700 Statement of Economic InterestPlease type or print in ink.
NAME OF FILER
1. Office, Agency, or Court
STATEMENT OF ECONOMIC INTERES
COVER PAGE
('}(LAST)(///y�,�� (FIRST)
c Y A ,46 6,442;
2;
Agency Name (Do not use acronyms)
Division, Board, Department, District, if applicable Your Position
C t,,4 � L_
► If filing for multiple positions, list below or on an attachment. (Do not use acronyms)
Agency:
2. Jurisdiction Of Office (Check at least one box)
Position,
Date Received
Official Use Only
D [E-V 111 11 W L14
rm _41T-171 I AIIr1moQL
❑ Stato ❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ Multi- County ❑ County of
City of . ��� - ❑ Other —
3. Type of Statement (Check at least one box)
❑ Annual: The period covered is January 1, 2013, through
December 31, 2013,
-or-
The period covered is i I through
December 31, 2013.
❑ Leaving Office: Date Leff I. ___ I
(Check one)
O The period covered is January 1, 2013, through the date of
leaving office.
❑ Assuming Office: Date assumed 1 O The period covered is L I through
the date of leaving office.
Candidate; Election year i" and office sought, if different than Part 1:
4, Schedule Summary
Check applicable schedules or "None." o- Total number of pages including this cover page:
M Schedule A -1 - Investments - schedule attached °[ Schedule C - income, Loans, & Business Positions - schedule attached
❑ Schedule A -2 - Investments - schedule attached ❑ Schedule D - Income - Gifts - schedule attached
Na Schedule B • Real Property - schedule attached ❑ Schedule E - Income - Gifts - Travel Payments - schedule attached
-o r•
❑ None - No reportable interests on any schedule
5. Verification
MAILING ADDRESS STREET CITY STATE ZIP COLE
(Business or Agency Address Recommended - Pubfio Document)
DAYTIME TELEPHONE NUMBER E -MAILA DRESS (OPTIONAL)
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 acknowledge this is a public document.
I certify under penalty of perjury under the laws of the State of California that the foregoing Is true and correct. !i
Date Signed i✓ �� l Signature
(month, day, year) (File tt rrginaltys)gned sfafement wf g oihcial.J
0
V AVC Form 700 (2013/2014)
FPPC Advice Email; advice @fppc.ca.gov
FPPC Toll -Free Helpline: 866/275 -3772 www,fppc.ca.gov
r
SCHEDULE B
Interests in Real Property
(Including Rental Income)
ASSESSOR'S PARCEL NUMBER R STREET ADDRESS
CITY
FAIR JARKET VALUE IF APPLICABLE, LIST DATE:
❑ $2,000 - $10,000
❑ $10,001 - $100,040 -1 1 13 �- 1
❑ $100,001 - $1,000,000 ACQUIRED DISPOSED
�e Over $1,000,000
NATURE OF INTEREST
'�f _'OwnershiplDeed of Trust ❑ Easement
❑ Leasehold ❑
Yrs. remaining Other
IF RENTAL PROPERTY, GROSS INCOME RECEIVED
❑ $0 - $499 ❑ $500 - $1,000 ❑ $1,001 - $10,000
❑ $10,001 - $100,000 ❑ 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 of
income of $10,000 or more.
❑ None
Name
► ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS
CITY
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
❑ $2,000 - $10,004
❑ $14,041 - $144,040 113
❑ $140,001 - $1,000,000 ACQUIRED DISPOSED
❑ Over $1,000,000
NATURE OF INTEREST
❑ Ownership /Deed of Trust ❑ Easement
❑ Leasehold ❑
Yrs. remaining
Other
IF RENTAL PROPERTY, GROSS INCOME RECEIVED
❑ $0 - $499 ❑ $500 - $1,000 ❑ $1,001 - $10,000
❑ $10,001 - $100,000 ❑ 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 of
income of $10,000 or more.
❑ None
* You are not required to report 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. Personal loans and
loans received not in a lender's regular course of business must be disclosed as follows:
NAME OF LENDER*
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF LENDER
INTEREST RATE TERM (MonthslYears)
❑ None
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500 - $1,000 ❑ $1,001 - $10,000
❑ $10,001 - $100,000 ❑ OVER $100,000
❑ Guarantor, if applicable
Comments:
NAME OF LENDER*
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF LENDER
INTEREST RATE TERM (MonthsNears)
❑ None
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500 - $1,000 ❑ $1,001 - $10,000
❑ $10,001 - $1001000 ❑ OVER $100,000
❑ Guarantor, if applicable
FPPC Form 700 (20'13/2014) 5ch. I3
FPPC Advice Email: advice @fppc.ca.gov
FPPC Toll -Free Helpline; $66/275 -3772 wwwJppc.ca.gov
SCHEDULE C
Income, Loans, & Business
Positions
(Other than Gifts and Travel Payments)
NAME OF SOURCE. OF INCOME er rre-1Z
r- Mom r & L-o k Al , NVA ° HO-AAc &L-0,
ADDRES (Business Address cep b!e)
BUSINESS ACTIVITY IF ANY, OF POUkCE
x0 L 6-14 -r& s r PR- OP&P -7 Y
YOUR BUSINESS POSITION ,
612-op-&-g
GROSS INCOME RECEIVED
❑ $500 - $1,000 ❑ $1,001 - $10,000
❑ $10,001 - $100,000 OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
[Salary F-1 Spouse's or registered domestic partner's income
❑ Loan repayment ❑ Partnership
❑ Sale of
(Reai property, cad boat, efc.)
❑ Commission or ❑ Rental Income, fist each source of $10,000 or more
❑ Other
(Describe)
NAME OF SOURCE OF INCOME 6,?r -+,5,A RaA43-
p>4 & & 1,0 ,4�j
ADDRESS (Business Address A epta_ bf)
BUSINE S ACTIVITY, IF ANY, OF SOURCE
)'loo g k>-r G S= cti' �"r a�j o �2 54L 6-JrfiPr SAL&
YOUR BUSIN SS POSITION
PA-AL 6,,ff,61r1b_ 6,:9_r k__ GVA_d i 86Fr_ftz i
GROSS INCOME RECEIVED
❑ $500 - $1,000 ❑ $1,001 - $10,000
❑ $10,001 - $100,000 JgOVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
❑ Salary Spouse's or registered domestic partner's income
❑ Loan repayment ❑ Partnership
❑ Sale of
(Real property, car, boat, etc.)
❑ Commission or ❑ Rental Income, JIM each source of $10,000 or mare
❑ Other
(Describe)
•A r OR OUTSTANDING r •O• TING PERIOD-
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. Personal loans and loans received not in a lender's
regular course of business must be disclosed as follows:
NAME OF LENDER"
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF LENDER
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500 - $1,000
❑ $1,001 . $10,000
❑ $10,001 - $100,000
F] OVER $100,000
Comments:
INTEREST RATE TERM (MonthsNears)
% ❑ None.
SECURITY FOR LOAN
❑ None ❑ Personal residence
0 Real Property
❑ Guarantor
❑ Other
Street address
City
(Dbscrlbe)
FPPC Form 700 (2013/2014) 5ch. C
FPPC Advice Email: advice @fppc.ca.gov
FPPC Toll-Free Helpline: 866/275 -3772 www.fppc.ca.gov