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Margaret Clark
STATEMENT OF ECONOMIC INT FR rm- C N iS&KE 45, 1 IT v P9 1 f I,le n c €rrl Z") MAILING ADDRE - 5rR E - CITY STATE ZIP CODE OPTIONAL: FAX I E -MAIL ADDRESS (May use business address) 3i ©5 cA q1 - 70 636 � 1 . Office, Agency, or Court Name of Office,, Agency, or 6 Court: Y � I!C 5 � /.X Divisio , Board, District, if applicable: Your Position: L t'�- r If fi ing for multiple positions, list additional agency(ies)/ position(s):. (Attach a separate sheet if necessary.) Agency: Position: 2. Jurisdiction of Office (Cheek at least one box) ❑ State ❑ County of City of I' O SCrn -� ❑ Multi- County ❑ Other 3. Type of Statement (Check at least one box) ❑ Assuming Office /Initial Date: ,Annual: The period covered is January 1, 2004, through December 31, 2004. -or- 0 The period covered is through December 31, 2004. ❑ Leaving Office Date Left: ��— (Check one) Q The period covered is January 1, 2004, . through the date of leaving office. -or- 0 The period covered is through the date of leaving office. ❑ Candidate 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 ❑ Yes – schedule attached Investments (Less than 10% Ownership) Schedule A -2 ❑ Yes – schedule attached Investments (10% or greater Ownership) Schedule B IZ Yes – schedule attached Real Property Schedule C 9 Yes – schedule attached Income, Loans, & Business Positions (income Omer than Gifts and Travel Payments) Schedule D (Eliminated – report loans on Schedule C) Schedule E ❑ Yes – schedule attached income – Gifts Schedule F KYes – schedule attached Income – Travel Payments -or- F1 No reportable interests on any schedule IT Total number of pages ' t-- completed including this cover page: 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 of the State of California that the foregoing is true and correct. Date Signed + l�l'I- - y9 0'' ( onlh, day, year) Signature f r ✓r 2LZL") / � ""'r (File the finally signed statement with your filing offaal.) FPPC Form 700 (200412005) FPPC Toll -Free Helpline: 866 /ASK -FPPC SCHEDULE B Interests in Deal Property (Including Rental income) > STREET ADDRESS OR PRECISE LOCATION 15 [ mny 9 S�Y1 P1 CITY F7�v dl9-C t - 7O FAIR MARKET VALUE IF APPLICABLE, LIST DATE ❑ $2,000 - $10,000 ® $10,001 - $100,0W JJ J J ACQUIRED - DISPOSED ❑ $100,001 - $1,000,000 . p Over $1,000,000 NATURE OF INTEREST lS ovmershlp1Deed of Trust ❑ Easement ❑ Leasahold ❑ Other Ym. remaining IF RENTAL PROPERTY, GROSS INCOME RECEIVED ❑ $0 - $499 ❑ $500 - $1,000 g $1,0D1 - $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. NAME OF LENDER' ADDRESS BUSINESS ACTIVITY OF LENDER INTEREST RATE TERM (MOnthslYeam) % ❑ Nana HIGHEST BALANCE DURING REPORTING PERIOD ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑.$10,001 - $100,000 ❑ OVER $100,000 - ❑ Guarantor, If applicable c > STREET ADDRESS OR PRECISE LOCATION CITY FAIR MARKET VALUE IF APPLICABLE, LIST DATE ❑ $2,000 - $10,OW ❑ $10,001 - $100,000 1__j JJ ACQUIRED j DISPOSED ❑ $100,001 - $1,000,000 ❑ Over $1,000,000 NATURE OFINTEREST ❑ Ownership/Deed of Trust ❑ Easement ❑ Leasehold ❑ Other Y. remaining 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 NAME OF LENDER* ADDRESS BUSINESS ACTIVITY OF LENDER INTEREST RATE TERM (MOnthslYears) % ❑ None HIGHEST BALANCE DURING REPORTING PERIOD ❑ $5110 - $1,000 ❑ $1,001 - $10,000 ❑ s1o,0o1 - $100,000 ❑ OVER $100,D00 ❑ Guarantor, if applicable Comments: * 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 Tall -Free Helpline: $661ASK -FPPC i SCHEDULE C income, Loans* & Business Positions (Other than Gifts and Travel Payments) ADDRESS ,/ 7 f If Y "Y44, XOtuA' i.BS T�rtaI PFF.�CS �!4 �'[di3L -S BUSINESS ACTIVITY, ANY, OF SOURCE YOUR BUSINESS POSITION GROSS INCOME RECEIVED /HIGHEST BALANCE. DURING REPORTING PERIOD, IF LOAN ❑ $500 - $1,000 ® $1,001 - $10.000 ❑ $10,001 - $100,000. ❑ OVER $100,000 - CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary Spouse's Income ❑ Loan repayment ❑ Sale of - (Property, car, boeL ac) ❑ Commission or ❑ Rental Income, 0st each saute of $10,000 or more ❑ Other- (Oesalae) ❑ LOAN RECEIVED (complete box 2) ADDRESS BUSINESS ACTIVITY,. IF ANY, OF SOURCE YOUR BUSINESS POSITION GROSS INCOME RECEIVED /HIGHEST BALANCE DURING REPORTING PERIOD, IF LOAN ❑ $500 - $1,000 ❑ $1,001 - $10,000 ,. ❑ $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary ❑ Spouse's Income ❑ Loan repayment ❑ Sale of (Properly, . boat etc.) ❑ Commission or ❑ Rental Income, list each some of $110,000 or more ❑ Other fpmaive) ❑ LOAN RECEIVED (complete box 2) ADDRESS BUSINESS ACTIVITY, IF ANY, OF SOURCE YOUR BUSINESS POSITION GROSS INCOME RECEIVED /HIGHEST BALANCE DURING REPORTING PERIOD, IF LOAN ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 . $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary ❑ Spouse's income ❑ Loan repayment ❑ Sale Of (Property, car, best etc.) Q commission or ❑ Rental Income, so each some a $10,000 or more ❑ Other (Desdibef ❑ LOIN RECEIVED (complete box 2) INTEREST RATE TERM (Monthsn'eam) % ❑ None SECURITY FOR LOAN ❑ None ❑ Personal residence ❑ Real Property Street admass I ❑ Guarantor ❑ Other * 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. Comments: FPPC Form 700 (200412005) Sch. C FPPC Toll -Free Helplina: 866 /ASK -FPPC SCHEDULE F Income -Gifts Travel Payments, Advances, and Reimbursements • Reminder — you must mark the gift or income box. • You are not required to report "income" from government agencies: > NAME OF SOU RCE I P,*, CC [ �a �ItDrh,n AD I, SS Noo k S'+ eei CITY AND STATE T �t A p c� �1 \arrn MV m-(-� CA J�O1T B ACTIVITY, I ANY, OF SOURCE 9 f. A4 A('1J dkf Gj7E -5 an,(- +�� Y2.SiLT / 'c� e s � 'T pp T =? DATE(S):_/J_-_IJ— AMT: (nappkau•) TYPE OF PAYMENT: (must check one) E] Gift X income DESCRIPTION LY'".a V41,44'S?t.e- SertL rrn0 P.(�,mm iVi > NAME OF SOURCE ADDRESS CITY AND STATE BUSINESS ACTIVITY, IF ANY, OF SOURCE DATE(S):--/- J_- -J —J_ AMT: S (IT -ApI eue) TYPE OF PAYMENT. (must check one) C] Gift ❑ Income _ DESCRIPTION: Comments: NAME OF SOURCE ADDRESS CITY AND STATE BUSINESS ACTIVITY, IF ANY, OF SOURCE DATE(S):_JJ_ --- )— AMC 5 - (11- ppkeue) - TYPE OF PAYMENT: (must check one) [] Gilt ❑ Income DESCRIPTION: > NAME OF SOURCE ADDRESS CITY AND STATE BUSINESS ACTIVITY, IF ANY, OF SOURCE DATE(S):J — AVE $ (meppxaue) TYPE OF PAYMENT: (must check one) [j Gift ❑ Income DESCRIPTION: FPFC Form 700 (200411005) Sch. F FPPC Toll-Free Heipline: 8661ASK -FPPC