20 i: o0 please type or pdnt in ink. name of filer (last ... · (mndd~2012) descdbe)* ca st econ...

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Please type or pdnt in ink. NAME OF FILER 1. Office, Agency, or Court (LAST) (FIRST) 20 I: O0 (MIDDLE) Agency Name Division, Board, Department, District, if applicable Your Position ~ If filing for multiple positions, list below or on an attachment. Agency: Position: , = Jurisdiction of Office (Check at least one box) ~i¢State [] Multi-County [] city of [~udge or Court Commissioner (Statewide Jurisdiction) ~’County of L¢. .~ /ozlo~,.,~z.~ [] Other J Type of Statement (Check at least one box) [] Annual: The period covered is January 1, 2012, through December 31, 2012. The period covered is __J / December 31, 2012. [] Assuming Office: Date assumed __/ L , through Leaving Office: Date Left / / (Check one) O The period covered is January 1, 2012, through the date of leaving office. O The period covered is J / , through the date of leaving office. [] Candidate: Election year and office sought, if different than Part 1: = Schedule Summary Check applicable schedules or "None." ~Schedule A-1 - Investments - schedule attached [~chedule A-2 - Investments - schedule attached ~chedule B - Real Property- schedule attached ¯ Total number of pages including this cover page: / t/ ~"¢"Schedule C - Income, Loans, & Business Positions - schedule attached ~"! Schedule D - Income - Gifts - schedule attached ~/~chedule E - Income - Gifts - Travel Payments - schedule attached -or- [] None - No reportable interests on any schedule I certify under penalW _/~ry under the laws of the State FPPC Advice Email: [email protected] FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca,gov

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Please type or pdnt in ink.

NAME OF FILER

1. Office, Agency, or Court

(LAST) (FIRST)

20 I: O0 (MIDDLE)

Agency Name

Division, Board, Department, District, if applicable Your Position

~ If filing for multiple positions, list below or on an attachment.

Agency: Position: ,

=

Jurisdiction of Office (Check at least one box)

~i¢State

[] Multi-County

[] city of

[~udge or Court Commissioner (Statewide Jurisdiction)

~’County of L¢.�.~ /ozlo~,.,~z.~

[] Other

J Type of Statement (Check at least one box)

[] Annual: The period covered is January 1, 2012, through December 31, 2012.

The period covered is __J / December 31, 2012.

[] Assuming Office: Date assumed __/ L

, through

Leaving Office: Date Left / / (Check one)

O The period covered is January 1, 2012, through the date of leaving office.

O The period covered is J / , through the date of leaving office.

[] Candidate: Election year and office sought, if different than Part 1:

=

Schedule Summary Check applicable schedules or "None."

~Schedule A-1 - Investments - schedule attached

[~chedule A-2 - Investments - schedule attached

~chedule B - Real Property- schedule attached

¯ Total number of pages including this cover page: / t/

~"¢"Schedule C - Income, Loans, & Business Positions - schedule attached

~"! Schedule D - Income - Gifts - schedule attached ~/~chedule E - Income - Gifts - Travel Payments - schedule attached

-or-

[] None - No reportable interests on any schedule

I certify under penalW _/~ry under the laws of the State

FPPC Advice Email: [email protected] FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca,gov

SCHEDULE A-1

Investments Stocks, Bonds, and Other Interests

(Ownership Interest is Less Than 10%)

Do not attach brokerage or financial statements.

/�

SPDR S&P 500 ETF TR Tracks the S&P 500 Index $100.001 - $1,000.000 ETF

JPMorgan Strategic Income Opportunties Fund Fund invests in range of FI products $100.001 - $1,000.000 Mutual Fund

iShares MSCi EAFE Index Fund Tracks the MSCI EAFE Index $100.001 - $1,000,000 ETF

Powershares DB Commodity Fund Tracks the D£~ Commodit7 Index $10,001 - $100.000 ETF

iShares Barclays Aggregate Bond Fund Tracks the Barlcays Aggregate bond Index $100.001 - $1,000,000 ETF

TCW Total Return Bond Fund Fund seeks to achieve total return $10,001 - $100,000 Mutual Fund

Double Line Total Return Bond Fuod ¯ Fund seeks to achieve total return $100,001 - $1.000.000 Mutual Fund 11/20/2012

iShares Emerg Mkt Min Vol Fund Tracks the MSCI Em Mid Min Vol Index $2,000 - $10.000 ETF 11115/2012

Vanguard MSCI Emerging Markets ETF Tracks the MSCI Em Mid Index $2,000 - $10.000 ETF

Vanguard EXTD Market ETF Tracks benchmarks for stocks sm to mid $10.001 - $100.000 ETF

Oppenheimer Senior Floating Rate Fund Fund invests In floating rate notes FI $10.001 - $100.000 Mutual Fund

LShares MSCI EAFE Index Fund Tracks the MSCI EAFE Index $2.000 - $10.000 ETF

FPPC Form 700 (2011/2012) Soh. A-lx

FPPC Toll-Free Helpline: 86SlASK-FPPC www.fppo.©a.gov

* Select from drop down list

SCHEDULE A-2

Investments, Income, and Assets

of Business Entities/Trusts (Ownership Interest is 10% or Greater)

Name

LIST DATE NAME AND ADDRESS OF BUSINESS GENERAL

ACQUIRED ENTITY OR TRUST DESCRIPTION OF FAIR MARKET

OR (Business Address Acceptable) BUSINESS VALUE*

DISPOSED (If Trust, go to 2) ACTIVITY

(mnddd/2012)

The Ella and Helga B Weinbach

Family Trust, dtd 12/23/80

Separate Property Trust of Helga B. Weinh~ch The Ella and Helga B Weinbach

Family Trust, dtd 12/23/80

Separate Property Trust of Helga B. Weinbach The Ella and Helga B Weinbach

Family Trust, dtd 12/23/80

Separate Property Trust of Helga

B. W~inhach The Elia and Helga B Weinbach

Family Trust, dtd 12/23/80

Separate Property Trust of Helga

R W~inbach The Ella and Helga B Weinbach

Family Trust, dtd 12/23/80

Separate Property Trust of Helga

B. W~inbach The Ella and Helga B Weinbach

Family Trust, dtd 12/23/80

Separate Property Trust of Helga B. Weinbach The Ella and Helga B Weinbach

Family Trust, dtd 12/23/80

Separate Property Trust of Helga

~, We-inhach The Ella and Helga B Weinbach

Family Trust, dtd 12/23/80

Separate Property Trust of Helga

B. Weinbach

NATURE OF A

INVESTMENT YOUR BUSINESS or

D (if "other," POSITION

descdbe)*

INCLUDE YOUR

PRO RATA

SHARE OF

GROSS

INC(~ME TO

ENTITYFFRUS’P

LIST SINGLE

SOURCES OF

INCOME OF

$10,000 OR MORE

INVESTMENT- REAL PROPERTY-

BUSINESS LIST PRECISE FAIR MARKET

ENTITYINAME, AND LOCATION OF VALUE*

BUSINESS ACTIVITY REAL PROPERTY

$100,001-

$1,000,000

iShares Trust Russell 2000 1 $100,001-

$1,000,000

iShares Trust Russell EO00 (

$1oo,ool-

$1,ooo,ooo

iShares MSCI EAFE Index Fu $100,001-

$1,000,000

SPDR 5&P Midcap 400 ETF

SPDR S&P 500 ETF $10,001 -

$100,000

Univ CA AMBAC Pre-Refun~ $1 o,001 -

$10o,0oo

Univ CA AMBAC Pre-Refun( $2,000 -

$10,000

CA ST Econ Recovery

LIST DATE NATURE OF

ACQUIRED A INTEREST

OR or

DISPOSED D (if"other,"

descdbe)* (mm/dd12012)

ETF

ETF

ETF

ETF

$100,001 - ETF

$1,000,000

Bond

Bond

Bond

FPPC Form 700 (201112012) Sch. A-2x FPPC Toll-Free Helpline: 866/ASK-FPPC www.fppc.ca.gov

~ SelectJ:rom drop down fist

SCHEDULE A-2

Investments, Income, and Assets of Business Entities/Trusts

(Ownership Interest is 10% or Greater) Name

LIST DATE NAME AND ADDRESS OF BUSINESS GENERAL

ACQUIRED DESCRIPTION OF FAIR MARKET

OR VALUE*

DISPOSED (If Trust, go to 2) ACTIVITY

(mnddd/2012)

The Ella and Helga B Weinbach

Family Trust, dtd 12/23/80,

Separate Property Trust of Helga B. Weinb~ch The Elia and Helga B Weinbach

Family Trust, dtd 12/23/80,

Separate Property Trust of Helga

The Elia and Helga B Weinbach

Family Trust, dtd 12/23180,

Separate Property Trust of Helga

The Elia and Helga B Weinbach

Family Trust, dtd 12/23180,

Separate Property Trust of Helga B W~inbach The Elia and Helga B Weinbach

Family Trust, dtd 12/23/80,

Separate Property Trust of Helga

~ W~inbach The Elia and Helga B Weinbach

Family Trust, dtd 12/23/80,

Separate Property Trust of Helga B W~inbach The Elia and Helga B Weinbach

Family Trust, dtd 12/23/80,

Separate Proper~ Trust of Helga B. Weinbach The Elia and Helga B Weinbach

Family Trust, dtd 12/23/80,

Separate Property Trust of Helga

B. Weinbach

NATURE OF A

INVESTMENT YOUR BUSINESS

D (if "other," POSITION

descdbe)*

INCLUDE YOUR

PRO RATA

SHARE OF

GROSS

INCOMETO

ENTITYKRUST*

LISTSINGLE

SOURCES OF

INCOME OF

$10,000OR MORE

LIST DATE INVESTMENT- REAL PROPERTY- NATURE OF

A INTEREST

OR ENTITYINAME, AND LOCATION OF VALUE*

DISPOSED D (If"other,"

BUSINESS ACTIVITY REALPROPERTY (mndd~2012)

descdbe)*

CA ST Econ Recovery

Oakland Calif SWR SER A

$10,001- Bond

$100,000

$10,001 o Bond

$100,000

$100,001 - Bond

$1,000,000

NO Orange CNTY CA CMMP $10,001 - Bond

$100,000

Univ CA AMBAC $100,001 - A Mutual Fund

$1,000,000

JPMorgan Strategic Income $100,001- A MutualFund

$1,000,000

Wells Fargo Advantage Ultr $10,001 - ETF

$100,000

Powershares DB Commodit $10,001 - ETF

$100,000

Health Care BElT INC

FPPC Form 700 (2011/2012) Sch: A-2x FPPC Toll-Free Helpline: 8661ASK-FPPC www.fppc.ca.gov

SCHEDULE A-2 Investments, Income, and Assets

of Business Entities/Trusts (Ownership Interest is 10% or Greater)

Name

Name

Address (Business Address Acceptable) "~l ~

Check one

¯ .~rust, go to 2 ~ Business Entity, complete the box, then go to 2

GENERAL DESCRIPTION OF BUSINESS ACTIVITY/~

FAIR MARKET VALUE IF APPLICABLE, LIST DATE:

[] $0 - $1.999

[] $2.ooo - $1o,ooo ! i 12 / I 12

[] $10,001 - $100.000 ACQUIRED DISPOSED

~’$100.001 - $1,000.000

[] Over $1,000,000

NATURE OF INVESTMENT

[] Partnership [] Sole Proprietorsh p r-7,,

YOUR BUS,NESS POS,T,ON Other

[] $0- $499

[] $500 - $1,000

[] $1,001 - $10,000

[] $10,001 - Sl00,000

~ OVER $100,000

~i None

V

Check one box:

~ INVESTMENT ~ REAL PROPERTY

Name o~ Business Entity, if Investment, or Assessor’s Parcel Number or Street Add-~ss el Real Property

Description of Business Activity o~r

C~ or Other Precise Location of Real Property

FAIR MARKET VALUE IF APPLICABLE, LIST DATE:

[] $2,ooo- $1o.ooo [~’$10,OOl - $10o.00o / /. 12 ~ .j 12

[]$100,001 - $1,000,000 ACQUIRED DISPOSED

[] Over $1,000,000

NATURE OF INTEREST

~"Property Ownership/Deed of Trust [] Stock [] Partnership

[] Leasehold [] Other _~_1~ ~,~.r~~ Yrs. remaining

[] Check box if additional schedules reporting investments or real oroperty are a~ached

Address (~usiness A~dress Acceptable)

Check o.~e

~..~rust, go to 2 ~ Business Enter},, complete the box, then go to 2

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

FAIR MARKET VALUE IF APPLICABLE, LIST DATE:

[--] $0 - $1,999

[] s2,ooo - S!o,ooo f L 1 2 __1 1 12

.~ $1o,001 - $1oo,ooo ACQUIRED DISPOSED

$I00,00i - $1,000,000

[] Over $1,000,000

NATURE OF INVESTMENT [] Partnership ~ Sole Proprietorship

YOUR BUSINESS POSITION

r750- $499

[] $500 - $1,000

[] $1,001 - $10,000

~ $10,001 - $100.000

h~ OVER $100,000

--INone

Check one box:

~NVESTMENT ~ REAL PROPERTY

~--~Tf ~ t!~--~- Name of Business Entity, if Investment, or Assessor’s Parcel Number or Street Add-~ss of Real PropeEy

Description of Business Activity o_r

City o[ Other Precise Location of Real Property

IF APPLICABLE, LIST DATE:

/ / 12 __j.__L12 ACQUIRED DISPOSED

FAIR MARKET VALUE

~ 2,000 - $10.000

10.001 - $100,000

[] $100,001 - $1,000,000

[] Over $1,000.000

NATURE OF INTEREST

,~ Prope~y Ownership;Deed of Trust [] Stock [-~Pa~nership

[] Leasehold Yrs. remaining

[] Check box ~ additional schedules reporting investments or real property are attached

Comments: FPPC Form 700 (201212013) Sch. A-2

FPPC Advice Email: advice@fppc,ca.gov

FPPC Toll-Free Helpline: 866/275-3772 www.fppc,ca.gov

SCHEDULE A-2 Investments, Income, and Assets

of Business Entities/Trusts (Ownership Interest is 10% or Greater)

Name

Address (Business Address Acceptable) ~ ~.~ ~A~O~21~

Chec~.~e ~ Trust, go to 2 [] Business Entity, complete the box, then go to 2

FAIR MARKET VALUE

[] $0 - $1,999

i[] $2,000-$1o,ooo i!]~’$1o,ool - $1oo,ooo

I E~ $1oo ooi - $i,ooo,ooo [] Over $1,000,000

IF APPLICABLE, LIST DATE:

NATURE OF INVESTMENT

t /. 12 .___j ! 12 ACQUIRED DISPOSED

C~artnership [] Sole Proprietorship []

YOUR BUSINESS POSITION ~l~-,/I ~

[] so - $4~9 - $ioo,ooo [] $500- $1.000 [] OVER $100,000 [] $1,001 - $10,000

[] None

Check one box,"

[~NVESTMENT

Other

Name of Business Entity, if Investment, or AssessorIs Parcel Number or Street Address of Real Property

Description of Business Activity or City or Other Precise Location of Real Property

Nar~ff~

/~ddres~ (Business Address Acceptable)

Check one

~ Trust, go to 2 [] Business Entity, complete the box, then go to 2

FAIR MARKET VALUE

[] $0 - $1,999

[] $2,000 - $10,000

[] $10,001 - $!00,000

~ $100,001 - $1,000,000

Over $1,000,000

IF APPLICABLE, LIST DATE:

__J.__l. 12 !__1 12

ACQUIRED DISPOSED

NATUREOFINVESTMENT d ~ C [] Partnership [] Sole Proprietorship

Other

YOU R BUSIN ESS POSitiON N~-~ ~-’~

[] $o - $499

[] $500 - $i,0oo [~$1,001 - $10,000

$100,000

[] OVER $100,000

-1 None

Check one box:

J~NVESTMENT [] REAL PROPERTY

Name or Business Enlity, if Investment, or Assessor’s Parcel Number or Street Address of Real Property

Description of Business Activity o._E City or Other Precise Location of Real Property

FAIR MARKET VALUE IF APPLICABLE, LIST DATE:

[] $2,000 - $1o,ooo

1~$1o,ool. $1oo,ooo / / 12 , L / 12

$1oo,ool - $1,ooo,ooo ACQUIRED DISPOSED

[] Over $1,000,000

NATURE OF INTEREST

[] Property Ownership/Deed of Trust [] Stock [] Partnership

[] Leasehold [] Other Yrs. remaining

[] Check box if additional schedules reporting investments or real property are altached

FAIR MARKET VALUE IF APPLICABLE, LIST DATE

[] $2,000 I $10,000

[] $1o,ool. $1oo,ooo __/ / 12 / /. 12

~’$1oo,ool - $1,ooo,ooo ACQUIRED DISPOSED

[] Over $1,000,000

NATURE OF INTEREST

[] Property Ownership/Deed of Trust [] Stock [] Partnership

[] Leasehold [] Other Yrs. remaining

[] Check box if additional schedules reporting investments or real property are allached

Comments: FPPC Form 700 (201212013) Sch. A-2

FPPC Advice Email: [email protected]

FPPC Toll-Free Helpline: 866/275-3772 wwwXppc.ca.gov

SCHEDULE A-2 Investments, Income, and Assets

of Business Entities/Trusts (Ownership Interest is 10% or Greater)

~rusL go to 2 ~ Business Entity, complete the box, then go to 2

GENERAL DESCRIPTION OF BUSI~ESS ACTIVITY

FAIR MARKET VALUE IF APPLICABLE, LIST DATE:

] $0 - $1.999

~.$2,ooo ~ $1o,ooo / ./. 12

] $10,001 :$100,000 ACQUIRED

~$100,001 - $1,000,000

__! / 12 DISPOSED

Over $1,000,000

NATURE OF INVESTMENT

~[~’Partnership [] Sole Proprietorship [] Other

YOUR BUSINESS POSITION ~’~~~’~"

Name

.

Name

Address (Business Address Acceptable> ~ ~~ C4. ~/~.~

Check one

~(b#t, go to 2 ~ Business E~tity, complete the box. then go to 2

GENERAL ..... DESCRIPTION OF BUSINESS ACTIVITY ~

FAIR MARKET VALUE IF APPLICABLE, LIST DATE:

[~ $0- $1,999 $2,od& - sic.coo __I / 12 __/ 11 12 [] $10.p0i - $100,000 ¯ACQUIRED DISPOSED

[] $100,001 -$i,000,000

[]Over $1,000,090

NATURE OF INVESTMENT

[] Partnership [] Sole Proprietorship [] Other

Y(JUR BUSINESS’POSITION - 5.~., ;.

[] $0 -$499

[] $5oo: ~ooo [] $t.001 -$t0,000.

[] Nohe

[] $500 - $1.ooo

$1o ooo

[] OVER $100,000

[] No~e ’1

Check one box." ..... "

J~INV~STM~_NT [] REAL PROPERTY

Name of Business Enlily, if Investment. or Assessor s Parcel Number or Street Address of Real Property

Description o[ Business Activity or Cily or Other Precise _ocation or Real Pr.gperiy

FAIR MARKET VALUE IF APPLICABLE LIST DATE:

Check*ohe box:

1 ~ INVESTMENT ~ REAL PROPERTY

Name of Business Entity, if nvestmenl or . Assessor’s Parcel Number or Street Address of Real ProBeYty

[] $2.000 - $10.000

[] $10,001 --$100.000 / /,12 / .-/ 12. ~ $100.001 - $1.0OO,000 ACQUIRED DISPOSED

[] Over $1.000.000

NATLRE OF INTEREST

[] Property O~ynershiplDeed of Trust [] ~tock [] Partnership

[] Leasehold [] Other Yrs. remaining

Description of BuIsiness Activity or City or Other P’r~ci~e Location of Real Property

FAIR MARKET ~ALUE IF APPLICABLE LIST DATE:

~1~ s2.ooo - slo.ooo $10.~301 - SlO0.O00 " ./ Z 12 __1 !. 12

~r.~ SlO0,001 ’- $1,0~0.0(~0 ACQUIRED DISPOSED

Over $1 000,000

[] Check box if addiliohal schedules reporting investments or real property a~e attached

NATURE OF INTEREST

[] Property Owflership/Deed of Trust [] Stock [] Parlnershio

[]Leasehold ~ Other Yrs remaining

[] Check box if additional schedules reporting investments o~ real property are attached

Comments: FPPC Form 700 (2012/2013) Sch. A-2

FPPC Advice Email: [email protected]

FPPC Toll-Free Helpiine: 866/275-3772 v,~Nw.fppc.ca.gov

SCHEDULE B Interests in Real PropeF&y

(Including Rental Income)

Name

CITY _

FAIR MARKET VALUE

[] $2,000 - $10,000 12 [] $10,001 - $100,000 /

ACQUIRED [] $100,001 - $1,000,000

,~ Over $1,000,000

NATURE OF INTEREST

[~j~OwnershiplDeed of Trust [] Easement

IF APPLICABLE, LIST DATE:

/___/12 DISPOSED

[] Leasehold [] Yrs, remaining Other

IF RENTAL PROPERTY, GROSS INCOME RECEIVED

[] $0 - $499 [] $500 - $1,000 [] $I,001 - $I0,000

~j~$1o,ool - $1oo,ooo D 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.

[] N

ASSESSOR’S PARCEL NUMBER OR STREET ADDRESS

FAIR MARKET VALUE IF APPLICABLE, LIST DATE:

[] $2,000 - $1o,ooo

F-]. $1o,ool - $1oo,ooo / / 12 / /. 12 [] $100,001 - $1,000,000 ACQUIRED DISPOSED

[] Over $1,000,000

NATURE OF INTEREST

[~wnership/Deed of Trust ] Easement

[] Leasehold [] Yrs. remaining 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 or 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 (Months/Years)

% [] None

HIGHEST BALANCE DURING REPORTING PERIOD

[] $500 - $1,ooo [] $1,OOl - $1o,ooo

[] $10,001 - $100,000 [] OVER $100,000

[] Guarantor, if applicable

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:

FPPC Form 700 (2012/2013) Sch. B FPPC Advice Email: [email protected]

FPPC Toll-Free Helpline: 866/275-3772 vwvw, fppc.ca,gov

SCHEDULE C Income, Loans, & Business

Positions (Other than Gifts and Travel Payments)

Name

BUSINESS ACTIVITY, IF ANY, OF SOURCE

YOUR BUSINESS POSITION

GROSS INCOME RECEIVED

[] $5oo- $1,ooo [] $1,oo7 - $1o,ooo

~$10,OO1 - $100,0OO [] OVER $100,000

CONSIDERATION FOR WHICH INCOME WAS RECEIVED

[] Salary [] Spouse’s or registered domestic partner’s income

[] Loan repayment [] Partnership

[] Sale of (Real property, car, boat, etc.)

[] Commission or [] Rental Income, list each source of $10,000 or more

[] Other (Descdbe)

NAME OF SOURCE OFINCOME

ADDRESS (Business Address Acceptable)

BUSINESS ACTIVITY, IF ANY, OF SOURCE

YOUR BUSINESS POSITION

GROSS INCOME RECEIVED

[] $500- $1,000 [] $1,001 - $10,000

[] S10,001 - $100,000 [] OVER $100,000

CONSIDERATION FOR WHICH INCOME WAS RECEIVED

[] Salary [] Spouse’s or registered domestic partner’s income

[] Loan repayment [] Partnership

[] Sale of (Real property, car, boat, etc.)

[] Commission or [] Rental Income, list each source of $10,000 or more

[] Other (Desc#be)

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)

BUSINESS ACTIVITY, IF ANY, OF LENDER

% [] None

SECURITY FOR LOAN

[] None [] Personal residence

HIGHEST BALANCE DURING REPORTING PERIOD

[] $500 - sl.ooo

[] $1,OOl - $I0,000

[] $1o,ool - $1oo,ooo

[] OVER $I00,000

[] Real Property

-"]Guarantor

[] Other

Street address

City

(Describe)

Comments:

FPPC Form 700 (201212013) Sch. C FPPC Advice Email: [email protected]

FPPC Toll-Free Helpline: 866/275-3772 www.fppc,ca.gov

SCHEDULE D Income - Gifts

Name

¯ NAME OF SOURCE (Not an Acronym)

ADDRESS (Business Address Acceptable)

BUSINESS ACTIVITY, IF ANY, OF SOURCE

DAT U DESCRIPTION OF GIFT(S)

FIPF I !

I

~ NAME OF SOURCE (Not an Ac~nym)

ADDRESS (Business Address Acceptable)

BUSINESS ACTIVITY, IF ANY, OF SOURCE

DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)

/ !

/ /

/ /

~ NAME OF SOURCE (Not an Acmnym)

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 DESCRIPTION OF GIFT(S)

]. ].__

L__J.

¯ NAME OF SOURCE (Not an Acronym)

ADDRESS (Business Address Acceptable)

BUSINESS ACTIVITY, IF ANY. OF SOURCE

DATE (mm/dd!yy) VALUE

L 1_

L L $

__J / $

l / $

__l / $

¯ NAME OF SOURCE (Not an Acronym)

ADDRESS (Business Address Acceptable)

BUSINESS ACTIVITY, IF ANY, OF SOURCE

DATE (mm!ddiyy) VALUE

__/ /.__ $

__/_ /___ $

__/_ /___ $

DESCRIPTION OF GIFT(S)

DESCRIPTION OF GIFT(S)

Comments:

FPPC Form 700 (2012/2013) Sch. D FPPC Advice Email: [email protected]

FPPC Toll-Free Helpline: 866/275-3772 v~rw.fppc.ca.gov

SCHEDULE E Income - Gifts

Travel Payments, Advances, and Reimbursements

Name

You must mark either the gift or income box. Mark the "501(c)(3)" box for a travel payment received from a nonprofit 501(c)(3) organization or the "Speech" box if you made a speech or participated in a panel. These payments are not subject to the $440 gift limit, but may result in a disqualifying conflict of interest.

NAME OF SOURCE (Not an Acronym)

ADDRE~’(~B~siness Address Acceptable)

DATE(S): (If gift)

TYPE OF PAYMENT: (must check one) [] Gift [] Income

[] Made a Speech/Participated in a Panel

[] Other - Provide Description

NAME OF SOURCE (Not an Acronym)

ADDRESS (Business Address Acceptable)

CITY AND STATE

BUSINESS ACTIVITY, IF ANY, OF SOURCE [] 501 (c)(3)

DATE(S): /. Z / / AMT: $. (If gift)

TYPE OF PAYMENT: (must check one) [] Gift [] Income

[] Made a Speech/Participated in a Panel

[] Other - Provide Description

NAME OF SOURCE (Not an Acronym)

ADDRESS (Business Address Acceptable)

CITY AND STATE

BUSINESS ACTIVITY, IF ANY. OF SOURCE

DATE(S): __/_ J. AMT: $. (If gift)

[] Gift TYPE OF PAYMENT: (must check one)

[] Made a Speech/Participated in a Panel

[] Other - Provide Description

NAME OF SOURCE (Not an Acronym)

ADDRESS (Business Address Acceptable)

CITY AND STATE

BUSINESS ACTIVITY, IF ANY, OF SOURCE

[] 5ol (c)(3)

[] Income

[] 501 (c)(3)

[] Income

DATE(S): I I. (If gift) I.__J.__ AMT:

TYPE OF PAYMENT: (must check one) [] Gift

[] Made a Speech/Participated in a Panel

[] Other - Provide Description

Comments:

FPPC Form 700 (2012/2013) Sch. E FPPC Advice Emaih [email protected]

FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov