Su TanDate Received
STATEMENT OF ECONOMIC INTERESTS off °v
COVER PAGE
Please type or print in ink.
NAME OF FILER (LAST) (FIRST) (MIDDLE)
1. Office, Agency, or Court
Agency Name at�\ „ rs &a ,(I
Division, Board, Departrnent, Disldct, if applicable
► If fling for multiple positions, list below or on an attachment.
Agency:
Position:
2. Jurisdiction of Office (Check at least one box)
❑ State ❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑Multi- County ❑
,,, -n,� County of
City of p �" 1 ❑ Other —
3. ��\Ty pppe of Statement (Check at least one box)
IVI Annual: The period covered is January 1, 2012, through ❑ Leaving Office: Date Left ---J--J
December 31, 2012. (Check one)
-or.
The period covered is ___J__J ,through O The period covered is January 1, 2012, through the date of
December 31, 2012. leaving office.
❑ Assuming Office: Date assumed ---J--J O The period covered is ___J ___J--, through
the date of leaving office.
❑ Candidate: Election year
and office sought, if different than Pad 1:
4. Schedule Summary
Chock 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
El Schedule A -2 - Investments - schedule attached ❑ Schedule D - Income -.Gifts - schedule attached
gJ schedule B - Real Property- schedule attached ❑ Schedule E - Income - Gifts - Travel Payments - schedule attached
❑ None - No reportable interests on any schedule
5. Verification
MAILING ADDRESS STREET U11
(Business wAgency Address R mr ded - Adic D u 0
RQ%A, V- TIUI. Z g�tr` -
DAYTIME
(OPTIONAL)
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 foregoi :(Fiieft mign
Date Signed q 1 I I ) Signature __
0", day yeas) hwlh your(lim - J
FPPC Form 700 (2 01 212 01 3)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 8661275 -3772 www.fppc.ca.gov
SCHEDULE B
Interests in Real Property
(Including Rental Income)
► ASSESSOR'S PARCEL NUMBER O TREET AD RESS
3�1� JC�r
U�
1`vsC/4 Lill.//
FAIR MARKET VALUE
IF APPLICABLE, LIST DATE:
❑ $2,000 - $10,000
El 01 - $10o,000
72
$1o0,001 - $1,000,000
ACQUIRED DISPOSED
Over $1,000,000
\ NATURE OF INTEREST
* Ownership /Deed of Trust
❑ Leasehold
Yrs_ remaining
❑ Easement
ONer
IF RENTAL PROPERTY, GROSS INCOME RECEIVED
❑ $0 - $499 ❑ $500 - $1,000 ❑ $1,0ol - $10,000
❑ $10,001 - $mo,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.
❑ None
Name
S� 1 &,\_�
► ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS
CITY
FAIR MARKET VALUE
❑ $2,000 - $10,000
❑ $10,001 - $100,000
❑ $100,001 - $1,000,000
❑ Over $1,000,000
NATURE OF INTEREST
❑ Ownership /Deed of Trust
❑ Leasehold
Yrs. remaining
IF APPLICABLE, LIST DATE:
ACQUIRED DISPOSED
❑ Easement
Other
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 of more.
❑ None
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 (MonihNYears)
% ❑ None
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500 - $1,Goo ❑ $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 (MonlllsiYears)
% ❑ 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 (2012/2013) Sch. B
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov