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Statement of Economic Interest ~~.._~. \ C ¡\'-'i,'! æ ,L)I,a '.. .~ I -\, ' STATEMENT OF ECONOMIC INTEREST 'Ji '''i' lì'I~;:-:-~~l !~ I~' l i~ L::¡ it 1'1 -- Date ;:e:: --r l i I' þ~~ffIG¡~I~O~r¡8S 10 CALIFORNIA FORM 700 fAIR POLITICAL PRACTICES COMMISSION Please type or print in ink A Public Document COVER PAGE ; If J /G'l/5 CUPERTINO CITY CLERK NAME (lAST) (FIRST) t~ MAILING A DRESS STREET (May use business address) CITY 1. Office, Agency, or Court Name of Office, Agency, or Court: (J'1 CvJ^C I I Division, Board, ~sr~t, if applicable: Your Position: ~ COJ^(¡I ~ "'\ - If filing for multiple positions, list additional agency(ies)! position(s): (Attach a separate sheet if necessary.) Agency: Position: 2. Jurisdiction of Office (Check at least one box) o State o County of "$... City of r v(JJ: ,\11'1> o Multi-County o Other 3. Type of Statement (Check at least one box) o Assuming Office/Initial Date: -----1-----1_ o Annual: The period covered is January 1, 2004, through December 31, 2004. -or- a The period covered is ----1----1_, through December 31, 2004. o Leaving Office Date Left: -----1-----1_ (Check one) o The period covered is January 1, 2004, through the date of leaving office. -or- a The period covered is ----1-----1_, through the date of leaving office. R Candidate (MIDDLE) DAYTIME TELEPHONE NUMBER v (CS-o) ~ - 3/"1(, OPTIONAL: FAX ! E-MAIL ADDRESS STATE ZIP CODE f" Ie, ("'-J. 180. J.~ )~, (,., ,..... h C/r ~ ''19J¿') 4. Schedule Summary (Check applicable schedules or "No reportable interests.") - During the reporting period, did you have any reportable interests to disclose on: Schedule A-1 0 Yes - schedule attached Investments (Less than 10% Ownership) Schedule A-2 0 Yes - schedule attached Investments (10% or greater Ownership) Schedule B Real Property ;¡,¡rYes - schedule attached Schedule C Income, Loans, Travel Payments) ~ Yes - schedule attached & ãlÆiness Positions (Income Other than Gifts and Schedule D (Eliminated - report ioans on Schedule C) Schedule E 0 Yes - schedule attached Income - Gifts Schedule F 0 Yes - schedule attached Income - Travel Payments -or- - 0 No reportable interests on any schedule Total number of pages completed including this cover page: ~s 5. Verification I have used all reasonable diligence in preparing this statement. I have reviewed this statement and to the best of my knowledge the information contained herein and in any attached schedules is true and complete. I certify under penalty of perjury under the laws ofthe State of California that the foregoing is true and correct. Date Signed i h 105 (month, day, year) Signature e originally signed statement with your filing official) FPPC Form 700 (200412005) FPPC Toll-Free Helpline: 866/ASK-FPPC SCHEDULE Ä-1 Investments Stocks, Bonds, and Other Interests (Ownership Interest is Less Than 10%) Do not attach brokerage or financial statements. CALIFORNIA FORM 700 FAIR POLITICAL PRACTICES COMMISSION Na~ 1i""I,'j rf!'),Jrv.tt.r ). NAME OF BUSI~ESS ENTITY f).. M D -II/I ~ Ulll GENERAL DESCRIPTION OF BUSINESS ACTIVITY f't\/(J'J1p" <! Ij oJ ~ ). NAME OF BUSINESS ENTITY ()6/l.-l GENERAL DESCRIPTION OF BUSINESS ACTIVITY ---- FAIR MARKET VALUE 1;8'$2,000 . $10,000 0$100,001 - $1,000,000 D $10,001 - $100,000 DOver $1.000,000 FAIR MARKET VALUE D $2,000 - $10,000 D $100,001 - $1.000,000 0$10,001 - $100,000 DOver $1,000,000 NATURE OF INVESTMENT ..M' Stock D Other NATURE OF INVESTMENT D Stock D Other (Describe) (Describe) IF APPLICABLE, LIST DATE: IF APPLICABLE, LIST DATE: ~--ºJ..¡~ ACQUIRED ~~~ DISPOSED ~~~ ACQUIRED ~~~ DISPOSED ). NAME OF BUSINESS ENTITY )0 NAME OF BUSINESS ENTITY DIe~1ft/JW ("N<J\<.I~/(j,¡) '5 GENERAL DESCRIPTION OF BU~]NESS ACTIV!TY - W-i I? Vn-N9' 0 GENERAL DESCRIPTION OF BUSINESS ACTIVITY ('D rc£ FAIR MARKET VALUE JiC $2,000 - $10,000 o $100,001 - $1,000,000 0$10,001 - $100,000 DOver $1,000,000 FAIR MARKET VALUE 0$2,000 - $10,000 0$100,001 - $1,000,000 0$10,001 - $100,000 DOver $1,000,000 NATURE OF INVESTMENT ~Stock o Other NATURE OF INVESTMENT o Stock o Other (Describe) (Describe) IF APPLICABLE, LIST DATE: ~-º-1~ ACQUIRED IF APPLICABLE, LIST DATE: ~~~ DISPOSED ~~~ ACQUIRED ~~~ DISPOSED » NAME OF BUSINESS ENTITY ÐDH GENERAL DESCRI? ION OF BUSINESS ACTIVITY ~ )0 NAME OF BUSIN~~TY GENERAL DESCRIPTION OF BUSINESS ACTIVITY ~ ~ FAIR MARKET VALUE 0$2,000 - $10,000 0$100,001 - $1,000,000 o $10,001 - $100,000 DOver $1,000,000 FAIR MARKET VALUE o $2,000 ~ $10,000 D $100,001 - $1,000,000 o $10,001 - $100,000 DOver $1,000,000 NATURE OF INVESTMENT o Stock o Other NATURE OF INVESTMENT o Stock D Other (Describe) (Describe) IF APPLICABLE, LIST DATE: IF APPLICABLE, LIST DATE: ~~~ ACQUIRED ~~~ DISPOSED ~~~ ACQUIRED ~~~ DISPOSED Comments: FPPC Form 700 (2004/2005) Sch. A-1 FPPC Toll-Free Helpline: 866/ASK-FPPC SCHEDULE A-2 Investments, Income, and Assets of Business EntitieslTrusts (Ownership Interest is 10% or Greater) ,. . Address ~ ",t:.v- J ~«y.^ J C,,,·v,' f~'" (? "I " Check one o Trust, go to 2 o Business Entity, complete the box, then go to 2 GENERAL DESCRIPTION OF BUSINESS ACTIVITY rv(þ ! FAIR MARKET VALUE iO $2,000 - $10,000 D $10,001 - $100,000 D $100,001 - $1,000,000 DOver $1,000,000 NATURE OF INVESTMENT o Sole Proprietorship D Partnership 0 IF APPLICABLE, LIST DATE ---1---1 04 ACQUIRED ---1---1~ DISPOSED ""'" YOUR BUSINESS POSITION CALIFORNIA FORM 7 0 0 FAIR POLITICAL PRACTICES COMMISSION Name L ~ j kÞ~ 1'.er > 1 BUSINESS ENTITY OR TRUST Name Address Check one D Trust. go to 2 f'F ,I Dr GENERAL DESCRIPTION OF BUSINESS ACTIVITY D Business Entity, complete the box, then go to 2 FAIR MARKET VALUE D $2,000 - $10,000 0$10,001 - $100,000 0$100,001 - $1,000,000 DOver $1,000,000 NATURE OF INVESTMENT D Sole Proprietorship D Partnership YOUR BUSINESS POSITION IF APPLICABLE, LIST DATE: ---1---1 04 ACQUIRED ---1---1~ DISPOSED o ""'~ o $0 ~ $499 o $500 ~ $1,000 D $1,001 - $10,000 0$10,001 - $100,000 DOVER $100,000 D $10,001 - $100,000 DOVER $100,000 » 3 LIST THE NAME OF EACH REPORTABLE SINGLE SOURCE OF INCOME OF $10,000 OR MORE lattaçM a separato sMeot f ne ~'saryl t.J(1r » 4. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD BY THE BUSINESS ENTITY OR TRUST Check one box: o INVESTMENT o REAL PROPERTY, rvlA Name of Business Entity Q.[ Street Address or Assessor's Parcel Number of Real Property Description of Business Activity 2r City or Other Precise Location of Real Property FAIR MARKET VALUE D $2,000 - $10,000 D $10,001 - $100,000 D $100,001- $1,000,000 DOver $1,000,000 NATURE OF INTEREST D Property Ownership/Deed of Trust IF APPLICABLE, LIST DATE: ---1---1 04 ---1---1~ ACQUIRED DISPOSED DStock D Partnership D Leasehold D Other Yrs.remaining D Check box if additional schedules reporting investments or real property are attached Comments: o $0 ~ $499 o $500 ~ $1,000 o $1,001 ~ $10,000 » 3 LIST THE NAME OF EACH REPORTABLE SINGLE SOURCE OF INCOME OF $10,000 OR MORE lattatM a soparato sMcot If necossary) Check one box o INVESTMENT » 4 INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD BY THE BUSINESS ENTITY OR TRUST o REAL PROPERTY Name of Business Entity Q.[ Street Address or Assessor's Parcel Number of Real Property Description of Business Activity Q.[ City or Other Precise Location of Real Property FAIR MARKET VALUE D $2,000 - $10,000 D $10,001 . $100,000 D $100.001 - $1,000,000 DOver $1,000,000 NATURE OF INTEREST D Property Ownership/Deed of Trust D Leasehold Yrs.remaining D Check box if additional schedules reporting investments or real property are attached IF APPLICABLE, LIST DATE: ---1---1 04 ---1---1~ ACQUIRED DISPOSED D Stock D Partnership DOther FPPC Form 700 (2004/2005) Sch. A-2 FPPC Toll-Free Helpline: 866fASK~FPPC CALIFORNIA FORM 700 FAIR POLITICAL PRACTICES COMMISSION SCHEDULE B Interests in Real Property (Including Rental Income) > STREET ADDRESS OR PRECISE LOCATION ~ ì~<t/L1~ '8'5"1 ~4Ie J1¡,... CITY / t '1" L.v fiff N.I FAIR MARKET VALUE 0$2,000 - $10,000 D $10,001 + $100,000 fia $100,001 - $1,000,000 o Over $1,000,000 IF APPLICABLE, LIST DATE: ~ --.lJ 04 --.f --.f 04 ACQUIRED DISPOSED NATURE OF INTEREST ~ownershjPlDeed of Trust D Easement D Leasehold o Other Yrs. remaining IF RENTAL PROPERTY, GROSS INCOME RECEIVED o $0 ~ $499 0 $500 ~ $1,000 0 $1,001 ~ $10,000 D $10,001 - $100,000 0 OVER $100,000 SOURCES OF RENTAL INCOME: If you own a 10% or greater interest, list the name of each tenant that is a single source õt income of $10,000 or more. NAME OF LENDER· Welts ~'" ADDRESS T ~.A~ ~~o---'" BUSINESS ACTI~TY OF L1NDER L..&-Vf (~'? INTEREST RATE TERM (Months/Years) 3Ó",¡-- /J;W) . C? % o None HIGHEST BALANCE DURING REPORTING PERIOD o $500 ~ 11.000 0 $1,001 ~ $10,000 o $10,001 - $100,000 ~ OVER $100,000 D Guarantor, if applicable Comments: -1 n,... "^J N 7 ~C( N~e 4.,) A ~'1'vJ::t' r- > STREET ADDRESS OR PR,CISE LOCATION f1 O~ (?(Lif CITY FAIR MARKET VALUE 0$2,000 - $10,000 o $10,001 - $100,000 0$100,001 - $1,000,000 DOver $1,000,000 IF APPLICABLE, LIST DATE: --.f --.f 04 --.f --.f.M- ACQUIRED DISPOSED NATURE OF INTEREST o Ownership/Deed of Trust o Easement D Leasehold 0 Yrs, remaining Other IF RENTAL PROPERTY, GROSS INCOME RECEIVED o $0 ~ $499 0 $500 ~ $1,000 0 $1.001 ~ $10,000 0$10,001 - $100,000 0 OVER $100,000 SOURCES OF RENTAL INCOMÈ: If you own a 10% or greater interest, list the name of each tenant that is a single source of income of $10,000 or more. NAME OF LENDER· ADDRESS BUSINESS ACTIVITY OF LENDER INTEREST RATE TERM (Months/Years) % o None HIGHEST BALANCE DURING REPORTING PERIOD o $500 ~ $1,000 D $1,001 ~ $10,000 o $10,001 - $100,000 0 OVER $100,000 o Guarantor, if applicable * Loans from commercial lending institutions made in the lender's regular course of business on terms available to members of the public without regard to your official status are not reportable. FPPC Form 700 (200412005) Sch. B FPPC Toll-Free Helpline: 8661ASK-FPPC SCHEDULE C Income, Loans* & Business Positions (Other than Gifts and Travel Payments) CALIFORNIA FORM 700 FAIR POLITICAL PRACTICES COMMISSION Na~ 4,J A~~,,,,\k-er ( AOORESS 1--./ '\2 71 t:>", r-N"", BUSINESS ACTIVITY, IF ANY, OF SOURCE 1.-01 v-.,) ,f7;.... YOUR BUSINESS POSITION I .1 f",kJ'o~~ -- !Jt}or!'() GROSS INCOME RECEIVED/HIGHEST BALANCE DURING REPORTING PERIOD, IF LOAN o $500 ~ $1,000 0 $1,001 ~ $10,000 o $10,001 - $100,000 ~OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED 12( Salary 0 Spouse's income D Loan repayment v ....."'- "Jm. ~ '6/ ,,) BUSINESS ACTIVITY, IF ANY, OF ~.QURCE t. .. VII f1 r,... (., kJ.- GROSS INCOME RECEIVED/HIG 5T BALANCE DURING REPORTING PERIOD, IF LOAN D $500 - $1,000 D $1,001 - $10,000 0$10,001 - $100,000 g OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ~a)ary 0 Spouse's income 0 Loan repayment o Sale of o Sale of (Property, car, boat, etc.) (Property, car, boat, ele.) D Commission or D Rental Income, !isl each SDurce 01 $10,000 or more D Commission or D Rental Income, !isl each source of $10,000 or more o Other (Describe) DOther (Describe) o LOAN RECEIVED (complete box 2) o LOAN RECEIVED (complete box 2) ~I'\~I ADDRESS v- I)ð\ ()" I ~\? f/rr Cfri'tjbl BUSINESS ACTI~TY, IF ANY, OF SO CE..bJ. r ~..r", "-L .,. VI'- ' YOUR BUSINESS POSITION \A.o\. r:.r.. 5........ f~...(........c...~ GROSS INCOME RECEIVED/HIGHEST BALANCE DURING REPORTING PERIOD, IF LOAN 0$500 - $1,000 0 $1,001 - $10,000 CX-$10,001 - $100,000 DOVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED IASalary ¡g'Spouse's income D Loan repayment % 0 None SECURITY FOR LOAN D None D Personal residence o Real Property Street address City D Guarantor D Other (Describe) D Sale of (Property, car, boat, ele.) * You are not required to report loans from commercial lending institutions, or any indebtedness created as part of a retail installment or credit card transaction, made in the lender's regular course of business on terms available to members of the public without regard to your official status. o Commission or D Rental Income, list each source of $10,000 or more D Other (Describe) Comments: o LOAN RECEIVED (complete box 2) FPPC Form 700 (2004/2005) Sch. C FPPC Toll-Free Helpline: 866/ASK-FPPC