Su TanSTATEMENT OF ECONOMIC
COVER PAGE I _ 12M12
Please type or print in ink.
1. Office, Agency, or Court
Agency Name 0 0� �OSeme a /
Division, Board, Department, District, if applicable
Your
P. If filing for multiple positions, list below or on an attachment.
Agency:
Position:
2. Jurisdiction of Office (check at Least one box)
❑ State
❑ Multi- County /�
City of Ko� of Y r -a
❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ County of
❑ Other —
3.�e of Statement (check at least one box)
Annual: The period covered is January 1, 2011, through ❑ Leaving Office: Date Left I I
December 31, 2011. (Check one)
- or-
The period covered is I I through O The period covered is January 1, 2011, through the date of
December 31, 2011. 1 leaving office.
g Office— Bafr- nsstxnPd O The period covered is I I through
the date of leaving office.
❑ Candidate: Election Year Office sought, if different than Pad 1:
4. Schedule Summary
Check applicable schedules or None. ° ► 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-
El None - No reportable interests on any schedule
5. Verification
(Business mAgencyAd &ess Recommended Public nomment)
9)(52-e-; f)W ,
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11
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 acknowledge this is a public document.
I certify under penalty of perjury under the laws of the State of California that the forego rs tr and orrect.
Date Signed I Signature
( mA dayyear) (File the miginallysignc slatemenl wmyow Fang o/Faal.)
FPPC Form 700 (2011/2012)
FPPC Toll -Free Helpline: 8661275 -3772 wvnvJppc.ca.gov
SCHEDULE B
Interests in Real Property
(Including Rental Income)
► ASSESSOR'S PARCEL NUMBER OR STR ADDRESS
3 4o �? SJLLF l 1 u �. C
CITY
FAIR MARKET VALUE
❑ $2,000 - $10,000
Il $10,001 - $100,000
�r L$100,001 - $1,000,000
❑ Over $1,000,000
, NNA AT TURE OF INTEREST
XV l ownershlp/Deed or Trust
❑ Leasehold
no_ ,mna, III ,
IF APPLICABLE, LIST DATE:
ACQUIRED DISPOSED
❑ Easement
0
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.
Name _
► ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS
CITY
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
❑ $2,000 - $10,000
❑ $to,00l - $1oc,00c
❑ $100,001 - $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 - $490 ❑ $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.
" 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:
NAME OF LENDER`
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, 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
Comments:
NAME OF LENDER'
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, 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
FPPC Form 700 (2011/2012) Sch. B
FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.c i.gov