real Property:
[-] Investment
[-] Real Property

Name of Business Entity, if Investment, or Address of Real Property:
Description of Business Activity of Real Property:

Fair Market Value:
[-] $10,000 to $50,000
[-] $50,001 to $100,000
[-] $100,001 to $1,000,000
[-] Over $1,000,000

Nature of Investment:
[-] Property Ownership
[-] Stock
[-] Partnership
[-] Other

If other checked, describe other:

If Applicable, Acquired Date:
If Applicable, Disposed Date:

Formats

Schedule A-1 Format:

Code: Select all

[divbox=#FFFFDA][br][/br][center][b][size=115]Form 700, Schedule A-1, Investments: Stocks, Bonds, and Other Interests (Ownership Interest is Less than 10 Percent) Form[/center][/b][/size]

[i]Investments must be itemized. Do not attach brokerage or financial statements. Mark your response with an X.[/i]
[br][/br]
[b]Filer's name: [/b]
[br][/br][hr][/hr]
Investment 1

[b]Name of Business Identity: [/b]

[b]General Description of this Business Activity: [/b]

[b]Fair Market Value: [/b]
[-] $10,000 to $50,000 
[-] $50,001 to $100,000
[-] $100,001 to $1,000,000
[-] Over $1,000,000

[b]Nature of Investment:[/b]
[-] Stock
[-] Partnership
[-] Other

[b]If other checked, describe other: [/b]

[b]Income Received:[/b]
[-] Income Received of $0 to $4,000
[-] Income Received of $4,001 or More (Report on Schedule B)

[b]If Applicable, Acquired Date: [/b]
[b]If Applicable, Disposed Date: [/b]
[br][/br][hr][/hr]
Investment 2 (If Another is Applicable)

[b]Name of Business Identity: [/b]

[b]General Description of this Business Activity: [/b]

[b]Fair Market Value: [/b]
[-] $10,000 to $50,000 
[-] $50,001 to $100,000
[-] $100,001 to $1,000,000
[-] Over $1,000,000

[b]Nature of Investment:[/b]
[-] Stock
[-] Partnership
[-] Other

[b]If other checked, describe other: [/b]

[b]Income Received:[/b]
[-] Income Received of $0 to $4,000
[-] Income Received of $4,001 or More (Report on Schedule B)

[b]If Applicable, Acquired Date: [/b]
[b]If Applicable, Disposed Date: [/b]
[br][/br][hr][/hr]
Investment 3 (If Another is Applicable)

[b]Name of Business Identity: [/b]

[b]General Description of this Business Activity: [/b]

[b]Fair Market Value: [/b]
[-] $10,000 to $50,000 
[-] $50,001 to $100,000
[-] $100,001 to $1,000,000
[-] Over $1,000,000

[b]Nature of Investment:[/b]
[-] Stock
[-] Partnership
[-] Other

[b]If other checked, describe other: [/b]

[b]Income Received:[/b]
[-] Income Received of $0 to $4,000
[-] Income Received of $4,001 or More (Report on Schedule B)

[b]If Applicable, Acquired Date: [/b]
[b]If Applicable, Disposed Date: [/b]
[br][/br]

Schedule A-2 Format:

Code: Select all

[divbox=#FFFFDA][br][/br][center][b][size=115]Form 700, Schedule A-2, Investments, Income, and Assets of Business Entities (Ownership Interest is 10 percent or greater) Form[/center][/b][/size]

[i]Mark your response with an X.[/i]
[br][/br]
[b]Filer's name: [/b]
[br][/br][hr][/hr]
[b][size=115]1. BUSINESS ENTITY[/b][/size]

[b]Name of business entity: [/b]
[b]Address of business entity: [/b]

[b]General Description of this Business Activity: [/b]

[b]Fair Market Value: [/b]
[-] $10,000 to $50,000 
[-] $50,001 to $100,000
[-] $100,001 to $1,000,000
[-] Over $1,000,000

[b]Nature of Investment:[/b]
[-] Partnership
[-] Sole Proprietorship
[-] Other

[b]If other checked, describe other: [/b]

[b]If Applicable, Acquired Date: [/b]
[b]If Applicable, Disposed Date: [/b]

[b][size=115]2. IDENTIFY THE GROSS INCOME RECEIVED (INCLUDE YOUR PRO RATA SHARE OF THE GROSS INCOME TO THE ENTITY)[/b][/size]

[b]Gross income received (include your pro rata share of the gross income to the entity):[/b]
[-] $0 to $4,000
[-] $4,001 to $20,000
[-] $20,001 to $40,000
[-] Over $40,000

[b][size=115]3. LIST THE NAME OF EACH REPORTABLE SINGLE SOURCE OF INCOME OF $100,000[/b][/size]

[-] None
[-] Names listed below

[b]If names listed below checked, list the name of each reportable single source of income of $100,000 or more: [/b]

[b][size=115]4. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD OR LEASED [u]BY[/u] THE BUSINESS ENTITY [/b][/size]

[b]Investments or Real Property: [/b]
[-] Investment
[-] Real Property

[b]Name of Business Entity, if Investment, or Address of Real Property: [/b]
[b] Description of Business Activity of Real Property: [/b]

[b]Fair Market Value: [/b]
[-] $10,000 to $50,000 
[-] $50,001 to $100,000
[-] $100,001 to $1,000,000
[-] Over $1,000,000

[b]Nature of Investment:[/b]
[-] Property Ownership
[-] Stock
[-] Partnership
[-] Other

[b]If other checked, describe other: [/b]

[b]If Applicable, Acquired Date: [/b]
[b]If Applicable, Disposed Date: [/b]
[br][/br]