Professional Documents
Culture Documents
, .'
CALiFORNIA FORM
FAIR POLITICAL PRACTICES COMMISSION
700 STATEMENT OF ECONOMIC INTERESTS ""
, ',' . " ~
Date Received
Official Use Only
. i :." . r _ ~. -.::. L ,-
Agency: Position:
o Assuming Office: Date ----1----1_ _ o The period covered is ----1----1_ _, through the date
01 leaving office.
o Candidate: Election Year _ _ _ _ _ __ Office sought, il different than Part 1: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
4. Schedule Summary
Check applicable schedules or "None." .. Total number of pages including this cover page: ~
0schedule A-1 - Inveslmenls - schedule attached o Schedule C - Income, Loans, & Business Positions - schedule attached
Q"5chedule A-2 - Inveslments - schedule attached 121
Schedule D - Income - Gifts - schedule attached
o Schedule B - Real Properly - schedule attached o Schedule E - Income - Gifts - Travel Payments - schedule attached
-or-
O None - No reporlable interests on any schedule
5.
I have used all reasonable diligence in preparing this statement. I have reviewed this
herein and in any attached schedules is lrue and complete. I acknowledge this is a
I certify under penalty of perjury under the laws of the State of California that
Name
Stocks, Bonds, and Other Interests
(Ownership Interest is Less Than 10%)
Do not attach brokerage or financial statements.
C O,X
FAIR MARKET VALUE FAIR MARKET VALUE
~ $2,000 - $10,000 D $10,001- $100,000 o $2,000 - $10,000 liZ! $10,001 - $100,000
tf1100,001 - $1,000,000 DOver $1,000,000 D $100,001 - $1,000,000 L:I Over $1,000,000
NATURE OF INVESTMENT /'JATURE OF INVESTMENT
tiil..Stock D Other ------,==:-:------
(Describe)
a. Stack D other ------:;==-C------
(Describe)
D Partnership o Income Received of $0 - $499
o Income Received of $500 or More (Report on Schedule C)
o Partnership o Income Received of $0 - $499
o Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE: IF APPLICABLE, LIST DATE:
j:,......-t--c..rCLc-h v-e-
FAIR MARKET VALUE
-r-cc.h ~€'N\c6 w+e.r+-a\'~meU\+
FAIR MARKET VALUE
00 $2,000 - $10,000 D $10,001 - $100,000 o $2,000 - $10,000 ~ $10,001 - $100,000
D $100,001 - $1,000,000 Dover $1,000,000 D $100,001 - $1,000,000 DOver $1,000,000
Comments: _________________________________________________________________________________________
FPPC Form 700 (2010/2011) Sch. A-1
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
SCHEDULE A-1 CALIFORNIA FORM 700
Investments FAIR POLITICAL PRACTICES COMMISSION
ph cq--mo"c.e.u-hc...Cl \
FAIR MARKET VALUE FAIR MARKET VALUE
D $2,000 - $10,000 !l!I $10,001 - $100,000 !SC1 $2,000 - $10,000 D $10,001 - $100,000
0$100,001 - $1,000,000 DOver $1,000,000 0$100,001 - $1,000,000 Dover $1,000,000
:tn+e I C6reC:>~T1.0(\
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
f\ll\ze "thC
GENERAL DESCR1IPTION OF BUSINESS ACTIVITY
L\o...ss
£ em ( Co J'\tlvcbr Chi prrut~ o...:!hle...-hc. {o oi.Wore./o.p po...re \
FAIR MARKET VALUE FAIR MARKET VALUE
D $2,000 - $10,000 j!g.$10,001 - $100,000 '5ZI_ $2,000 - $10,000 D $10,001 - $100,000
0$100,001 - $1,000,000 DOver $1,000,000 0$100,001 - $1,000,000 DOver $1,000,000
NATURE OF INVESTMENT
'i'l Stock D Other - - - - - : : :(Describe)
:--::-:-----
NATURE OF INVESTMENT
~ Stock D
Other _ _ _ _ _ ==-::-_____
(Describe)
o Partnership o Income Received of $0 - $499
o Income Received of $500 or More (Repolt on Schedule C)
o Partnership 0 Income Received of $0 - $499
o Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE: IF APPLICABLE, LIST DATE:
/l _ G
+
,.. N~ OF BUSINESS ENTITY ,.. NAME OF BUSINESS ENTITY ~
l'{! l Gro.sO.f
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
L-D rf> C.harieG (c.hUtCLD -QCtl.
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
Sof+ Wo..r-e
FAIR MARKET VALUE FAIR MARKET VALUE
D $2,000 - $10,000 fS2I $10,001 - $100,000 Iil $2,000 - $10,000 0$10,001 - $100,000
D $100,001 - $1,000,000 a Over $1,000,000 0$100,001 - $1,000,000 DOver $1,000,000
Comments: ______________________________________________________________________________________
FPPC Form 700 (2010/2011) Sch, A-I
FPPC Toll-Free Helpline: 866/275·3772 www.fppc.ca.gov
SCHEDULE A-2 CALIFORNIA FORM
FAIR POLtTlCAL PRACTICES COMMISSION
700
Investments, Income, and Assets
Name
of Business EntitiesITrusts
(Ownership Interest is 10% or Greater) f; Pkv~'i
~ 1 BUSINESS ENTITY OR TRUST
Name
~
10'001 - $100,000 0$10,001 - $100,000
$100,001 - $1,000,000 ACQUIRED DISPOSED D $100,001 - $1;000,000 DISPOSED
ver $1,000,000 DOver $1,000,000
... 2 IDENTIFY THE GROSS INCOME RECEIVED (INCLUDE YOUR PRO RATA
SHARE OF THE GROSS INCOME IQ THE ENTITYfTRUST)
.... 4 INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD BY THE ... 4 INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD BY THE
BUSINESS ENTITY OR TRUST BUSINESS ENTITY OR TRUST
Check one box: Check one box:
o INVESTMENT o REAL PROPERTY
FAIR MARKET VALUE IF APPLICABLE, LIST DATE: FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
.[d
$2,000 - $10,000 D $2,000 - $10,000
~O,001 - $100,000 ---1---1~ ---1---1~ D $10,001 - $100,000 ---1---1~ ---1---1~
D $~OO,001 - $1,000,000 ACQUIRED DISPOSED D $100,001 - $1,000,000 ACQUIRED DISPOSED
DOver $1,000,000 Dover $1,000,000
o Leasehold
Yrs, remaining
0 Other _ _ _ _ _ _ _ _ _ __ D Leasehold D Other - - - - - - - - - -
Yrs. remaining
o D
'iI,,,
Check box if additional schedules reporting investments or real property Check box if additional schedules reporting investments or reat property
are attached are attached
Comments: ~ 1Mtt M{ tJo ~%~ FPPC Form 700 (201012011) Sch. A-2
or-
10,000 frf '{'NYv
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
..
CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
SCHEDULE D
Income - Gifts
DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S) . DATE (mm/ddJyy) VALUE DESCRIPTION OF GIFT(S)
113 l?
...Lt~-.lQ' $ II 0. 1 Ccu,IWS. y-ck..etVr.I
-----.l-----.l_ >-$_ _ _,-- -----.l-----.l_ ...
$ _ __
-----.l-----.l_ $ _ __ -----.l-----.l_ $, _ __
DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S) DATE (mmiddtyy) VALUE DESCRIPTION OF GIFT(S)
\OI351~ $ 459· ~q
-----.l-----.l_ $_ _ __ -----.l----.l_ $. _ __
-----.l-----.l_. $ _ _ __ .......:..1-----.l_ $, _ _ __
-----.l-----.l_ $ _ _ __ -----.l-----.l_ $, _ _ __
Comments: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~ _ _ _ ____
." .
CALIFORNJAFORM
FAIR POl.ITICAl. PRACTICES COMMISSION
700
SCHEDULE D
Name
Income - Gifts
.. NAME OF SOURCE
~"'-'..L.>4-"---'-''''-'-'''''''I'r'''~/'J+-,-,W,-=-'(...=.S-=-f't-""'-"-'I.e.
-:-:,'M':'::'::c';""""I
ADDRESS (Business Address Acceptable) ADDRESS (Busine s Address Accepta )
!..LJ~200 $ soo-
vv>~a.l S J 3, 'j'f,,{.,..../I
--.J--.J_ $_ _ __ -\v/v». ., f wfM.r'6v- --.J--.J_ $._ _ __
--.J--.J_ $_ __ --.J--.J_ $_ _ __
--.J--.J_ $_ _ __
--.J--.J_ $._ _ __
DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S) DATE (mm/ddlyy) VALUE DESCRIPTION OF GIFT(S)
--.J~_ $, _ _ __ --.J~_ $_ _ __
Comments: __________________________________________