John ScottSTATEMENT OF ECONOMIC
Please type or print in ink
NAME (LAST)
(FIRST)
(MIDDLE)
!'ie OnIY v
0 ` PO C,EI'�1F_AD
N 1 4 2005
CITY CLERK'S nFFjrG
HONE NUMBER
.X.� r/ AJ V rV l c.rG w w ° �� e°
MAILING ADDRESS STREET CITY STATE ZIP CODE OPTIONAL: FA% / E -MAIL ADDRESS
(May use business address)
835 Btu k St G /��e,>,o,1f , CA qj�# (z� f
1 . Office, Agency, or Court
Name of Office, Agency, or Court:
Division, Board, District, if applicable:
Your Position:
If filing for multiple positions, list additional agency(ies)/
position(s): (Attach a separate sheet if necessary.)
Agency:
Position:
2. Jurisdiction of Office (Check at least one box)
❑ State
❑ County of
Xcity of OSl=a�1
❑ 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 J_ through
December 31, 2004.
❑ Leaving Office Date Left:
(Check one)
O 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
COVER PAGE
A Public Document
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 (lo% or greater Ownership)
Schedule B Yes – schedule attached
Real Property
Schedule C
❑ Yes
– schedule attached
Income, Loans,
& Business
Positions (Income Other than Gifts and
Travel Payments)
Schedule D (Eliminated –
report loans on Schedule C)
Schedule E
❑ Yes
– schedule attached
Income – Gifts
Schedule F
❑ Yes
– schedule attached
Income – Travel Payments
-o r-
r ❑ No reportable interests on any schedule
Total number of pages
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.
in
Date Signed 3 _ l / — V s
(month, day, year)
Signature
(File the originally signed statement wilh your filing official.)
FPPC Form 700 (2004/2005)
FPPC Toll -Free Helpline: 666 /ASK -FPPC
SCHEDULE B
Interests in Real Property
(Including Rental Income)
> STREET ADDRESS OR PRECISE LOCATION
M Bvtt}2
st
CITY
� /gR2�vton�
CA . �il'711
FAIRMARKETVALUE
IF APPLICABLE, LIST DATE:
❑ $2,000- $10,000
❑ $10,001 - $100,000
-1J 04 J -j 04
$100,001- $1,000,000
ACQUIRED DISPOSED
❑ over $1,000,000
❑ Ownership /Deed of Trust
NATURE OF INTEREST
�XownershiplDeed of Trust ❑ Easement
❑ Leasehold _ ❑
Yrs. remaining Other
IF RENTAL PROPERTY, GROSS INCOME RECEIVED
❑ $0 - $409 ❑ $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.
N AME OF LENDER'
/
( OUn bVj #VMe
ADDRESS
A 0.60k 1021 nl w
BUSINESS ACTIVITY OF LENDER IPA//o _ 0211
yY)p V �t�Artr
INTEREST RATE TERM (Months /Years)
5 Od / S M-21
❑None
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500 - $1,000 ❑ $1,001 - $10,000
❑ $10,001 - $100,000 XoVER $100,000
❑ Guarantor, if applicable
Comments:
> STREET ADDRESS OR PRECISE LOCATION
CITY
FAIR MARKET VALUE
IF APPLICABLE, LIST DATE:
❑ $2,000 - $10,000
❑ $10,00' - $100,000
�� 04 _/_104
❑ $'00,001 - $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 - $400 ❑ $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 (Months /Years)
❑ None
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500 - $1,000 ❑ $1,001 - $10,000
❑ $10,001 - $100,000 ❑ OVER $100,000
❑ Guarantor, if applicable
* 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 Toll -Free Helpline: 666 1ASK -FPPC