2003 (20)D at ece�ed
. STATEMENT OF ECONOMIC INTERE Y O R E /at..
COVER PAGE MAR 9 2004
A Public Document
71TY CLERK'S OFFIr
NAME (LAST) (FIRST) _ (MIDDLE DAYTIME TELEPHONE NUMBER
K A 4A oat
MAILING ADDRESS 'STREET CITY STATE ZIP CODE OPTIONAL: FAX I E -MAIL ADDRESS
(May be business address)
1 . Office, Agency or Court
Name of Office, Agency or Court:
� i eta t9 f-- -py-0 �>
Division, Board, Distri t, 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 1 np
E] County of `^d .'CJ
❑ City of
❑ Multi-County
❑ Other
3. Type of Statement (Check at least one box)
❑ Assuming Office /Initial Dater)
❑ Annual: The period covered is January 1, 2003,
through December 31, 2003.
-or-
0 The period covered is ___J ___J, through
December 31, 2003.
❑ Leaving Office Dale Left:
(Check one)
• The period covered is January 1, 2003, through
the date of leaving office.
-or-
O The period covered is —J /, through
the date of leaving office.
❑ Candidate
4. Schedule Summary
(Check applicable schedules or 'We reportable interests.')
— During the reporting period, did you have any reportable
interests to disclose on:
Schedule A -1 ❑ Yes - schedule attached
Investments (Less than to %Ownership)
Schedule A -2 J es - schedule attached
Investments (m % greater Ownership)
Schedule B ❑ Yes - schedule attached
Reel Property
Schedule C ❑ Yes - schedule attached
Income & Business Positions (income omerihan Loans, raft, and Traci
Schedule D ❑ Yes - schedule attached
Income - Loans ��,//�
Schedule E LgYe3 schedule attached
Income - Gifts �� ,
Schedule F ❑ Yes - schedule attached
Income - Travel Payments
-or-
- ❑ 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. t 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 t 1 14 , h, Ua r)
Signature
your
FPPC Form 700 (2 00 312 0 0 4)
FPPC - Toll -Free Helpline: 8661ASK -FPPC
SCHEDULE A -2
Investments, Income, and Assets
of Business Entities /Trusts
(Ownership Interest is 10% or Greater)
�FS� �oseru�aai Rlud `?� 1�A
Address
Check one
E] Trust go fo 2 ❑ Business Entity, complete the box, Men go to 2
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
FAIR MARKET VALUE - IF APPLICABLE, LIST DATE:
❑ $2,000 - $10,000
❑ $10,001 - $1Do,aoo -JJ 03 JJ 03
❑ $100,001 - $1,000,000 ACQUIRED DISPOSED
❑ Over $1,000,000
NATURE OF INVESTMENT
❑ Sole Proprietorship ❑ Partnership ❑ -
Mar
YOUR BUSINESS POSITION
$.$ 0 - $499 ❑ $10,001 - $100,000
500- $1,000 ❑ OVER $100,000
❑ $1,001 - $10,000 _
k one
❑ Trust, go to 2 ❑ Business Entity, complete the box, Men go to 2
DESCRIPTION OF BUSINESS ACTIVITY
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
❑ $2,000 - $10,000
❑ $10,001 - $100,000 J 03 JJ 03
❑ $100,001 - S1 000,000 ACQUIRED .DISPOSED
Over $1,000,000
NATURE OF INVESTMENT
❑ Sole Proprietorship ❑ Partnership
YOUR BUSINESS POSITION
❑ $0 - $409 ❑ $10,001 - $100,000
❑$500 - $1,000 ❑ OVER $100,000
❑ $1,001 - $10,000
Check one box:
❑ INVESTMENT ❑ REAL PROPERTY
Name of Business Entity or
Street Address or Assessors Parcel Number of Real Property
Description of Business Activity Q
City or Other Precise Location of Real Properly -
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
❑ $2,000 - $10,000
❑ S1o,00l - sloo,0o0 J 03 JJ 03
❑ $100,001 - $1,000,000 ACQUIRED DISPOSED
❑ Over $1,000,000 -
NATURE OF INTEREST
❑ Property Ownership /Deed of Trust ❑ Stock ❑ Partnership
❑ Leasehold ❑ Other
Ym remaining
❑ Check box if additional schedules reporting investments or real property
are attached
Check one box:
❑ INVESTMENT ❑ REAL PROPERTY
0
name of business enmy or
Street Address or Assessors Parcel Number of Real Property
uescripuon of business Ac ivny or
City or Other Precise Location of Real
Property.
FAIR MARKET VALUE
IF APPLICABLE, LIST DATE:
❑ $2,000 - $10,000
❑ $10,001 - $100,000
JJ 03 JJ 03
❑ $100,001 - $1,000,000
ACQUIRED DISPOSED
❑ Over $1,000,000
NATURE OF INTEREST
❑ Property Ownership /Deed of Trust
❑ Stock ❑ Partnership
Leasehold ❑ Other
Yrs. remaining
Check box 0 additional schedules reporting investments or real property
are aU.ch.d
FPPC Form 700 (200312004) Sch. A -2
FPPC Toll -Free Helpline: 888 /ASK -FPPC
SCHEDULE E
Income — Gifts
> NAME OF SOURCE
C o+� 0 S e
ADDRESS
29 �' octp.
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm /tltl /yy) VALUE" DESCRIPTION OF GIFT(S)
y
> NAME OF SOURCE -
ADDRESS
- BUSINESS ACTIVITY, IF ANY, OF SOURCE
- DATE (mm /dd /yy) VALUE DESCRIPTION OF GIFT(S)
$
$
Jam_ $
- > NAME OF SOURCE
ADDRESS
`BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm /tltl /yy) VALUE DESCRIPTION OF GIFT(S)
$
Comments:
> NAME OF SOURCE
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm /tltl /yy).
VALUE DESCRIPTION OF GIFT(S)
__J __J
$
> NAME OF SOURCE
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm /ddlyy)
VALUE DESCRIPTION OF GIFT(S)
$
> NAME OF SOURCE
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOURCE
)ATE (mm /dd /yy) VALUE
DESCRIPTION OF GIFT(S)
FPPC Form 700 (200312004) Sch. E
FPPC Toll -Free Helpline: 866 /ASK -FPPC