CALIFORNIA FORM FDD '

STATEMENT OF ECONOMIC INTERESTSfflC[ OF

I
FAIR POLITICAL PRACTICES COMMISSION I
A PUBUC DOCUMENT '
COVER PAGE
2012 HAR - 7 AM 10: , 7
Please type or print in ink
(FIRST) (MIDDLE)
Q vtlfJl4M
1. Office, Agency, or Court
Agency Name
FlNVlruGE a fttl4NfA-GEMEIJJi AG-JJ
G
'1
Division, Board, Department, District, if applicable Your Position
f<EVENL-tE
E.V E..tJU E 6 -n4-)( 14 OMl NI S7YIf7Ot2
If filing for multiple positions, list below or on an attachment.
Agency: ____________________ Position: _________________
2. Jurisdiction of Office (Check at least one box)
o State o Judge or Court Commissioner (Statewide Jurisdiction)
Multi-County --:----:_______________ o County of _______________
DOther ________________
!1CitYOf Oi'tl<{ I4-rvD
3. Type of Statement (Check at least one box)
IQ"'"Annual: The period covered is January 1, 2011, through o Leaving Office: Date Left ---'---'____
r- December 31,2011. (elleck one)
-or
o The period covered is January 1, 2011, through the date of
The period covered is ---'---' , through
leaving office.
December 31,2011.
o The period covered is ---'---'____, through
o Assuming Office: Date assumed ---'---'____
the date of leaving office.
Candidate: Election Year ______ Office sought, if different than Part 1: _________________
4. Schedule Summary
2..
Check applicable schedules or "None." .. Total number ofpages including this cover page: ___
o Schedule Al - Investments schedule attached Schedule C Income. Loans, & Busuless Positions schedule attached
Schedule A2 Investments - schedule attached o Schedule D - Income - Gifts schedule attached
o Schedule B Real Property - schedule attached o Schedule E Income - Gifts - Travel Paymel)l,S - schedule attached
or-
None - No reportable interests on any scl7edule
5. Verification
MAILING ADDRESS STREET -1;ITY STATE ZIP CODE
Public Document)
eA
COP'V'
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 umenl.
(monU;, day, yeiJl)
FPPC Form 700 (2011/2012)
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
SCHEDULE C
Income, Loans, & Business
2D12 MAR - 1 ftH 10: 11
Positions
(Other than Gifts and Travel Payments)
CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMiSSION '
Name
oA\JLD lAG PItt,-rSo"';
II> 1. INCOME RECEiVED
NAME OF SOURCE OF INCOME C "" fill> t C
1'1 O ~ 1..14 TlSl2fl tc=l e.f- \ 3" '- r.;;
I4N D"'OSE. C eg <lSI2
ADDRESS (Business ;';;I!ress Acceptable)
'l0411:1 SeeR {$ U tAIlfU2 E
BUSINESS ACTIVITY. IF AN OF SOURCE
U u a ~ (JFf=lCLlArttoQ
YOUR BUSINESS POSITION
UIM,PlRE
GROSS INCOME RECEIVED
$500 - $1.000 t8J:$1,001 $10,000
510.001 - $100,000 0 OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
o Salary Spouse's or registered domestic partner's income
o Loan repayment 0 Partnership
[J Sale of __________________
(Real property, car. boal. "IC.)
Commission or 0 Rental Income, lisl each soure<; of $10.000 or mo",
Other ________---,,__________
(Describe)
II> 1. iNCOME RECEIVED '
NAME OF SOURCE OF INCOME
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOUR BUSINESS POSITION
GROSS INCOME RECEIVED
0$500 - $1,000 0 $1,001 - $10,000
0$10,001 - $100,000 OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
oSalary Spouse's or registered domestic partner's income
o Loan repayment o Partnership
oSale of -----------------
(Real property. car boat. etc.)
o Commission or Rental Income, list each sou"", of $10,000 or more
oOther ---------:=----,,,....,...-------
II> 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.
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
0$500 - $1,000
$1,001 $10,000
$10,001 - $100,000
OVER $100,000
Comments:
Personal loans and loans received not in a lender's
INTEREST RATE' TERM (Months/Years)
----%. 0 None
SECURITY FOR LOAN
o None Personal residence
o Real Property -------:---,--,-,.--------
Street address
City
o Guarantor -----------------
o Other ___________________
(DeSCribe)
FPPC Form 700 (2011/2012) Sch. C
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov