700 Statement of Economic InterestSTATEMENT OF ECONOMIC INTERESTS
COVER PAGE
Please type or print in ink.
Date Received
Offclai use Only
NAME OF FILER (LAST) (FIRST) (MIDDLE)
?A1.4 L- ��Ac-Y
1. Office, Agency, or Court
Agency Name (Do not use acronyms) r 19) i� � � u U 1_1�1
CZ-Pr of 1 ""My -r1Nb � 7`i iu�L
Division, Board, Department, District, if applicable Your Position � N JU'L 2 4 2014
► If filing for multiple positions, list below or on an attachment. (Do not use acronyms)
Agency: Position:
2. Jurisdiction of Office (check at least one box)
CUPERTINO CITY CLERK
❑ State ❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ Muni- County ❑ County of
®'City of ❑ Other
3. Type of Statement (Check at least one box)
❑ Annual: The period covered is January 1, 2013, through ❑ Leaving Office: Date Left I I
December 31, 2013, (Check one)
-or- The period covered is _____ I I through O The period covered is January 1, 2013, through the date of
. December 31, 2013. leaving office.
❑ Assuming Office: Date assumed 1. _ 1 O The period covered is I I through
the date of leaving office.
0"Eandidate: Election year -LON and office sought, if different than Part 1:
4. Schedule Summary
Check applicable schedules or "None."
❑ Schedule A -1 - Investments - schedule attached
®°Schedule A -2 - Investments - schedule attached
❑ Schedule B - Real Property - schedule attached
o- Total number of pages including this cover page: 2—
[] Schedule C - Income, Loans, & Business Positions - schedule attached
❑ Schedule D - Income - Gifts - 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 CODE
(Business or Agency Address Recommended - Public Document)
DAYTIME TELEPHONE NUMBER I E -MAIL ADDRESS (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.
Date Signed 7/2 3/ 1Y Signature
(monih, day, year) (File Iho o y signed statement with your filing of Val)
FPPC Form 700 (2013/2014)
FPPC Advice Email: advice @fppc.ca.gov
FPPC Toll -Free Helpline: 8661275 -3772 www.fppc.ca.gov
SCHEDULE A -2 CALIFORNIA FORm
. FAIR POLITICAL PRACTICES COMMISSION
Investments, Income, and Assets
Name
of Business Entities /Trusts
(Ownership Interest is 10% or Greater)
Name
-
Address (Business Address Acceptable)
Check one
❑ Trust, go to 2 Business Entity, complete the box, then go to 2
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
❑ $0 - $1,999
❑ $2,000 - $10,000 ,13 113
❑ $10,001 - $'100,000 ACQUIRED DISPOSED
01100,001 - $1,000,000
❑ Over $1,000,000
NATURE OF INVESTMENT
❑ Partnership ❑ Sole Proprietorship ��i- lSSiunA,
YOUR BUSINESS POSITION A-0022e h -
❑ $0 - $499
❑ $500 - $1,000
❑ $1,001 - $10,000
ne
❑ $10,001 • $100,000
ja'OVER $100,000
Check one box:
❑ INVESTMENT ❑ REAL PROPERTY
Name of Business Entity, if Investment, or
Assessor's Parcel Number or Street Address of Real Property
Description of Business Activity or
City or Other Precise Location of Real
Property
FAIR MARKET VALUE
IF APPLICABLE, LIST DATE:
❑ $2,000 - $10,000
❑ $10,001 - $100,000
❑ $100,001 - $1,000,000
ACQUIRED DISPOSED
❑ Over $1,000,000
NATURE OFINTEREST
❑ Property ownership/Deed of Trust
❑ Stock ❑ Partnership
p'� Lsed 4 OLher
I� Jj rs, ain
❑ Check box if additional sc ul reporti
are attached
JUL 2 4- 2014
Comments:
CUPERTINO CITY CLERK
Investments or real property
1 1. BUSINES5 ENTITY OR TRUST
Name
Address (Business Address Acceptable)
Check one
❑ Trust, go to 2 ❑ Business Entity, complete the box, then go to 2
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
❑ $o - $1,999
❑ $2,000 - $10,000 ---/--J-13 � -J___! 13
❑ $10,001 - $100,000 ACQUIRED DISPOSED
❑ $100,001 - $1,000,000
[] Over $1,000,000
NATURE OF INVESTMENT
❑ Partnership ❑ Sole Proprietorship ❑
Other
YOUR BUSINESS POSITION
SHARE OF • •
❑ $0 - $499 ❑ $ioxi - $100,000
❑ $500 - $1,000 ❑ OVER $100,000
❑ $1,001 - $10,000
None
Check one box:
❑ INVESTMENT ❑ REAL PROPERTY
Name of Business Entity, if Investment, or
Assessor's Parcel Number or Street Address of Rea[ Property
Description of Business Activity or
City or Other Precise Location of Real Property
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
❑ $2,000 - $10,000
❑ $10,001 - $100,000
[] $100,001 - $1,000,000 ACQUIRED DISPOSED
❑ Over $i,co0,000
NATURE OF INTEREST
❑ Property Ownership /Deed of Trust ❑ Stock ❑ Partnership
❑ Leasehold ❑ Other
Yrs. remaining
❑ Check box if additional schedules reporting investments or real property
are attached
FPPC Form 700 (2013/2014) Sch. A -2
FPPC Advice Email: advice @fppe.ca.gov
FPPC Tall -Free Helpline: 866/275 -3772 www.fppc.ca.gov