Jean Hall RECEIVED
CALIFORNIA FORM 700 STATEMENT OF ECONOMIC INTERESTS CITY oF``1 PIU @b Inns
FAIR POLITICAL PRACTICES COMMISSION ived
AN 1 eC29j o^N
A PUBLIC DOCUMENT COVER PAGE
Please type or print in ink. CITY CLERK'S OFFICE
NAME OF FILER (LAST) �/ (FIRST) B''
Hall ail
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
City of Rosemead
Division, Board, Department, District, if applicable Your Poston
City Council Member
If filing for multiple positions, list below or on an attachment. (Do not use acronyms)
Agency: Community Housing Corporation 8 Su,r,f Pb 9 Position Board Member
f79en,i cffo e ,t)nc,omPn,�/i�lrylmunri4-he UPLopmevit @imm/;cciiu
2. Jurisdiction of Office (Check at least one box)
❑State ❑Judge or Court Commissioner(Statevnde Jurisdiction)
❑Multi-Counly ❑County of
City of Rosemead
❑Other
3. Type of Statement (Check at least one box)
❑ Annual: The period covered is January 1, 2014,through Z Leaving Office: Date Left 12 1 08 / 2015
December 31,2014. 7_/;r Jb(,J (Check one)
The period covered is iL of,]6/,C through C The period covered is January 1,2014, through the date of
1+-Ammo..,it M114. leaving office. {{
❑ Assuming Office: Date assumed J� $ The period covered is 7 /L ea2I Ar ough
the date of leaving office.
❑ Candidate: Election year and office sought, if different than Part 1:
4. Schedule Summary
Check applicable schedules or "None." • Total number of pages including this cover page:
El Schedule A-I •Investments-schedule attached g Schedule C-Income, Loans, &Business Positions-schedule attached
a Schedule A-2 Investments-schedule attached U Schedule D-Income-Grns-schedule attached
g Schedule B-Pea/Property-schedule attached ❑ Schedule E-Income-Gifts-Travel Payments-schedule attached
-or-
❑ None-No reportable interests on any schedule
5. Verification
MAILING ADDRESS STREET CT! STATE ZIP CODE
(Business or Agenc Address Recommend d PUNT DccLment)
8388 E. Valley Boulevard Rosemead CA 91770
DAYTIME TELEPHONE NUMBER E-MAIL ADDRESS
( 626 ) 569-2100
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 foregoing is true and correct.
Date Si ned /�
9 Signature
Immsday Yea/ (file the cdpinalr signed srelemenl min yOurEng 05S0
FPPC Form 700(2014/2015)
FPPC Advice Email:advice @fppcca.gov
FPPC Toll-Free Helpline:866/275-3772 www.fppc.ca.gov
SCHEDULE A-'I CALIFORNIA FORM 700
Investments FAIR POLITICAL PRAcTMES COMMISSION
Stocks, Bonds, and Other Interests Name
(Ownership Interest is Less Than 10%) it E.A- F. A/4 L ,(_
Do not attach brokerage or financial statements.
_.$ NAME OF-BUSINESSPNTTi`(—rte. . . .,,�J — •., OF BUSINESS-EN ITY --_.--- /�—
////44/ leCC.('9A L A-V).N qtr 4 ni o '. c.G C-, 414---s---t-E4 Al / A-ni k
GENERAL DESCRIPTION OF THIS BUSINESS Y. C /4t GENERAL DESCRIPTION OF THIS BUSINESS - - -- ------
.
//��
/04M: % Ns4m E.'
CD r - SA. i/rr/cf.... [dt.CC/{h - CFkP/T.o L : .�v/e (65
FAIR MARKET VALUE FAIR MARKET VALUE
❑f$2000-510,000 U $10,001 -$100000 p$2,000-$10,000 ❑$1D,00l -$100,000
(J $100,001 -$1.090,990 0 Over$1,000,000 ®$100,00+ -$1,000,01)0 9 over$1,000,000
NATURE OF INVESTMENT NATURE OF INVESTMENT
L Stock l Other _ ❑ Stock D Other
/Describe) (Oesmbe)
O Partnership 0 Income Receive]of$0-$499 D Partnership 0 Income Received of$0-$499
0 Income Received of$500 or More(Repod on Schedule c) 0 Income Received of$500 or More(Report on Schedule C)
IF APPLICABLE, LIST DATE: IF APPLICABLE, LIST DATE:
__I_/ 14 _/_/ 14 / 1 14 _/ / 14
ACQUIRED DISPOSED ACQUIRED DISPOSED
0- NAME OF BUSINESS ENTRY lb NAME OF BUSINESS ENTITY
r' F AscniA/c4 /�S.91A CA L0rtieg BUR3Addk,Sa/114J
GENERAL DESCRIPTION OF THIS BUSINESS1 GENERAL DESCRIPTION OF THIS BUSINESS
CV-6C 41/44/11b/ COS -.5aw1A/VS
FAIR MARKET VALUE FAIR MARKET VALUE
f®f-�� $2099-$10,000 0510,001-$100000 p❑�$2000-$10,000 9$10,001 -$100,000
LD 5100901 -$1,000,000 9 Over$1000,000 N$100,001-$1,000,000 U Over 51,000,000
NATURE OF INVESTMENT NATURE OF INVESTMENT
E Stock 0 Other 9 Stock 0 Other
(Des bo) (Describe)
El Partnership 0 Income Received of$0-$499 p Partnership O Income Received of$0-$499
O Income Received of$500 or More(Report on schedule C) O Income Received of$500 or More(Report on Schedule c)
IF APPLICABLE, LIST DATE: IF APPLICABLE, UST DATE:
/14. ._ice 14 _____/_J _/J iC
ACQUIRED DISPOSED ACQUIRED DISPOSED
- NAME OF BUSINESS ENTITY 1 NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF This BUSINESS GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE FAIR MARKET VALUE
9$2,000-$10,000 ❑mow -$100,000 9 92,000-$10,000 ❑$10,001 -$100,000
❑ $100,001 -51000000 ❑over$1000,000 ❑5100,001 -$1,000,000 ❑ Over$1,000,000
NATURE OF INVESTMENT NATURE OF INVESTMENT
9 stock 0 Other D Stock 9 Other —-
(Describe) (Describe)
9 Partnership 0 Income Received of$0-$499 9 Partnership 0 income Received of$9-$499
O Income Received of$500 or More(Report on Schedule C) O Income Received of$500 or More(Repod on Schedule C)
IF APPLICABLE, LIST DATE. • IF APPLICABLE, LIST DATE:
/_J 14 _i / 14 _/_/ 14 /_J 14
ACQUIRED DISPOSED ACQUIRED DISPOSED
Comments:
FPPC Form 700(2014/2015)Sch.A-1
FPPC Advice Email:advice @fppc.ca.gov
•
•
SCHEDULE A-2 CALIFORNIA FORM 700
Investments, Income, and Assets °"TICALPR""ICEa`°'`';0551°"
of Business Entities/Trusts Name
(Ownership Interest is 10% or Greater)
_.—:.t 1. BUSINESS ENTITY OR TRUST
7—C;),_.4 P-laL4 S,ev ✓d %i° feri __. - -- --
Name - -- _-- -. Name
340:5— M 17V`$c.47— 4 ,a✓4 ££,
Address(Business Address Acceptable) ` CA Address(Business Address Arvptable)
Ch k one Check one
Trost,go to 2 ❑ Business Entiy, complete the box,Men go to 2 0 Trost,go to 2 0 Business Entity, complete the box, then go to 2
GENERAL DESCRIPTION OF THIS BUSINESS (GENERAL DESCRIPTION OF THIS BUSINESS M1
lFAIR MARKET VALUE IF APPLICABLE, LIST DATE: FAIR MARKGI VALUE IF APPLICABLE,UST DATE:
0 $0-$1,299 'Q$0-$1,999
'I0$2,000-$10,000 _/_/ 14 _ / 14 '0 szpoo-$10,000 J / 14 rJ 14
{0 $10001 -sl04OOo ACQUIRED DISPOSED 0 s-wool-$1 co,000 ACQUIRED DISPOSED
0$100,001-$1000,000 0$100,001-$1,000,000
0 Over$1000,000 0 Over$1,000,000
NATURE OF INVESTMENT NATURE OF INVESTMENT
D Partnership 0 Sole Proprietorship 0
Diner 0 Partnership 0 Sole Proprietorship 9 Other
YOUR BUSINESS POSITION I YOUR BUSINESS POSITION
t 2. IDENTIFY THE GROSS INCOhiE RECEIVED(INCLUDE YOUR PRO RATA 2. IDENTIFY THE GROSS INCOME RECEIVED(INCLUDE YOUR PRO RATA
SHARE OF THE GROSS INCOME TO THE ENTITY/RUST) SHARE OF THE GROSS INCOME TO THE ENTITY;TRUST)
0 so-Sass 0 s-goof -sioo,o00 0$0-$499 0 $10,001 -$100,000
0$500-$1000 xi OVER$1Lg1,000 0$500-$1000 0 OVER$100,000
0 stool -sto,000 0 $1001-$10,000
IN 3. LIST THE NAME OF EACH REPORTABLE SINGLE SOURCE OF 3. LIST THE NAME OF EACH REPORTABLE SINGLE SOURCE OF
INCOME OF 510,000 OR MORE P1mcn.a..mtE sheer ene,osry.l INCOME OF$14000 OR MORE i lLtI,e r...3t eer.r o:LLSSOrv.i
0 None or 0 Names listed below None or 0 Nanles listed below
tre 4. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD OR 4. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD OR
LEASED BY THE BUSINESS ENTITY OR TRUST LEASED BY THE BUSINESS ENTITY OR TRUST
Check one box: Check one box:
9 INVESTMENT 0 REAL PROPERTY 0 INVESTMENT 0 REAL PROPERTY
Name or'BBusiness el NUmbeifonvestm Address r of Real Property Name of Business Entity, if Investment or
perry Assessor's Parcel Number or Street Address of Real Property
Description of Business Activity or Description of Business Activity a
City or Other Precise Location of Real Property City or Other Precise Location of Real Property
FAIR MARKET VALUE IF APPLICABLE, LIST DATE: FAIR MARKET VALUE IF APPLICABLE,LIST DATE:
0$2,000-$10,000 0$2,000-$10,000
0$10,001 -$100,000 / / 14 / 114 0 siaom-sloo,00o / 114 __/ i 14
[1$100,w1 -$1,000,000 ACQUIRED DISPOSED 0$100,001 -¶1000,000 ACQUIRED DISPOSED
0 Over$1,000,000 0 Over$1,000,000
NATURE OF INTEREST NATURE OF INTEREST
0 Property OvmeahiplDeed of Tryst 9 Stock 0 Partnership 9 Property Ownershp/Deed of Trust 9 Stock 9 Partnership
0 Leasehold 9 Other ._ 0 Leasehold 9 Other
Yre.remainn9 Yrs.remaining
9 Check box if additional schedules reporting investments or real property 9 Check box if additional schedules reporting investments or real property
are attached are attached
FPPC Form 700(2014/2015)Sch.A-2
Comments: ---- FPPC Advice Email:advice@fppaca.gov
•
CALIFORNIA FORM 700
SCHEDULE B FAIR POLITICAL PRACTICES 60fd'ARSIOH
Interests in Real Property Name
(Including Rental Income) ✓i ce 4 //g2 C
Is ASSESSORS PARCEL NUMBER OR STREET ADDRESS is ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS
...26.3 T ( 1031 a>a dE - a?/7 ent--et=N Go ASE
Cr CITY//0 C</-1)9 131
SA / E44 C4
FAIR MARKET VALUE IF APPLICABLE, LIST DATE: FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
0$2,000-$10,000
❑$10,am -$100,000 / / 74 _. / / 74 G$2,000-$10,000 p
$$100,001 -$1,000,000 ACQUIRED DISPOSED ❑$10,001 -$100,000 �bCQUIRE�
.5100,001 - ,000 ,0o0 ACQUIRED DISPOSED
G over$1.000,000 0 Over$1 000,000
NATURE OF INTEREST NATURE OF INTEREST
NIownershlw•Deed of Trust G Easement G Ownership/Deed of Trust 0 Easement
G Leasehold G ❑
Yrs.remaining Other Leasehold G
Yo.remaining Other
IF RENTAL PROPERTY, GROSS INCOME RECEIVED IF RENTAL PROPERTY GROSS INCOME RECEIVED
Gso-$499 ❑ssoo-sloop ❑stool -$10,000 G so-5499
❑ $500-$1,000 ❑$1,001 -$10,0011
6$111,001 -$100,000 9 OVER$100,000 G$10,001-$100,000 G OVER$100,000
SOURCES OF RENTAL INCOME: If you own a 10% or greater SOURCES OF RENTAL INCOME: If you own a 10% or greater
interest, list the name of each tenant that is a single source of interest, list the name of each tenant that is a single source of
income of$10,000 or more, income of$10,000 or more.
G None 0 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* NAME OF LENDER*
ADDRESS(Business Address Acceptable) ADDRESS(Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY OF LENDER BUSINESS ACTIVITY, IF ANY,OF LENDER
INTEREST RATE - TERM(Months/Years) INTEREST RATE TERM(Months/Years)
o G None % ❑
Non e
HIGHEST BALANCE DURING REPORTING PERIOD HIGHEST BALANCE DURING REPORTING PERIOD
9$500-$1,000 E$1001-$10,000 0$500-$1,000
❑31,001-$10,000
G$10,001 -$100,000 9 OVER$100000 G $10001 -$100,000 9 OVER$100,000
G Guarantor,if epP':eable G Guarantor, if applicable
Comments: _
FPPC Form 700(2014/2015)Sch.B
FPPC Advice Email:advice @fppc.ca.Rov
SCHEDULE C CALIFORNIA FORM 700
Income, Loans, & Business FAIR POLITICAL PRACTICE'S COLIWISAON
Positions Name
(Other than Gifts and Travel Payments) �~ `
( yments .1� ( C ' 4.
1 INCOME RECEIVED ■ 1.INCOME RECEIVED
tti
- - -NAME OF SOURCE OFINCOM NAME OF SOURCE OF INCOME
el E,
ADDRESS(Su-ness Address Acceptable) ADDRESS(Business Address Acceptable)
BUSINESS ACTMTY, IF ANY, OP SOURCE ( / BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOUR BUSINESS POSITION //L YOUR BUSINESS POSITION
GROSS INCOME RECEIVED GROSS INCOME RECEIVED
❑s5eg-$1,000 '31,001 -$10.000 ❑$500-$1000 ❑ 51,001 -$10,000
❑$10,001 -3100,000 ❑OVER 51100,000 ❑$10,001 -$100,000 ❑OVER$100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED CONSIDERATION FOR WHICH INCOME WAS RECEIVED
❑Salary ❑ Spouse's cr registered domestic partner's income ❑Salary ❑Spouse's or registered domestic partner's income
(For self-employed use Schedule A-2. (For self-employed use Schedule A-2.)
❑Partnership(Less than 10%ownership. For 10%or greater use ❑Pai,ership(Less than 10%ownership. For 10%or greater use
Schedule A-2) Schedule A-2)
❑Sale of ❑ Sale of
(Real CmcerDY car,boat etc.) (Real properly cat Wag eta)
❑ Loan repayment
❑ Loan repayment
❑ Commission or ❑ Rental Income,list each mume or s119,000 or more ❑ commission or ❑ Rental Income,ha eadr source or sla000 or more
(Dssa ) (ces'dbe)
❑Other ❑other
N roe) Pawnee)
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. Personal loans and loans received not in a lender's
regular course of business must be disclosed as follows:
NAME OF LENDER' INTEREST RATE
TERM(Months/Years)
ADDRESS (Business Address Acceptable) o ❑Nona _.
SECURITY FOR LOAN
BUSINESS ACTIVITY, IF ANY,OF LENDER ❑None ❑Personal residence
0 Real Property
HIGHEST BALANCE DURING REPORTING PERIOD srree(aWress
❑
$ oo-gacoo _
City
❑ Stott -$io,00n
❑ $10,001 -$togoo0 ❑Gue nfor
❑OVER$100!000 Other__ _
(Describe)
Comments:
FPPC Form 700(2014/2015)Sch.C
FPPC Advice Email:advice @fppc.ca.gov
FPPC Toll-Free Helpline:866/275-3772 www.fppc.ca.gov
CALIFORNIA FORM 700 STATEMENT OF ECONOMIC INTL. . 'STS CITY OhE yEAD
• FAIR POLITICAL PRACTICES COMMISSION
A PUBLIC DOCUMENT COVER PAGE ' l��� 1 22015
Please type or print hn ink
CITY CLE K'S OF ICF
NAME OF FILER (LAST) (FIRST( BYIMIDD
/21 L LTr fa rr
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
r
e. 7-y o r lees " ne v CA , (10 Lit—) L ,nIc/n4c-�
Division, Boa Department, Distdet,if applicable I Your Position
If filing for multiple positions, list below or on an attachment. (Do not use acronyms)
Agency: Position'.
2. Jurisdiction of Office (Check at least one box)
State ❑Judge or Court Commissioner(Statewide Jurisdiction)
J Multi-County [County of - LOS -A0Ar 2 z
City of /X Si f-int R'L0/ C ❑Other
3. Type of Statement (Check at least one box)
❑ Annual: The period covered is January 1, 2014,through ❑ Leaving Office: Date Left_1_1
December 31, 2014. (Check one)
or-
The period covered is I ,through 0 The period covered is January 1,2014,through the date of
December 31, 2014. leaving office.
NI Assuming Office: Date assumed il_.I� 10 f O The period covered is , through
the date of leaving office.
❑ Candidate: Election year and office sought, if different than Pad 1:
4. Schedule Summary
Check applicable schedules or "None." ■ Total number of pages including this cover page: NS
0 Schedule A-I • Investments-schedule attached Ad'.Schedule C • Income, Loans, 8 Business Positions-schedule attached
CO Schedule A•2- Investments-schedule attached LI] Schedule D•Income-Gifts-schedule attached
X Schedule B-Real Property-schedule attached ❑ Schedule E•Income- Gifts- Travel Payments-schedule attached
-ar-
❑ None•No reportable interests on any schedule
5. Verification
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Busws w Agmrcy Address Reemmended-Ruble.Document)
8,' a' E. 114LL l /3Lvo /jo5S ,,,q 7 CA- c)
DAYTIME TELEPHONE NUMBER 1E-MAIL ADDRESS /
(t24s ) 5'G J-. 2/0 U
t 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 foregoing is true and correct
Date Signed 7'- — Z d' Signature /XL'_ /—A" `-
LA
(cum Oey,year) '.,(File the engnelle sSned NNemen(mill your mug office!)
FPPC Form 700(2014/2015)
FPPC Advice Email:advice @fppc.ca.gov
FPPC Toll-Free Helpline:866/275-3772 www.fppc.ca.gov
SCHEDULE A-1 CALIFORNIA FORM 700
Investments FAIR POLITICAL PRACTICES COMMISSION
Stocks, Bonds, and Other Interests Name
(Ownership Interest is Less Than 10%) —;era N 7--, //:1[ L
Do not attach brokerage or financial statements.
I• NAME OF BUSINESS ENTITY la NA OF BUSINESS ENTITY
1,
�i"N� ✓EP,StatJA::,�i✓y.l smo gtrFi� L✓�%Si�✓:n/ /-�a"/IC.,
GENERAL DESCRIPTION OF THIS BUSINESS r C 4' GEN RAL DESCRIPTION OF THIS
BUSINESS
"PP ✓ NAM G Cvr - S�JtNY - CHGC(<'Ns
CA-p;ra C ,JaaJ KS' CCS
FAIR MARKET VALUE FAIR KIARKET VALUE
0$2000-$10,000 0 $10,001 -$100,000 ❑$2,000-$10000 ❑sto,oat -5100,000
J$100,001 -51,000,000 ❑ Over$1,000,000 iA$100,001 -$1,000,000 ❑Over$1,000,000
NANRE OF INVESTMENT NATURE OF INVESTMENT
❑ Stock ❑Other ❑ Stock ❑Other
(Descrme) (Describe)
El Partnership O Income Received of$0-$499 ❑ Partnership 0 Income Received of$0-$499
0 Income Received of$500 or More(Repo4 on Schedule C) 0 Income Received of$500 or More(Repoli on schedule C)
IF APPLICABLE, LIST DATE. IF APPLICABLE, LIST DATE.
_7_0_1 14._ (i 14 _J_/ 14 _/_/ 14
ACQUIRED DISPOSED ACQUIRED DISPOSED
Is NAME OF BUSINESS ENTITY ■ NAME OF BUSINESS ENTITY
r/S9rschirg czf A,ncc ,c4 /?5,n, CA
GENERAL DESCRIPTION OF THIS BUSINESS/ GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE FAIR MARKET VALUE
$2,000-s10,000 E$10.001 -$100,000 ❑$2,000-sto,omo ❑$10,001 -$100,000
$100,001 -$1,000,000 ❑over st o00,00o ❑$100,001 -s1,000,000 ❑over$1,000.000
NATURE OF INVESTMENT NATURE OF INVESTMENT
❑ Stock ❑Other ❑ Stock ❑Other
(Deembel (Descibe)
• Partnership 0 Income Received of$0-$499 LI Partnership O Income Received of$0-$499
o Income Received of$500 or More(Report on Schedule Co C)Income Received of$500 or More(Report on Schedule C)
IF APPLICABLE, LIST DATE: IF APPLICABLE, LIST DATE.
_11_7 14 _J__J_14 _J_J 14 _J—/ 14
ACQUIRED DISPOSED ACQUIRED DISPOSED
0 NAME OF BUSINESS ENTITY • NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE FAIR MARKET VALUE
❑$2,000-$10,000 0$10,001 -$100000 ❑$2,000-$10,000 ❑ $10 a01 -$100,000
❑$100,001 -$1000,Deo ❑over$1,000,000 ❑$100,001 -$1,000,000 ❑ over$1,000,000
NATURE OF INVESTMENT NATURE OF INVESTMENT
❑ stock ❑Other ❑ dock ❑Other
(Describe) (Describe)
❑ Partnership 0 Income Received of SO-5499 ❑ Partnership 0 Income Reciived of$0-$499
o Income Received of$500 or More(Report on Schedule C) 0 Income Rewired of$500 or More(Report on Schedule c)
IF APPLICABLE, LIST DATE: IF APPLICABLE, LIST DATE-
_7 _J14 _/_/ 14 1 ( 14 _/_/ 14
ACQUIRED DISPOSED ACQUIRED DISPOSED
Comments:
FPPC Form 700(2014/2015)Sch.A-1
FPPC Advice Email:advice @fppc.ca.gov
FPPC Toll-Free Helpline:866/275-3772 www.fppc.ca.gov
SCHEDULE A-2 CALIFORNIA FORM 700
Investments, Income, and Assets
FAIR POLITICAL PRACTICES COMMISSION
of Business Entities/Trusts Name
(Ownership Interest is 10% or Greater)
• 1BUSINESS ENTITY OR TRUST
✓- .E-». Pd-/-Lip ././../144.1 I
V'/ ✓a/C 7 fiy
Name /QJ Name
3455 ti� l'�u c -c�4 A1/ /) ,
Address(Business Address Acceptable) 1 (4 Address(Business Address Acceptable)
C k P/79 Check one
c Trust,go to 2 ❑ Business Entity, complete the box,then go to 2 ❑ Trust go to 2 ❑ Business Entity,complete the box, then go to 2
GENERAL DESCRIPTION OF THIS BUSINESS i GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE IF APPLICABLE, LIST DATE: I FAIR MARKET VALUE IF APPLICABLE, LIST DATE: I
❑ so-$1,999 • ID$0-$1,999
O$2000-$10,000 _/_/ 14 _/_./14 0 52.000-$10000 _/____/ 14 I 114
5 $10001 -s100000 ACQUIRED DISPOSED 5 s10,001 -sio0,000 ACQUIRED DISPOSED
❑ $100,001 -$1,000,000 ❑ $m0.001 -$1.000,000
[] Over$1 000,000 I5 Over$1,000,000
NATURE OF INVESTMENT NATURE OF INVESTMENT
5 Partnership D Sole Proprietorship ❑ 5 Partnership 5 Sole Proprietorship D 1
other Other
YOUR BUSINESS POSITION YOUR BUSINESS POSITION
P. 2. IDENTIFY THE GROSS INCOME RECEIVED(INCLUDE YOUR PRO RATA 2. IDENTIFY THE GROSS INCOME RECEIVED INCLUDE YOUR PRO RATA
SHARE OF THE GROSS INCOME TO THE ENTITY/TRUST) SHARE OF THE GROSS INCOME TO THE ENTITY/RUST)
❑ so-$499 ❑$10,001 -$100,000 ❑so-sass ❑s10,00l -5100,000
❑$500-$1 000 g OVER$100,000 ❑$so0-$1,000 ❑ OVER$100,000
❑ stool -$18,990 ❑ stool -sio.000
1 LIST THE NAME OF EACH REPORTABLE SINGLE SOURCE OF 3. LIST THE NAME OF EACH REPORTABLE SINGLE SOURCE OF
INCOME OF$10000 OR MORE!Attach.rename sneer rr r...e....rrl INCOME OF 510.000 OR MORE mums,vrv...m:hee.r,,c Sao.l
5 None or El Names listed below None or • Names listed below
I. 4. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD OR 4. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD OR
LEASED BY THE BUSINESS ENTITY OR TRUST LEASED BY THE BUSINESS ENTITY OR TRUST
Check one box: Check one box:
❑ INVESTMENT 0 REAL PROPERTY 5 INVESTMENT 0 REAL PROPERTY
Name of Business Entity, if Investmert,or Name of Business Entity, if Investment. or
Assessors Parcel Number or Street Address of Real Property Assessor's Parcel Number or Street Address of Real Property
Description of Business Activity m Description of Business Activity or
City or Other Precise Location of Real Property City or Other Precise Location of Real Property
FAIR MARKET VALUE IF APPLICABLE, LIST DATE. FAIR MARKET VALUE IF APPLICABLE, LIST DATE
❑ $2,000-$10,000 5 52.000-$10,000
n $10,001 .$100,000 1 114 / 1 14 0 $10,001 -$100,000 I 1 14 I 1 14
❑ $100,001 -$1,000,000 ACQUIRED DISPOSED El$100,001 -$1,000,000 ACQUIRED DISPOSED
❑Over$1,000,000 5 Over$1,000,000
NATURE OF INTEREST NATURE OF INTEREST
LI Property Ownership/Deed of Trust 0 Stock ❑ Partnership 0 Property Ownership/Deed of Trust ❑Stock 0 Partnership
❑ Leasehold ❑Other ❑ Leasehold ❑Other
Yrs.remaining YTS remaining
5 Check bcx if additional schedules reporting investments or real property 5 Check box if additional schedules reporting investments or real property
are attached are attached
FPPC Form 700(2014/2015)5ch,A-2
Comments: — FPPC Advice Email:advice @fppc.ca.gov
FPPC Toll-Free Helpline:866/275-3772 www.fppcca.gov
CALIFORNIA FORM 700
SCHEDULE B FAIR POLITICAL PRACTICES COMMISSION
Interests in Real Property Name
(Including Rental Income) 4-N' 4C //4z c
I. ASSESSORS PARCEL NUMBER OR STREET ADDRESS • ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS
J6s S-` 4 ✓ t,s( a;at c 4v 4.,2 f 7 /z7& FiN GQ A t--''e-
m.- CITY
/- ,».G C 21 i 454 ,JC a <
sc' 4
FAIR MARKET VALUE IF APPLICABLE, LIST DATE: /
❑ $2,000-$10,000 FAA$MARKET VALUE IF APPLICABLE, LIST DATE'.
❑$10,001 -5100.000 / / 14 /_J 14 ❑$20oo-$$1.000 `�j ) p
ig $100.01 -$1.000,000 ACQUIRED DISPOSED ❑ $t0.00t -$100,000 / //"/
$ X.$10001, -$1,000,000 ACQUIRED DISPOSED
❑over$1000,000 ❑over$1000,000
NATURE OF INTEREST NATURE OF INTEREST
❑ OwnershIp/Deed of Trust ❑ Easement ❑ Ownership,'oeed of Trust ❑ Easement
❑ Leasehold ❑ ❑ Leasehold
Yrs.remaining Other Yrs.remaining Other
IF RENTAL PROPERTY, GROSS INCOME RECEIVED IF RENTAL PROPERTY,GROSS INCOME RECEIVED
❑ $0-$499 9 $500-$1,000 ❑ stool -s10,000 ❑ so-$499 9 5500-$1,000
❑$loot -$l0000
❑ sio ooi -$100000 ❑ OVER$100,000 ❑$10,001 -$100,000 ❑ OVER$100000
SOURCES OF RENTAL INCOME: If you own a 10% or greater SOURCES OF RENTAL INCOME: If you own a 10% or greater
interest, list the name of each tenant that is a single source of interest, list the name of each tenant that is a single source of
income of$10,000 or more. Income of$10.000 or more
❑ None ❑ 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 bans and
loans received not in a lender's regular course of business must be disclosed as follows:
NAME OF LENDER' NAME OF LENDER'
ADDRESS(Business Address Acceptable) ADDRESS(Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF LENDER BUSINESS ACTIVITY, IF ANY, OF LENDER
INTEREST RATE TERM(MOnths/Years) INTEREST RATE TERM (Months/Years)
— e ❑ None - % ❑ None
HIGHEST BALANCE DURING REPORTING PERIOD HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500-$1,000 ❑stool -$1000o ❑$500-$1,c00
❑ stool -$10,000
❑ $10,001 -sloo,0Oo ❑OVER $100,000 ❑ siQool-$100000 ❑ OVER $100,000
❑Guarantor, if applicable ❑Guarantor. if applicable
Comments:
FPPC Form 700(2014/2015)5ch.a
FPPC Advice Email:advice @fppc.ca.gov
FPPC Toll-Free Helpline:866/275-3772 www.fooc.m.env
SCHEDULE C CALIFORNIA FORM 700
Income, Loans, & Business FAIR POLITICAL PRACTICES COMMISSION
Positions Name
(Other than Gifts and Travel Payments) ,//%41-\f / f4Z-1
1. INCOME RECEIVED • 1. INCOME RECEIVED
NAME OF SOURCE OF INCOME oPty NAME OF SOURCE OF INCOME
e 7 c,/! - /�ea= e R 0
ADDRESS((pBusiness Add4ss Acceptable) ADDRESS(Business Address Acceptable)
BUSINESS ACTIVITY, IFANY,OF SOURCE �✓� l A BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOURR BUSINESS POSITION / YOUR BUSINESS POSITION
._ I✓'h l oc Nce(ICJ L-M.ni Le
GROSS INCOME RECEIVED GROSS INCOME RECEIVED
[� $500-st oo0 ❑Stool -$10000 ❑ $500-stow ❑$1,001 .sto,0o0
❑$10,001 -$100.000 ❑ OVER$100000 ❑ $10,001 -$100,000 ❑ OVER$I0000o
CONSIDERATION FOR WHICH INCOME WAS RECEIVED CONSIDERATION FOR WHICH INCOME WAS RECEIVED
❑Salary ❑ Spouse's or registered domestic partners income ❑ Salary ❑Spouse's or registered domestic partner's income
(For self-employed use Schedule A-2.) (For self-employed use Schedule A-2.)
❑Partnership(Less than 10%ownership For 10%or greater use ❑Partnership(Less than 10%ownership. For 1D%or greater use
Schedule A-2.) Schedule A-a)
9 Sale of 0 Sale of
(Rea/properly can boat etc) (Peal property car boat etc-)
❑ Loan repayment ❑ Loan repayment
9 Commission or ❑ Rental Income, list each source of570.000ormore 9 Commission or 9 Rental Income Iis each sourc of$I0.Uco or mom
(Desoto) (Desoibe)
[J Other ❑ Other
(oescwbe) (Describe)
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. Personal loans and loans received not in a lender's
regular course of business must be disclosed as follows:
NAME OF LENDER' INTEREST RATE TERM/Months/Tears)
% ❑ Wore
ADDRESS (Business Address Acceptable)
SECURITY FOR LOAN
BUSINESS ACTIVITY, IF ANY OF LENDER ❑None 9 Personal residence
❑Real Property
Street address
HIGHEST BALANCE DURING REPORTING PERIOD
$500-$1,000 _
❑ stool -$10,000 offs
0$10,001 -$100,000 ❑Guarantor
9 OVER $100,000 ❑Other _
(Describe)
Comments: _
FPPC Form 700(2014/2015)Sch.C
FPPC Advice Email:advice @fppc.ca.gov
FPPC Toll-Free Helpline:866/275-3772 www.fppc.ca.gov
RECEIVED
`
CITY OF unGF•AEAD
CALIFORNIA FORM 700 STATEMENT OF ECONOMIC INTERESTS c :� o---E.� .. ;._:;<93V
FAIR POLITICAL PRACTICES COMMISSION
vALPUBLIC DOCUMENT COVER PAGE CITY_C K'S OFFICE
Please type or pent in ink. BY. __ ___
NAME OFFILER I_ASTI (FIRST) (MIDDLE)
Hall Jean E.
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
City of Rosemead
Division, Board, Department, District. if applicable Your Position
Traffic Commission Commissioner
. If tiling for multiple positions, list below or on an attachment. (Do not use acronyms)
Agency:Cm mtnu 4/./ 7- 7 NO b"S:N4 Gee,a• f. Position: /n A"ev AiEertFiER
SLe•-cHy'54 tie' 'to b i l k' A'a 3 P t n 4 P t Co/Pin un rry Pe✓a44-0mEAU7 Co rn fly,S.5i° N
2. Jurisdiction of Office (Check at least one box)
❑State ❑Judge or Court Commissioner(Statewide Jurisdiction)
❑Multi-County ❑County of
Q City of Rosemead ❑Other
3. Type of Statement (Check at least one box)
Z Annual: The period covered is January 1, 2015,through [Leaving Office: Date Left ✓2-5 8 I A 6 t 5^
December 31, 2015. (Check one)
-or•
The period covered is 71 c tS O The period covered is January 1,2015.through the date of
`!`i �- through p 7
}5' ✓a- S !3 -or-leaving office.
❑ Assuming Office: Date assumed J__ r Cr the period covered is . i through
the date of leaving office.
O Candidate: Election year and office sought, if different than Part t.
4- Schedule Summary(must complete) • Total number of pages Including this cover page: `r
Schedules attached
Schedule A-1-Investments-schedule attached A Schedule C-Income,Loans, &Business Positions-schedule attached
Schedule A-2-Investments-schedule attached ❑Schedule D•Income-Gigs-schedule attached
iaSchedule B•Real Property-schedule attached ❑Schedule E•Income-Gifs-Travel Payments-schedule attached
-or-
_ ❑ None• No reportable interests on any schedule —
5. Verification
MAILING ADDRESS STREET CITY STATE ZIP CODE
leuslrress of Agency Address Recommended-Punne oocumeom
8838 East. Valley Boulevard Rosemead CA 91770
DAYTIME TELEPHONE NUMBER E-MAIL ADDRESS
( 626 ) 569-2100
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 foregoing is true and correct.
(Q
Date Signed °2 -.pi- dy Signature
Knit day wad Ile the odemsuy sgned s,aemem wee your ill p°tar)
FPPC Form 700(2015/2016)
FPPC Advice Email:advice@fppc.ca.gov
FPPC Toll-Free Helpline:866/275-3772 www.fppc.ca.gov
SCHEDULE A-1
Investments CALIFORNIA FORM 700
FAIR POLIRCAL PRACTICES COMMISSION
Stocks, Bonds, and Other Interests Name
(Ownership Interest is Less Than 10%) /
Do not attach brokerage or financial statements. `/ _ _ r//R Z L
----6 NAME-OF-BUSINESS ENTITY -c - - 6 EOFBUSINESS-EN1R
�.-!'A/, ✓3�e�$a G ✓.11-kit"-(1-r AL fl P - �' )__ �G"✓�l✓ /snl4,
-GENERAL a G4Gf ES/C. hF- $U�
tSCRILfION OF THIS BUSINESSl L .Q!- GENERAL Uc'SCRIPTION-0FTHis BUSINESS
CDi- - ,.S,avr ,e.0-- ClAia-ei</e-i /�et'F ✓, rVs}s+%E.' _
FAIR MARKET VALUE
FAIR ARKT.a. L S v IC (6S
❑ $2,000-$10,000 $10,091 -$100,000 FAIR f ARKET VALUE
Z$100,01 -$1,000,900 ❑ Over$1,000000 ❑$1 0,00 -$i,00 El O eO$1 - 0,0000
- �$100,001 -$1,DOO,oOJ ❑Over$1,000,000
NATURE OF INVESTMENT NATURE OF INVESTMENT
❑ Stock D Omar
0 Stock 0 other
❑ Parnership ( z) (0$mDe)
O Income Received of So-$4M ❑ Partnership 0 Income Received of$0-$499
0 Income Received of$500 or More(Reporter Schedule c) 0 Income Received of$500 or More(Report on Schedule C)
IF APPLICABLE,LIST DATE: IF APPLICABLE, UST DATE:
-t_J 14
ACQUIRED DISPOSED 14 ACCUIRED74 DISPOSED
6 NAME OF BUSINESS ENTITY �+ 6 NAME OF BUSINESS ENTITY Y7
F Arn.t(�'/C4 /?.Siflp Ct /.0 [/JCK 6084(3 _AK ✓a v' s
GENERAL DESCRIPTION OF THIS BUSINESSF ' GENERAL DESCRIPTION OF THIS BUSINESS
_1711-64-k,,,,/ C o s - -SA, fw s -.
FAIR MARKET VALUE
FAIR MARKET VALUE
FR� $2.000-$10,000 ❑mote -$100,090 ❑$2,000-$10000
n$100,01 _$1.00 .000 ❑Over$1,003000 71$100-QO1 -$l.000,00 Over$1 - 0000
3�-' - over$1,00D,009
NATURE OF INVESTMENT NATURE OF INVESTMENT •
❑ Stock ❑Other. ❑ Stock F?Other C t' .S
D Perhrership 0 Income P.ea+IVed of$000$9 e1 (' (-$499
❑ Partnership 0 Income Received of$0-$499
0 Income Received of$500 or More(Roped on Schedule C) C)Income Received of$500 or More(Report on Schedule C)
IF APPLICABLE, LIST DATE: IF APPLICABLE LIST DATE'.
_J / 14 ( /_14 _l_/ 1�
ACQUIRED DISPOSED ____/___/
ACQUIRED DISPOSED
6 NAME OF BUSINESS ENTITY e NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE FAIR MARKET VALUE
❑52,000-310,000 0313001-$100,000 0$2,000-510,000 3
❑ $100,001-$1,000,000 ❑Over$1,000,000 ❑$100,001 -$1,900,000 0 over$1,000,000
NATURE OF INVESTMENT NATURE OF INVESTMENT
0 Stock ❑Other__ ❑ Stock ❑Other
(Describe)
(Describe)
❑ Partnership O Income Received of$0-$499 Parinershl
0 Income Received of$500 or More(Report on Schedule C) ❑ P O Income Received of$0-
O Income Received of$500 or or More(Repot on Schedule G)
IF APPLICABLE,LIST DATE: IF APPLICABLE, LIST DATE:
/ 1 14
ACQUIRED DISPOSED / E 14 ____/_11 14
ACQUIRED DISPOSED
Comments:
FPPC Form 700(2014/2015)Sch.A-1
FPPC Advice Email:Rneiranb.,.,...,,....
•
•
SCHEDULE A-2 CALIFORNIA FORM 700
Investments, Income, and Assets
FAIR°°LET""` PRACTICES`Drnr.,la$I°"
of Business Entities/Trusts Name J_EAN GALL
(Ownership Interest is 10% or Greater)
Name.. _.. Name —_
34.f� iv l''2v'sc4 r Z A1/‘ i&
Address(Business Address Acceptable) r CA Address.!Business Address Acceptable)
Ch e Check one
Trust,go to 2 ❑ Business Entity, complete the box, then go to 2 ❑ Trust,go to 2 ❑ Business Entity complete the box, then go to 2
GENERAL DESCRIPTION OF THIS BUSINESS GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE F APPLICABLE, LIST DATE: FAIR MARKET VALUE IF APPLICABLE, LIST DATE
0$0-$1,999 10 $0-$1,99
0$2,000-$10,000 _/.00/ 14 _00 14 10 $2,000-$10,000 / 114 J /14 I
❑slo.001-$100,000 ACQUIRED DISPOSED 0$10001 -$100,0100 ACQUIRED DISPOSED
❑$100,001-$1,000,000 ❑ $100,001-$1,000,000
{❑Over$1,000,000 ❑ Dyer$1,000,000
I
NATURE OF INVESTMENT i NATURE OF INVESTMENT I
❑Partnership ❑ Sole Proprietorship ❑ arts j ❑ Partnership ❑ Sole Proprietorship ❑
6 Other
YOUR BUSINESS POSITON - ] YOUR BUSINESS POSITION—_
• 1 IDENTIFY THE GROSS INCOME RECEIVED(INCLUDE YOUR PRO RATA 2. IDENTIFY THE GROSS INCOME RECEIVED(INCLUDE YOUR PRO RATA
SHARE OF THE GROSS INCOME TO THE ENTRY/TRUST) SHARE OF THE GROSS INCOME TO THE ENTITY/TRUST)
❑so-$409 ❑$10,001-$100,000 ❑$0-sass ❑$10,001 -$100000
❑Saar-$1.000 ROVER 5100,000 ❑$500-$1,000 ❑ OVER$100,000
❑$1,001-$10,000 ❑ $t,0o1 -sio,000
3. LIST THE NAME OF EACH REPORTABLE SINGLE SOURCE OF 3. LIST THE NAME OF EACH REPORTABLE SINGLE SOURCE OF
INCOME OF$10,000 OR MORE■au. .-,omam..amr n ILwLyJ INCOME OF$10,000 OR MORE IAli 1,h z�,-nammoet n.wcmay_I
❑None or I]Names listed below None or ❑ Names listed below
pt.4. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD OR 4. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD OR
LEASED BY THE BUSINESS ENTITY OR TRUST LEASED BY THE BUSINESS ENTITY OR TRUST
Check one box: Check one box:
❑ INVESTMENT [] REAL PROPERTY ❑INVESTMENT ❑REAL PROPERTY
Name of Business Entity,if Investment,m Name of Business Entity,if Investment,pi
Assessor's Parcel Number or Street Address of Real Property Assessor's Parcel Number or Street Address or Real Property
Desodpuon of Business Activity or Description of Business Activity at
City or Other Precise Location of Real Properly City or Other Precise Location of Real Property
FAIR MARKET VALUE IF APPLICABLE, LIST DATE: FAIR MARKET VALUE IF APPLICABLE, LIST DATE'
0$2,000-$io000 ❑$2,000-$10000
0 $t0,001-,100[000 __/_114 / 114
0$1o,0o1-$100,000 / / 14 _/ -/ 14
❑$100,001 -$1,000,000 ACQUIRED DISPOSED ❑$100,001 -51,000,000 ACQUIRED DISPOSED
❑Over$1,000,000 ❑over$1000,000
NATURE OF INTEREST NATURE OF INTEREST
❑ Property Ownership/Deed of Trust ❑ Stock ❑Partnership ❑Property Ownership/Deed of Trust ❑Stock ❑Partnership
❑ Leasehold ❑Other ___._ ❑Leasehold ❑Other
Ys remaining Yes remaining
❑Check box if additional schedules reporting investments or real property ❑Check box if additional schedules reporting investmen s or real property
are attached are attached
FPPC Form 70012014/2015)56.A-2
Comments: ------ FPPC Advice Email:advice @fppc.ca.gov
FPPCTnll-Gran.Helolinel RER/775-4777 wwwfnnr.ra vnv
•
CALIFORNIA FORM 700
SCHEDULE B FAIR POLITICAL PRACTICES commission
Interests in Real Property Name
(Including Rental Income) et -1j 4, ✓ ..ZL c
• PARCEL NUMBER OR STREET ADDRESS ASSESSOR'S PARCEL R STREET ADDRESS�L-5°.. ) - F � A �
CIT/ cm/
4.14 AC'rii4 K-,
FAIR MARKET VALUE IF APPLICABLE.LIST DATE: FAIR MARKET VALUE IF APPLICABLE. LIST PATE
❑$10,001 -$100,000 _l__I 14 —1—J 14 ❑$2,000-5$1000 iT I�iirg
JE$100,001 -$1,000.000 ACQUIRED DISPOSED ❑$10001 --$1,0000 Q_
01 -$1,000,000 ACQUIRED DISPOSED
❑ Over$1,000,000 ❑ova,Over$1,000,000
NATURE OF INTEREST NATURE OF INTEREST
'Ownership,Dead of Trust ❑Easement IN OwnershipfDeeb of Trust ❑ Easement
❑ Leasehold ❑ ❑ Leasehold_. ❑
Yrs.mount* Other Yrs.remairg Other
IF RENTAL PROPERTY, GROSS INCOME RECEIVED IF RENTAL PROPERTY GROSS INCOME RECEIVED
❑$0-$490 ❑$500-$1,000 ❑$1,001 -$10,000
❑$10,001 - ❑s1-s499 ❑ S510-s1,101 ❑ $1 ore-$1aoo1
$10?000 ❑OVER 5100,000 ❑$10001 -$100,000 ❑OVER 3100 000
SOURCES OF RENTAL INCOME: If you own a 10% or greater SOURCES OF RENTAL INCOME: If
interest, list the name of each tenant that is a single source of tenant own a sin or greater
income of$t0,i�o or more. g interest, list the name of each tenant that is a singie sour of
income of$10,000 or more.
❑ one ❑None
You are not required to report loans from commercial lending institutions•made in the lender's regular course of
business on terms available to members of the public without regard to your official status. Personal loans and
loans received not in a lender's regular course of business must be disclosed as follows:
NAME OF LENDER* NAME OF LENDER*
ADDRESS(Business Address Acceptable) ADDRESS(Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY,OF LENDER BUSINESS ACTIVriY, IF ANY, OF LENDER
•
INTEREST RATE TERM(MOnthsalears) INTEREST RATE TERM(Monts/Years)
—% ❑ None % ❑None _
HIGHEST BALANCE DURING REPORTING PERIOD HIGHEST BALANCE DURING REPORTING PERIOD
0 5511-51,000 ❑51,001-$IQ000
0 4500--1,100 ❑-1,ea1 .-11,100
❑$10,001-$100,000 ❑OVER$100,000 ❑sio,001 -$100,010 ❑OVER 3100,000
❑Guarantor, if applicable
❑Guarantor,£applicable
Comments: _
FPPC Form 700(2024/2015)Sch.B
FPPC Advice Email:advice @copc.ca.eov
SCHEDULE C CALIFORNIA FORM 700
Income, Loans, & Business FAIR POLITICAL PRACTICES CO:.ciss;oN
Positions Name
(Other than Gifts and Travel Payments) f
At � • {-�at c
1.INCOME RECEIVED --� - _—-
—NAMEOFSOURCEOF INWFhb 1.INCOME SOURCE O
NAME OF SOURCE OF INCOME
C17/v� O//L 5� eg0
ADDRESS(9 ess Add4ss Acceptable) ADDRESS(Business Address Acceptable)
tAyy 41 1/4 6- , di ye
�r , ,
BUSINESS ACTIVITY, IF ANY OF SOURCE if l
BUSINESS ACTIVITY, IF ANN.OF SOURCE
YOUR BUSINESS POSITION 2
L YOUR BUSINESS POSITION
GROSS INCOME RECEIVED
GROSS INCOME REOENED
�5
❑$300-51,000 cif S1po1-$10,000
❑slo,001 -$100,000 ❑ ❑$io0-$1$10 ❑ OVER - 00.0000
OVER$100,000 ❑slo,00l -$100,000 ❑OVER$100 000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
❑ ❑ Spouse's or registered domestic partners income CONSIDERATION alary 7 FOR WHICH INCOME dome RECEIVED
Salary
(For self-employed use Schedule A2) Salary ❑Spuus=5 or registeree Schedule partner's Income
(For selnemployed use Schedule A2)
❑Partnership(Less than 10%ownership. For 10%or greater use ❑Partnership(Less than 10%ownership. For 10%or greater use
Sch ale A-2.)
-Schedule A-2.)
❑Sale of
(Real awed.car,boat ate) ❑ 65k of
❑ Loan repayment
(Real properly car,boar,�)
Loan repayment
❑ Commission or ❑ Rental Income, llot each.mace of 5100000 or more
❑ Commission or ❑ Rental Income,ear each sevrce of SWAM or more
peones/ _
(Gattnbe)
❑Other
(Descrte) 111 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. Personal loans and loans received not in a lender's
regular course of business must be disclosed as follows:
NAME OF LENDER*
INTEREST RATE TERM(Months/Years)
ADDRESS (Business Address Acceptable) --% ❑ None
SECURITY FOR LOAN
BUSINESS ACTIVITY, IF ANY, OF LENDER ❑None ❑Personal residence
❑Reel Property
HIGHEST BALANCE DURING REPORTING PERIOD stze:address
❑ssoo-$1,000
❑$1,001 -$10,000 Grey --
❑ $10,001 -$100,000 ❑GUeranfw
❑OVER,$100,000
❑other
(Describe)
Comments:
FPPC Form 700(2014/2015)5ch.C
FPPC Advice Email:advice @fppc.ca.gov
FPPC Toll-Free Helpline:866/275-3772 www.fonc ra one.