700 Statement of Economic InterestPlease type or print in ink.
NAME OF FILER
1. Office, Agency, or Court
(LAST)
STATEMENT OF ECONOMIC INTERESTS
COVER PAGE
(FIRST)
Agency Name (Do not use acronyms) T
Division, &ard, Department, District, 46ppfioable Your Position
► If fling for multiple positions, list below or on an attachment. (Do not use acronyms}
Agency:
Position,
Date Received
Omcial Use Only
000" '-r 4 2014
2. Jurisdiction of Office (Check at least one box)
[❑ State
❑ Judge or Court Commissioner (Statewide Jurisdiction)
Multi- County
❑ County of
City of ��� � i
❑ Other
3. Tyne of Statement (Check at least one box)
❑ Annual: The period covered is January 1, 2013, through
❑ Leaving Office: Date Leff t
December 31, 2013.
(Check one)
.or- The period covered is I
through O The period covered is January 1, 2013, through the date of
December 31, 2013.
leaving office.
A ssuming Office: Date assumed 1.
O The period covered is I through
the date of leaving office,
Candidate: Election year 2 and office sought, if different than Part 1:
4, Schedule Summary
Check applicable schedules or `None,"
a Total number of pages including this cover page:
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
❑ Schedule B - Real Property — schedule attached
❑ Schedule E - Income -- Gifts -- Travel Payments — schedule attached
.or-
F] None - No reportable interests on any schedule
5, Verification
MAILING ADDRESS MREET CITY swA ZIP CODE
{Business or Agency Address Recommended - Public Doc=ent)
Jp�
)
DAYTIME TELEFHONE NUMBER E -MAIL ADDRESS (OPTIONAL)
(.
I have used all reasonable diligence in preparing this slafement. I have reviewed this statement and to the best of my knowledge the information contained
herein and in any attached schedules is true and complele. 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 + ( Signature
(ma1fh, day, year] (Frfe the odginally signed slaiemenl wilh your rifiag nrficlai.)
FPPC Farm 700(2013/2014)
FPPC Advice Email: advice @fppc.ca,gov
FPPCToll -Free Helpline: 866/275 -3772 www.fppc.ca.gov
RK
SCHEDULE A -1 , . , _
Investments
Stocks, Bonds, and Other Interests game
(Ownership Interest is Less Than 1 a %) / lU
Do not attach brokerage or financial statements. _!!
0- NAME OF BUSINESS ENTITYfp
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE
$2,000 - $10,000 ❑ $10,001 - $100,000
❑ $100,001 - $1,000,000 ❑ Over $1,000,000
N TURE OF INVESTMENT
Stock ❑ Other
(Describe)
Partnership Q Income Received of $0 - $499
Q Income Received of $500 or More (Report on Schedule q
IF APPLICABLE, LIST DATE:
_ /. _� 13 —1 13
ACQUIRED DISPOSED
NAME. OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE
❑ $2,000 - $10,000 ❑ $10,001 - $100,000
❑ $100,001 - $1,000,000 ❑ Over $1,000,()DD
NATURE OF INVESTMENT
❑ Stock ❑ Other
(Describe)
❑ Partnership O Income Received of $0 - $499
O Income Received of $500 or More (Report an Schedule C)
IF APPLICABLE, LIST DATE:
___j 13
ACQUIRED DISPOSED
NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE
❑ $2,000 - $10,000 ❑ $10,001 - $100,000
❑ $100,001 - $1,000,000 ❑ Over $1,000,000
NATURE OF INVESTMENT
E Stock ❑ Other
( Describe)
F1 Partnership O Income Received of $0 - $499
O Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
ACQUIRED DISPOSED
Comments:
r NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE
❑ $2,000 - $10,000 ❑ $10,001 - $100,000
❑ $100,001 - $1,000,000 ❑ Over $1,000,000
NATURE OF INVESTMENT
❑ Stock ❑ Other
(Describe)
❑ Partnership O Income Received of $0 - $499
O income Received of $500 or More (Report on Schedule C}
IF APPLICABLE, LIST DATE:
J____ J 13
ACQUIRED DISPOSED
Pi NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE
❑ $2,000 - $10,000 ❑ $10,001 - $100,000
❑ $100,001 - $1,000,000 ❑ Over $1,000,000
NATURE OF INVESTMENT
❑ Stock ❑ Other
(t]escri be)
❑ Partnership Q Income Received of $0 - $499
O Income Received of $500 or More f,Repori on Schedule C)
IF APPLICABLE, LIST DATE:
-� / 13 — .� 1 13
ACQUIRED DISPOSED
NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE
❑ $2,000 - $10,000 $10,001 - $100,000
$100,001 - $1,ODD,000 L] Over $1,000,000
NATURE OF INVESTMENT
Stock ❑ Other
(Describe)
❑ Partnership O income Received of $0 . $499
O Income Received of $500 or More (Repod on Schedule C)
IF APPLICABLE, LIST DATE:
�__i 13 13
ACQUIRED DISPOSED
FPPC Form 700 (2013/2014)
FPPC Advice Email: advice @fppe.ca.gov
FPPCToli -Free Helpline:866 /275 -3772 www.fppc.ca.gov
SCHEDULE C I - • - �'
Income, Loans, & Business ' " '
Positions Name
(Other than Gifts and Travel Payments) o
NAME OF SOURCE OF INCOME
-V E0 R �W S
ADDRESS (Business Address Acceptable)
-�
BUSINESS ACTIVITY, IF ANY, OF SOURCE'
411 ft �?
YOUR BU (NESS POSITION
A AV( Se—
GROSS INCOME RECEIVED
❑ $500 - $1,000 e$1,001 - $10,000
❑ sla,00l • $1oo,ow ❑ OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
Salary ❑ Spouse's or registered domestic partner's income
D Loan repayment ❑ Partnership
❑ Sale of
(Real property, car, boat, etc.)
❑ Commission or ❑ Rental Income, list each source of $10,000 or more
❑ Other
(Describe)
NAME OF SOURCE OF INCOME
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOUR BUSINESS POSITION
GROSS INCOME RECEIVED
❑ $500 - $1,000 ❑ $1,001 - $10,000
❑ $10,001 - $100,000 ❑ OVER $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 ❑ Rertal Income, list each source of $10,000 or more
❑ Other
(Describe)
* 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
❑ 510-,001 - $10a,0o0
❑ OVER $100.000
Comments:
INTFREST RATE TERM (Mont]hslYears)
❑ None
SECURITY FOR LOAN
❑ None Personal residence
❑ Real Property
Street address
City
❑ Guarantor
❑ Other
(Describe)
FPPC Form 700 (2013 12014) 5ch. C
FPPC Advice Email: advice @fppc.ca.gov
FI'PCTo1l- FreeHelpline:866 /275 -3772 www.fppc.ca.gov