Margaret ClarkOab•:fo"iiRel ceived
•- O 1 STATEMENT
OF ECONOMIC INTERESTS
FAIR -.
A PUBLIC DOCUMENT
COVER PAGE
Please type or print in ink.
-: y fiLER'WS OF
NAME OF FILER (LAST) (FIRST( - Sy (MIDDLE)
C k MLt rq-aref"
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
0
&1-q 0� r�oserne-0-A
Division, Board, Department, District, if applicable
Your Position
Gounodl Mew�l�er
► 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)
❑ Multi -County
❑ County of
®•City of Ro 5e M Beed'
❑ Other
3. Type of Statement (Check at least one box)
Annual: The period covered is January 1, 2017, through
❑ Leaving Office: Date Left —J I
December 31, 2017.
(Check one)
-or-
The period covered is _JI
through O The period covered is January 1, 2017, through the date of
December 31, 2017.
or- leaving office.
❑ Assuming Office: Date assumed I 1
O The period covered is I I through
the date of leaving office.
❑ Candidate: Date of Election and office sought, if different than Part 1:
4. Schedule Summary (must complete) ► Total number of pages including this cover page,
Schedules attached
❑ Schedule A-1 - Investments - schedule attached ® Schedule C - Income, Loans, & Business Positions - schedule attached
❑ Schedule A-2 - Investments - schedule attached ® Schedule D - Income - Gids schedule attached
❑ Schedule B - Real Property - schedule attached ❑ Schedule E - Income - Gifts - Travel Payments - schedule attached
-or-
E]
OM1
5.
❑ None - No reportable interests on any schedule
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business nrAgeneyriddress Recommended - Public Document)
3109 Prosrje_r�i" Avco, Rose-meoLd CFS-. 91 Zi6) --
clar-keee-s
co (Y)
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 taws of the State of California that the foregoing is true and correct.
Date Signed Ma"k )q, )_0/8 Signature X47 e `'F C611_10_�
(month, day, year) (Fl". oifidd)
FPPC Form 700(2017/2018)
FPPC Advice Email: advice@fppc.m.gov
FPPC Toll -Free Helpline: 866/275-3772 www-fppc.m.gov
SCHEDULE C
Income, Loans, & Business
Positions
(Other than Gifts and Travel Payments)
NAME OF SOURCE lOF INCOME
Ri k C_ F,c' ICicy. rIC:..
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF A -MY, OF SOURCE
YOUR BUSINESS POSITION
GROSS INCOME RECEIVED ❑ No Income - Business Position Only
❑ $500 - $1,0007[]. $1,001 - $10,000
❑ $10,001 - $100,000 ❑ OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
❑ Salary ® Spouse's or registered domestic partner's income
(For self-employed use Schedule A-2.)
❑ Partnership (Less than 10% ownership. For 10% or greater use
Schedule A-2.)
❑ Sale of
❑ Loan repayment
(Real property, car, boat, etc.)
❑ Commission or ❑ Rental Income, list each source of $10,000 or more
NAME OF SOURCE OF INCOME
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOUR BUSINESS POSITION
GROSS INCOME RECEIVED ❑ No Income - Business Position Only
❑ $500 - $1,000 ❑ $1,001 - $10,000
❑ $10,001 - $100,000 ❑ OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
❑ Salary ❑ Spouse's or registered domestic partner's income
(For self-employed use Schedule A-2.)
❑ Partnership (Less than 10% ownership. For 10% or greater use
Schedule A-2.)
❑ Sale of
(Real property, car, boat, etc.)
❑ Loan repayment
❑ Commission or ❑ Rental Income, list each source of $10,000 or more
❑ Other (DF1 Other
escribe) (Describe)
10 2. LOANS RECEIVED OR OUTSTANDING DURING THE REPORTING PERIOD
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'
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF LENDER
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500 - $1,000
❑ $1,001 - $10,000
❑ $10,001 - $100,000
❑ OVER $100,000
Comments:
INTEREST RATE TERM (MonthsNears)
❑ None
SECURITY FOR LOAN
❑ None ❑ Personal residence
❑ Real Property
❑ Guarantor
❑ Othei
Street address
City
(Daccnba)
FPPC Form 700 (2017/2018) Sch. C
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov
SCHEDULE D
Income — Gifts
► NAME OF SOURCE (Not an Acronym)
�Ccct,(ae c�,p lLL &OrV1f0. i�r�i eS
ADDRESS (Business Address Acceptable)
6400 S'#Y e_ Smcr0.1' oi+-o, CA 9'5814
BUSINESS ACTIVITY, IF ANY, OF SOURCE
/W\roec`c y dor clf Tes av A tkeir re_! c;Aenf5
DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
fitO t-1 $ t5,�y Lunch
3 i / 17 $ 31 a5- Ltkn&Gi
_6 j q_j )),, $ 1 ?. v' y Lunc-k
► NAME OF SOURCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
$
► NAME OF SOURCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/dd/yy) VALUE
Comments:
DESCRIPTION OF GIFT(S)
► NAME OF SOURCE (Nat an Acronym)
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/dd/yy) VALUE
$
$
$
► NAME OF SOURCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
DESCRIPTION OF GIFT(S)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/dd/yy) VALUE
—i $
► NAME OF SOURCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
DESCRIPTION OF GIFT(S)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/dd/yy) VALUE
$
$
DESCRIPTION OF GIFT(S)
FPPC Form 700 (2017/2018) Sch. D
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov