Professional Documents
Culture Documents
Agency: Position:
The period covered is -----.l-----.l_ _ , through December 31, o The period covered is January 1, 2010, throuJl~ the~~t~ of
2010. leaving office. s; ,. _', .__ .
o Assuming Office: Date -----.l-----.l_ _ o The period covered is -----.l----1_ _,.!hrough'lbe date
of leaving office. ,-, .-
-0 C)~:'
~ Schedule A-l - Investments - schedule attached gj Schedule C - Income, Loans, & Business Positions - schedule attached
99 Schedule A-2 - Investments - schedule attached ~ Schedule 0 - Income - Giffs - schedule attached
III Schedule B - Real Property - schedule attached ~ Schedule E - Income - Giffs - Travel Payments - schedule attached
-or-
O None - No reportable interests on any schedule
5.
⁾⁾⁾⁾⁾⁾⁾⁾⁾⁾⁾⁾⁾⁾⁾⁾⁾⁾⁾⁾⁾⁾⁾⁾⁾⁾⁾‧
•
⁖⁜⁾‡†•‧⁾⁾ · CAM
herein and in any attached schedules is true and complete. I acknowledge this is a
I certify under penalty of perjury under the laws of the State of California that
zKlZ- Z 7-1/
Date Signed _ _---'-_-;:=-:;:::::::::;-_ _ __ Signature ⁾⁾›※※※⁾‱※※‽›⁾⁾※※※›※※⁾⁾⁾⁾
(manlh, day, year)
D Partnership o
o
Income, Received of $0 - $499
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)
Comments: ___________________________________________________________________________________
FPPC Form 700 (2010/2011) Sch. A-1
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
SCHEDULE A·2 CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
Investments, Income, and Assets Name
of Business Entities/Trusts
(Ownership Interest is 10% or Greater)
Name Name
FAIR MARKET VALUE IF APPLICABLE, LIST DATE: FAIR MARKET VALUE IF APPLICABLE. LIST DATE:
D $2,000 - $10,000 D $2,000 - $10,000
D $10,001 - $100,000 --1--1~ --1--1~ D $10,001 - $100,000 --1--1~ --1--1JQ..
D $100,001 - $1,000,000 ACQUIRED DISPOSED D $100,001 - $1,000,000 ACQUIRED DISPOSED
DOver $1,000,000 Dover $1,000,000
NATURE OF INVESTMENT NATURE OF INVESTMENT
o So[e Proprietorship D Partnership D
other
o Sole Proprietorship D Partnership D
Other
YOUR BUSINESS POSITION YOUR BUSINESS POSITION
2. IDENTIFY THE GROSS INCOME RECEIVED (INCLUDE YOUR PRO RATA ~ 2. IDENTIFY THE GROSS INCOME RECEIVED (INCLUDE YOUR PRO RATA
SHARE OF THE GROSS INCOME IQ THE ENTITYITRUST) SHARE OF THE GROSS INCOME IQ THE ENTITYITRUST)
~ 4. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD !lY THE ~ 4. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD !lY THE
BUSINESS ENTITY OR TRUST BUSINESS ENTITY OR TRUST
Check one box: Check one box:
D INVESTMENT D REAL PROPERTY D INVESTMENT D 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
D $10,001 - $100,000 D $10,001 - $100,000 --1--1~ --1--1~
D $100,001 - $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
D Other - - - - - - - - - - o Leasehold
Yrs. remaining
D Other _ _ _ _ _ _ _ __
CITY CITY
FAIR MARKET VALUE JF APPLICABLE, LIST DATE: FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
o $2,000 - $10,000 o $2,000 - $10,000
o $10,001 - $100,000 ---.l---.l~ ---.l---.l~ o $10,001 - $100,000
o $100,001 - $1,000,000 ACQUIRED DISPOSED
o $100,001 - $1,000,000 ACQUIRED DISPOSED
0 Leasehold
Vrs. remaining
0
Other
0 Leasehold
Yrs. remaining
0 - -other
----
IF RENTAL PROPERTY, GROSS INCOME RECEIVED IF RENTAL PROPERTY. GROSS INCOME RECEIVED
0$0 - $499 o $500 - $1,000 o $1,001 - $10,000 0$0 - $499 0$500 - $1,000 0$1,001 - $10,000
* 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:
HIGHEST BAlANCE DURING REPORTING PERIOD HIGHEST BALANCE DURING REPORTING PERIOD
0$500 - $1,000 0 $1,001 - $10,000 0$500 - $1,000 0$1,001 - $10,000
o $10,001 - $100,000 o OVER $100,000 0$10,001 - $100,000 o OVER $100,000
o Guarantor, if applicable o Guarantor, if applicable
Comments: _________________________________________________
FPPC Form 700 (2010/2011) Sch, B
FPPC TaU-Free Helpline: 866/275-3772 www.fppc.ca.gov
SCHEDULE C CALIFORNIA FORM 700
Income, Loans, & Business FAIR POLITICAL PRACTICES COMMISSION
Name
Positions
(Other than Gifts and Travel Payments)
/knot Qf
YOUR BUSINESS POSITION
~V't.(b<s
~\d/A-w
GROSS INCOME RECEIVED GROSS INCOME RECEIVED
D $500· $1,000 ~ $1,001" $10,000 D $500" $1,000 D $1,001 "$10,000
D $10,001 "$100,000 DOVER $100,000 Oi $10,001 "$100,000 DOVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED CONSIDERATION FOR WHICH INCOME WAS RECEIVED
IE Salary D Spouse's or registered domestic partner's income I:}G Salary o Spouse's or registered domestic partner's income
D Sale of -------c::'-.,--,.-,-,-,-------
(Property, cat; boat, etc.)
D Sale of -----~-c::'--,---,--,,--:--,------
(Property, car, boat, etc.)
D Commission or D Rental Income, list each source of S10,000 or more o Commission or D Rental Income, list each source of $10, 000 or more
D Other _ _ _ _ _ _ _ _ ==:;-_______
(Describe)
D 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:
_ _ _ _% DNone
ADDRESS (Business Address Acceptable)
SECURITY FOR LOAN
Comments:
~t-"'ilO $ ~~.T-o
LPl,LO $ Z.~.b-
\I!-I'i.'! W. O~ic.
BUSINESS ACTJVl,IFY,
Alvd. k-s ~, M
BUSINESS ACTIV ,IF ANY, OF SOURCE OF SOURl:E
~~ ~t~lil2
DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S) DATE (mmldd/yy) VALUE DESCRIPTION OF GIFT(S)
-----.l-----.l_ $
()q.. ~IMO~C Q~ y
ADDRESS (Business Address Acceptable) I ADDRESS (Business Address Acceptable)
DATE (mm/dd/yy) VALUE DESCRIPT~N OF GIFT(S) DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
-----.l-----.l_ $ -----.l-----.l_ $
-----.l-----.l_ $ -----.l-----.l_ $
Comments: _________________________________________________________________________________
Income - Gifts
Travel Payments, Advances,
and Reimbursements
BUSINESS ACTIVITY, IF ANY, OF SOURCE 0501 (e)(3) BUSINESS ACTIVITY, IF ANY, OF SOURCE o 501 (c)(3)
TYPE OF PAYMENT: (must check one) D Gift D Income TYPE OF PAYMENT: (must check one) 0 Gift D Income
DESCRIPTION: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ DESCRIPTION: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
BUSINESS ACTIVITY, IF ANY, OF SOURCE o 501 (e)(3) BUSINESS ACTIVITY, IF ANY, OF SOURCE 0501 (e)(3)
TYPE OF PAYMENT: (must check one) D Gift D Income TYPE OF PAYMENT: (must check one) D Gift D Income
DESCRIPTION: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ DESCRIPTION: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Comments: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __