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HomeMy WebLinkAbout76-72 2SCHSOUI»E nveatmenu and lntera its In Real Propaenry Hold by Eusinss4 Entities or Truste BUSINESS ENTITIES: If you,, ywir sg+ousd or dependent children .own, individually or col extively , from 10,percent to 49 percent of abusincsa entity, you trust report your pea rata share, if worth Sl .600 orAare, of ury �nvesttneat or iatarest in real property (as described in your disclosure category) which is held by the bditteda cavity.; p or collectively, SO percent or more of a business'entity you If you, your g Dasa or dependent children own. Individually ra her thast merely your proof triveistmenu and rata share of such tnvescmentests saddi property wor�b SI,OOU or orea hold by tha business' nesa amity interests is lest proaerty.'or each reportable in or interest in real property, you must provide, the same iaformadon that u required for any othrtr investment orintrrpt it7.reo! Property, (Sep discussions of Schcdulca A and B.)„ TRVTS: If you, your spause or depcudcarchildren have, individually or collelm'Velyi0pot dtetr ii iriai trusto you inust report your pro rata► share, if wot S1,OOO or more, of any investment or interest in real property (as described in your disclosure catajory)whiIch is held by the trust. According to FPCItcgulatiort 18L94� you have an interest in a trust if you art; i. A maker and:` a. can ravolte or terminate the trust; or b have retained tuty rights to the income or principal of the trust or retained say reversionary or re - rider interest: or c. have retained any power of appointment including the power to change the benefciaties I A beneficiary and: a presently receive income; or b; have an irrevocable future right to receive income or principal. If you are only a trustee, you do not have a reportable interest in the trust. For each reportableinvestment or interest in real property you must provide the sama information tha: is required for say , other investment or interest in real property. ;(See discussions of Schedules A and a,) EXAMPLE. SCHEDULE C. You:have a 20 perceatinterest in lnvestots, Inc., wf,uchowns 54,000 worth of common-stog. k us xYZ Corp., S60,000worth Orth of common Stock in QED Corp., and a 250 acre tract of undeveloped land with an equity ofS23,000. The corporations and the [and are ani iocated within your jurisdiction and are described in your disclosure category..As your'pro ratashare of the XYZ stock is worth only $800, you need not report it. Schedule C should; be completed as followst 1446649 or sunNCrss KMTITVI TAusT Inves t ars p 1xic . VVESTMENTS RELD BY BU$&ZSS ENTrTY ORI rxvs'r n AM6' OR tP, T1TT _ .. c3t=K'OMus r :. CiEA Corporation (� vAwa'o+srs5eausn Sto.oeq "(+^TURK OR PMVRSTT. m"T. 9-6.:COpMOR sTO:�K;. ;fam"sMSHIP ,IRTE92ST. RSG - r-avi ton stock, S10 0o0 811T Doss aoT sa:assa Stop.Ooe GLNSRAL' D,gng"I TLOM OR BJAINSXX ACTIVtT7 AQOYIWRO `Q,ATR -•.x -� • manufactures wid ets ' 9 �IlPOlat7 ( yAl.u'! sa c:aSor , rtO OW INTERESTS IN REAL PROPERTY H= BY BLrSIlYE55 E�VTl�'Y OR';TI�UST STRR6T AOOOXMP OR: PRsl CIs6 WCATIOM OP PROP7[ATT .: CN60K:OIIIL _ ' Mudville County Assessor's Parcel 6-428-034B VA{.YSOOt/' 0 3toi>� roT (1ATUR■ 7I'+NTRRilT, A. O... a0u1TTj-O►TION nn egtli is '�.1 0VA 4 Lux m noT saes S10.coe, euT',` PATR CiED $IR10�OOe tltlPos tO V11L1mLaGCf1i01! EXAMPI Ic. SCHEDtj.0 .C` . . Assume that the income below is made reportable by your disclosure category. You own stock in Callt`arnfu' Midget Corporktion. a large publicly-owned company registered witlt the Securities,,anct B ctrango-ommis�ian and doing business in your jurisdiction. You received SZ.OgO during the reporting period is dividends. Yqu.a1sa received S 15,000 in salary from your insurance business and you sold your car"to Fred' Brown for 53,500. You need opt report the dlvidends as income since California Widget is registered with the 5ecuricics and Exchange Corxmisean.:9.-c he"I"T3.e1ould be, completed as follows, rt"s AP SoYRRRIor IMROGI! - 6N qN�A Smith . 6 Tone9 1n�ut& nCG COMEan�� , __,ter 1►usloYhr ® `' a S.ogO Aau1t Irsarslwas Dose N1r,7 sxaaRb A®®RtAN..gR tgYM� OR IN4aItlR - .. _. ... .. g11'T.04�0`Hp 41.YNE.MReilftbRD AX4R1COh 31.000. 123 FgUrtla . AvantMudville � r sxsatma >aiD,Ooo 9UAl11si6' AWnVMT OR SQUA192O1M.'1NQOMU.•. lI ear 4MWUW1' OR:V1o1.616 A114A'iVRD ,AiiCSM011 xnSt=anCe brokarage C ato,00a :DRi U" OF '_.N 4 NU161YN47,C40iWax W1116N: IAQ 610 HIAA 114 7C3... _ NA.1R ar wYRca oR 1>Maotlls - caRcx on F ted B.tz4n s OGo aq V+►Wr: Aiessta,� oeaUs clot ixellRo wooRgss,>.or a4YR R o aMac+r _ . i 1.010 Main S't tadt, MuclVil`Z j� *141 * dr k vna* asassv+Aar ezcssa si,ogo . � @ a.,`.,:3 AYT ao�cr not a* z= >tio,aoo �OUAUIRAS:}CT1V1, OP ACYRC O NGama...._lip AM - .. - Carperz er . Aa0O11R7 6R'VAit11A lo6saaysc+ Ifit Uno ,. 3RACAIVROR Or T1/R CON810RAA71nN POR WNICR :INCO.M4 vl" XX4AIVW Sale of automobile S'CMEDULE E Loan You must reppot outstanding loans aggregating =Oor more from reportable sources of income (as described in your disclosure caro o P 9 --� Oita which are not used and whictt.'within 30- days after receipt, are returned to the; donor or delivered to a charitable organization without being claimed as a charitable contribution for tax purposes, — With respect to an event at which you spcak, servo on a panel, loud a seminar or provide siMW services; free admission, focus, bavcrages and similar notninal beneflu provided at the event; reimbursement or advance for actual travel within California.. to an from, the event: and reimbursement or advance for necessary accoimodations provided directly, in: connection with the event. For esirtt reportable gift you trust disclose the folloWIL4.. Name of the donor — Address of the donor -- Busidess activity, if any, of the donor — Date the gift was received — Value of the gift -- Description of the gift • g% through intermediary. y lose, the name, address and business activity of both the if you receive a ft throu an �ntormedi you trust disc donor and the intermediary. EXAMP�I�E, SCHEDULE F Assume that the gifts wore received from sources made reportable by your disclosure category; t received complimentary season tickets worth S 100 from your local professional basebali team which you kept. You awo received a complimentary dinner certificate worth $75 from a local restaurant. You must report the baseball rickets whether or not: you used theca. Schedule F should be. completed as follows: rens cP ecNow w . _ Mudville N:�ne 3-1-:79 AOORtaa'U/ DONOR .. VA_ LUBcoP SdIPT(a _ ;�•• • 700 Stadl.= Way'.. Mudville 5100.00 MUaIN6l1/ ACTT'/I?Y OF OONOII. IV ANY ptaCA1Pg70N OP-afPT a -.: Baseball team ...^.�� Season tickets Awn Or t3c"OW - _ QA?3(a 1.:QP 6IPTd0.i: Le Corinoiss.eur Restaurant VALUt OP':OIPT a AOOHLOaOP OOIEOR � I 1100 Firth Street, Mudv.ille 575.100. -aUatNtl<O ACTIVISM OP OONON, IP ANr QtaCRIPTION tlP OIl/T17) Restaurant..' Food & Drinks $CHEOULE G Incarne of business Entities if you. youtspouse or dependent children. iridividually de collectively, own a l0 percent or greater interest in a business entity, yeti trust report the name of any source of income (as described in your disclosure category which provides gross receipts to the business entity if your "pro rata share of such gross receipts is S10.000 or more. If you believe that your cidertts' names are prvrleged'under California Iaw, you may request from the Commission an exemption from disclosure of their harries. 1 �. Afth ok� Amok . 4. EXAMPLE, SCHEDULE C3 ., Asstuna that Supdr Hotel Corporation and Mudville Construction arereportable sources of Income. You awn one- third of Hank's Plumbing Supply which sold $454000 wottli cIf equipment to Super Hotal-Canxtructian, You o -stn 5 percent of California Lumber Company which sold'S200,000 wo► h oflumberto Mudviiic.Constructio- Company,. You ;need not re}�0n inftirmatian concerning the California Lumbar Company since you,own lis than a l0 percent int— Lu in the business, but you must list super Hotei Corparatio_ n since you owit more than l0pergentof Hankfs Plumbing supply and your pro rata share of gross receipts from °Super."' Hotel Carporatioct was chore than. S 10,00% Schedule G should be cornpleted as t ows 0U31N..4(l8 4NTiTY ._, . `WOOAe7s:"OW AUSIN6lir. .... Hank I s Plutnbin S U002 ly 789 Tenth Street Mudyille_ . yr l3C RI tLT{QN OP OU71Nit9A xNTmY pNO.VIOR9 494A6 0 P DOWI N01' P$t7VMOft t.3QA1. ,�hol4sale plumbing supplier s9A0✓,aNAilt lRAVICft7 ® ep Og0{�fZ11A62 AK ptVOGiCf names of clients and customers who provide income to the filer's busine«ws entity must be disclosed if tha threshold set forth on the reverse side of this schedule are satisfied. _ Super Aotel corporation SCHEDULE H Employment and Management Positions in Business entities You crust report the name of any business entity for which you are a director, officer, partner, trustee, employee or. Y p g rtnation is required by your disclosure category. You must disclose the hold an position of mans ement, If such info fallowing: ,. Name of the entity -- Addccss of the entity General description of the bust --noes activity of the entity, Your postcion within the entity. EXAMPLE. SCHEDULE H' Assume that management positions held in the kind of business entities listed below are made teportable by your, disclosure cote o, g ryYou are vice.prmidtlnt of, General Widgets, Inc. Schedule H should be completed as'foilaws NAME ZOF rNTITY `. -.; AOCR Cl3',OF"Z?4TITY General Widgets, Inc. 6`39-NOielrth Street, Kud"villa 'GENCAAt.;SOClCAI.PTION OF BUSINESS ACTIVITY YfQVR JO® TITI.Z OR POSITION manufactures widgets.,, ViCe—P=esid'ent '12 FORM 730,,; $tate meht of toonom"Ic 1n1 br�sis Pop De E�pleyedes (Instructions attached on, Page: .13): plealle typ'O'dr,pr nt to ink, y 1'4 -STATE 0XPAKTM%NT'AN'0 QNIT O.M LOCAL. AGENCY TA "0' , RM 0 Nit -4U a Check the ap0topriate boX(es): INITIAL StA-TSIVIENT: TheConflIct, of Interest Code for your Agency becomes efUct(Ve on Youmustfile A. Statement within thirty days After this date, d1scidsing yourreportable, Interests held on this date. You are not required to disclose income, gifts or loans on this Statement. ASSUMING OF�F(CB STATEMENT; You 'have assumed o(ficd, on Position subject to State Senate confirmation — file thirty days after appointment or nomination All other positions osItlons - file thirty days after assuming office. You must discloseall Interest's gifts d other than income, and loarn'8, 116[d on the ate you assumed your position. ANNUALSTATEMENT:l You are required to (Ile A Startement no later than aftdIcsing all reportabld interests held .or received during the ,period from Jan U" 1, 1980throughr December 31 1 r You Arre,'L '`LEAVING OFFIC,t ATEMEN 0-rf Your position tri On and must tile.a Statement within thirty days of that date.. You. must disclose All reportable interests held or received during the period from January 11,, 1980, through the, date you, left office. CA r NDIVAT E STATEMENT: L You area Candi f o'r elective office. You must dIsdIoSLe all reportable interests, other thanlhcome# giftsand loarsheldon the d a t,e, you fI I'Ld, nonihation, papers. You must file this Statement withI n five days After the tindVd,ate f& f!] ipg,no nomination papers y ming E., TO ALL # a4Lsl_r, M_111t 'Whr, may: affect !LMq�: in the even you are: given an gn en I ch y 'Ur, fln-anctal interests you 06,uld, consult your agency's Conti ic't Of Jn't4e6gt Code fdr guidance hLd-6 ddn ' dernior 9 disqualification. FILING OFFiCKA CL/ U it UJIS ' I, your f1f3i jail 11 Si4l(eM �,tbd the �i7.tjr, backs qr Mr attachedto, t)g4 attached form, edr dlrecfions on m6dify 16g, did poil0d, covered by this Statement. t. $TO 730 (9/80) TIM 'FOLLWING S IR,X:Wi ST BO COMPI, TW- BX ALL ,I: i AR5 ti + SCHEDULE A Inveatmen►s' ❑ Schedule c0101eted & attached ❑ No reportable interests ❑ Schedule not ajipllcabla to my dtSCiaSurO t:aticgory SCHiFOULE E,• intereela In Baal Property Schedule completed & attached No reportable Interests disclo disclosure not appllaaule to my ❑ ❑ ❑ disclosure eategcry. SCHEDULE C . Investmonts aria Interest; In . OP ropetty, MOM OY Business Dasa nt ea or Trusts , ❑ Schedule completed & attached ❑ No reportable interests ❑ SChidule not 40p11cabl'6 to my disclosure at SCHEDULE q • Income (other than Gift$ and Loans). ❑ St.hedule'com letebd &attached No reportable Interest Schedule not applicable' to this'ype of- p ❑ P s ❑ Statement or to my disclosure, category SCHEDULE E - Loans' ---- L- Schedule completed & attached No reportable interests Schedule not appficable'to this type of ❑ ❑ Statement Or to,my disclosure category Mile, Schedule completed d attached ❑ No reportable interestst ❑ Schedule not appiicabie to this type of Statement or to my dsclosure category SCHEDULE G - Income to Business Entities ❑ Schedule completed & attached ❑ No reportable Interests ❑ 'Schedule not applicable to this type of Statement or to my disclosure category SCHEDULE H Business Positions ❑ Schedule completed & attached ❑ No reportable Interests- ❑ Schedule of applicable to my :Schedule not a category MOORTANT: If boxes are che0ked for all schedules abovWto Indicate "No, reportable interests'" or "'Schedule not applicable..." you should detadh the schedules arld file only gages 1 and L, if you need' mora space on, any schedule, obtain at supplemental schedule from your tiling officer. VERIFICATION declare tinder penalty o f perjury" that t have I sed all redsonable diligence in prepannq this Statement and to the best of my 'know 'edge iIt is true aft complete. Ezecuted on , 19 , ai` Si GNAtURE All of the informatian reyu'red by, this form Is mandatory, is. requ',ired by the prwlRfons of, he Political Ftafoxm Act, Govertrnient 0,od6 Section 81000 et sed:, and Will be available to a'riy member of th' 'tibtiC upon request. This trlfor'mattons to be used to reveal to public scrutiny certain, financial Interests of public affielals and employees 16 order to d"isdlose 'potential conflicts of interests and to aid in the prevention of actual conflicts of interests: Page;>2 NAME '. SCHEDM A • 1.NVESTIAENTS _ Investments (of,the tv e desctibed iii your disclosure cats p gory) owned by the filer,, spouse and dependent children aggregating 51.000 or more in value. NAM19 or RNTITY- VALUK ockil'.NOT Kx_anxe !j10.aa0 NATVRK OF INTSRI[9Tl. K,D.. COMMON STOCK, P.ARTNK:RSHIP INT;RKlT. :STC. I� VALUK KXdKKD! 110,000 !UT DORA NOY RQiCKSG .3001000 OIKNK RAL 06lCRIPTION ON DUAINiD6 ACTIVITY ACgU1RQD OATK - - -. _ . VALUR NAPS OJT SNTiTY 'dmK51C GtIS � VALUk oo,R! ND'T KXCSKD 516,000 N ATURK OF.INTXHXXT.S, R.Ov. COMMON STOCKJPARTNQRlNIF INTI[RKST, KTC. - - - - VAL'UQ KXCK`na Sta,IX10 BUT ,. 'Obsk NOT IGxeKsa51oa1as0 - aKNQRAL aKBCRIPTI4N OF-DUNINRS! ACTIVITY AGQ17iRQn I aATK ej PODQD Q VALUK exanzoD si001o0a 9AMI9 OF KHTITY ( � un '¢NRCIS OIdK - .___ VALUS'OC/gD NOT RxciiKa 510+000 NATUHN OPP INTSRKZITS, K.O,+ COMMON IDTOCX.' PARTTIKRDHIF INTKRQST,; CTC. -^ 4ALUR KXC6KD! 510.000 OUT '.. c; NOT a xcKKO 5100,000• 6964KRAL OUSCRIPTION OF ISUIINQDD ACTIVITY. ACOUIRQn ' I OATQ - 0Id"Gaq j I� I I itALIJS KXCR Kat $100,000 ..IYI� �Olali' I• ! / f NAMK or ENTITY - .iiYaaall6iL... qI J C K O N R VALUK DOKS..N07 EXCEED 51n.000 - . .. NATVRK OF:INTXRCMTZ, K.O., 'COMMON. STOCK,' PARTNSASNIF INT6RKST. RTC. .. -" Y 600 du 100,000 T 0445 NOT KXCKKD 3QN6 RAL ORJCAIPF O 170N OU91NSit A.C71V1?Y. AROUIRKD.0ATX : I � 013PO EIQn : I � VALUK KXCS COS $100,000 scgwU= B - WTERESTS IN REAL PROPERTY Interests ,in Real Property (of the type described in your disclosure category) in wtAch the filer, spouse and dependent children have an aggregate interest of $1,000 or rnore in value. WRNS? ADORKS! OR 7RKCISR' WCATIO,N OF PROPERTY :C►1SCK tlNK VALUK DOQD'.YOT Kxcx%tdI IO.00a NATURE OF.`INTURKST', K.O., KQUtTY, OPTION IST VALUR KXCzxcIq 510.000 BUT DOKO NOT KxCSKa 5 (_1 I00 wo AcawRQo PATIC `I olarosdb I I , vALuR Kxassos 51001000, lTREKT ADnRKDf ORPRS C1lK :GO CATION OF PROPS RT Y "CHSCK.ONR , .. ,.. - VALUS'Oe7SR,NOTKXCRSD $10,000 NATURE 001 INTSRSSTr K.O... COUITY,: OPTION VALUQ Qxctsaa! Sid BUT _ OCRs NOT KxCSKn 10 100.000 , Q `Aetluinsto overs +(( dllPtlSKO 1 VALUr K*cXxi,! 5100,000 SiTR6ST AD O.Rtt! OR..PRSCIDK'.LOCATION OF I-ROFKRTY'." - CNRCK ONK � VALUK Calls NOT EXCEED 51,1,000 NATURE OF""INTKRKST. R.Oy tDU1TY-1;O.PTION VALUE, RXeszas510;000 KUT 1019T Lit 'OCRs 46T Kxdz to 00 ACOUTA¢O I DATE, .,. „'OIDPOltO ) *'ALU$ KXC> SDII 5100.000 '. „...: ufi�Q! A'X(]%8lfi3 tlOff30/►-/BVQ%39 JIOB � . �. !I 639- 3 3'I`O',73q 19.'801 NAME SCHEDULE D,— INCOME (OTHER THAN G1.PTS AND LOANS) " Income aggregating 5250 or snore from reportable sources of income (Of the type described In your'disclos.Ure category). NAMK -OP IOUkOR OP IMCDMR CHKgx _ IWO A1,10 'r qq yALt7ct RRCZIVQa 00744 40Y.YXC CX0 4910"922 OP sOUNCZ OA INCOMR - 3.1/: QO - A'#AUNR T OR VAIU4 RCSIVQa Q%CZZDs lS.O yiO 4UT 004/ NOT ZXCXXa :lOr000 4UtlINKItl ACTIVITY OP lOUNCZ-O PANCaNR. IP ANp. AMOUNT ON VALthe Ri'#3Sl Vlta RXCxjtj3x'.. 330000 qRy C$MT1ON Op 7H1¢ COHtllO KNATIOq ROA�,W HIO"-INCOMKW Atl NKCKIV D OI satin,1-:XOP, PmzIt _. 111ANK -CHIC a <xON s1 OOo �_....: AMOUNT ON VAIZ r' n,2C=1YRa COMMOO KB rygT L%CXXD,. ' AOORKOO OP ]OUgCX O.q'IN�CON� ,, a �OP AMOUNT Op ALUM IIRCXtVRD CXCZKD V OUT 04" NOT %XCXZD'..f301000.. tl $1,000 BUXIMM iO ACTIVITY OP AaUNCI INCO,M 6, IP ANY , `���"• - - ' -` r� TON VAL11Z R4CZ1V4a ZX::XZDO 310 O 00 :I r THR CONtl10EN.:?tON POR WHICH.INCOMIC RQCX1VRa r HANK OF saUNCZ OP INComs: 11iECx rU-'"1 OMR AMOUNT ON VAI.U4 RRCsi1VRD OOR9 NtlT Z%CZZD sx.aag A : _1,140m.- - • Amets" OR VAwR 44CX1VMn CXCxM*j 3;1,000 QUT OQKII Nur CXCXZa S30.o0o OU■INKOtl ACTIVITY OF ZCURCX QP INCDM4. IP ANY AMOUNT -OR C ALUX RZYIVQO EX CZZOO ,. slo,0o O�KOCRIPTIOq OP THK ONOIDKRATION PON WNICII INCaN11 MAO RKCtiVKD NAi4R ON stlUN6'X O¢'. INCOM4 .C:NRCst ONE . - AMOU" ON VALUR RRCXIVZa CO4i0 NOT %xCZRO ADOA�SII OP 70URCX OI LINCOMIE 3 i,a0a a AM42UN4 Oq VALUIs RRCXIV4a ImexLMan T 31.J00 QUDan! NaT 6XCJIZO 31Li.00a ■USINQO4 ACTIVITY OP 2QURCX OP INCOME,_ IR ANY c - Oq VALU't R4CZIVZ0 IIXCXXOO QANOUI�T 330,000 101LOCRU"r10N OP THK CONOIOKNAT1 is PON WNICN INCOMK 'R AID Ra CZIV QO �14AN9 SOI SCURCX OP IN.. 'CMB ... AMOUNT AN VALUE RRCXIVaa OORa: NOT ZXCZZD X1,000 AOOgKAO OF, 70URCX OP IN CONI - - ("1 U AMOUNT ON VALUX Rt CZiVXU CXCSZDQ 3 1' 000 PUT PaMsf NOT QkCXZa 310,000 ■U OINSC>t� ACTIVITY OP sOti NCZ OP. INCOMq.. IA AHY.. AMOUNT ON VA6UX RRCZIY$a iXCYXDO ' a 3.10.000 OZ7CXI►T10N OP TNX CONOtaRNAT;ON raw MNIr:H IN4:930A4 WAS, RXC3;IVXa i i See ttxp/enatlans on`reVetsD''si�e Page 7 i s.'.p Tso .'srMaol Nw HOW TO FILL OUT THE FORM 730 _ Stop is Complete the first page. it you Left office after Oece.mber 31; 1880, but before yotfr aend you nnual tiling, date want to file a consolidated leaving office and annual Statement, check the boxes, for both' kends of Statements, in the space for the date you left office, and disclose all reportable interests' held or received at any time between January 1,; i980 and the data you left office, It the filing deadllne for the leaving otfice Statemo procedure, is' later than the annual filing date, you must Infonfl the filing officer in writing before the annual deadline that you; intend to follow this The period covered by the Statement is printed on the form. If you are filing your first annual Statement rind fahi into the situations described below, you should modify the period covered printed on the .form as indicated.. % If you assumed office afterJanuary,1, 1980 draw a line through "January I and write in the date you_. assumed office. 2, it' your agioncy's Conflict of Interest Code became aftective after January i, 1980, !tawa line through "January 1" and write In tha date the Coda became of fact I've 3. If you flied an initial or assuming office Statement before January 1, 1980, and have not filed a Statement since, you should draw a line through "January 1, 1980" and write in the data 'your agency's Code became effective (It your last Statement was an initial Statement) or the date You assumed office (If your last' Statement was;an assuming office Statement). Step 2 if you are filling an initlal or assuming ;office Statement, turn to the summary oage (back of ist page) and check the box "Schedule not applicable to this type of Statement or to my disclosure categbry'' for Schedules D, E F and G. Step 3: Consult your disclosure category. It It does not require the reporting of any of the generai kinds of Interests covered by the form, tum to the summary page and for the schedule for that kindof interest, check the box marked "Schedule not appilcab:j to my disclosure category." For example, It your discidsure category does not require you to report business positions, mark the box entitled "Not applicabis to my disclosure categotY'r or Schedule H, - Step 4 If you have not already. checked Schedutes C and G "not applicable" and if you, your spouse and dependent children do not collectively own 10% or more of a business entity or trust; check the box on the summary page marked "No.reportabie interests" for Schedules ;C and G. Step 5, With respect to the remaining schedules, determine If you have any interests of the, kind described in your die closure,_category, It not, check the box on the summary -page -marked "No reportable interests," NOTE —a) You must report investments and interests in real property held at any time during the period covered by this Statement regardless, of whether they ars sti'iI held at the time of filing. b) You must report investments and Interests In real property held by youY e' r'spouse and dependent children and your community property share In your spouss Income. c) You must report only investments In business entities, sources of income. (other than gifts) and real property which are located In or doing business or planning to do business, in the geographical area subject to your ;agency s authority, Heal property is deemed to be located wtthin the','geographicalarea subject to the agency's authority If it is within two miles of the"area subject to the agency's authority or any land owned or used by the agency; . Step 6: If you have, rtahle interests,' you must complete the appropriate schedules, If there Is no change In the infarrt+atir� 'C-Vlously.filed schedule, you may make a copy, of that schedule and attach i.t to your Statement Instead a whole new schedule, Fore each schedule containing repoetabie Interests, mark the box on the sur, heed "Schedule compieted and attached. Step 7, Sign th, s n i fill In the data and the city where yo- did so. SPECIAl. REPOR. , t, Reporting Rental Property: If, you own an interest in rerita'I property directly, (I.e., not through a business entity such as a partnership, corporation, joint venture', etc.) you should as a general rule; report the prop- erty on Schodule !3, the total amount of rents as income on Schedule 0 and any tenants who pay rents of which your pro rata share fs 510,000 or more on Schedule G. On the other hand, It you own 10% or more of a business entity which owns rental property, you should report the' business entity, on Schedule A, the aroper<y on Schedule C, the fatal amount of rents as Income ,on 5cheduie D, and tenants who pay rents of which your p'ro rata share Is more"than S10,000 ion Schedule. G:`Flnalllj If you own less than 10°'0 of a business entlry . whictt owns rental property, you should report vour interest in the business entity on. Schedule A and any income from the business entity on Schedule D, you need not report elther, the property or the tenants. ; 2. Interest'in a Trust: if you have sec up a trust tot others or If you are a beneficiary of a trust,; including a blind trust, see your, agency's ffiing officer or legal officer for reporting in_siructians; Page 14: s•r©; 3o rs,eci ,, r Herbert T. . Wheeler $epj--eM_ueI9 .8 r 1581 Page Two r be, from January J r 1980, tbroUgIi December" 31 r 19804li Your Statement foes not accuratelr"eport your inter�Gl s for 'tho correct er-tod p you should complete p any necessary schedules. Enclosed is e supplemental Schedule 721 cotter page and.. summary page which shQUId. be completed as reguestec7 and seri' 1.o the count" c -perk Y who "wild rQtin a - copy and i:orward the ' original to the Commission. g Please call. me, at 916/32,2-6,444 if- you have any, questions. Sincerely, , Alice Hughes Documents Examiner Aft:plh cc: County Clerk CERTIF19D :MAIL_ - RETURN AECETPT REOUEST b 'i SUPPLEMENTAL THE FOLLOWINGSUMMARY MUST BE COMPLETED BY AHL Fit EFt5 ONLY SCHEDULESA, S AND C ARE RECIUIRED FOR CANDIDATE STATEMENT'S AND ASSUMING OFFICE STATEMENTS SCHEDULE A --Investments ( I Schedule completed and attached ( Jo reportable interest u' SCHEDULE B• --Interests in Real Property ( l Schedule completed and attached [_ J No reportable interests' SCHEDULE C --Investments and Interests in Real Property Heid by Business Entities or Trusts ( ] Schedule completed, and attached ( J No reportable interests SCHEDULE D -Income (Other Than Gifts or Loans) [ l Schedule completed and attached' (: } No reportable interests [ ] Schedule completed and attached ` I ]No reportable interests SCHEDULE F—Gifts ( ]'Schedule completed; and attached [ ] l to, reportable, interests, SCHEDULE G—Honoraria ( J' Schedule completed and attached [ J Ni o reportable Interests SCHEDULE H --Income to Business Entities; [ ] Schedule completed and attached J No reportable interests NOTE: Filers whose reportable intere3ts an arTYL particular scheduka have not; changed sines; a previously Fifed annual 5titement may p by ous annual Statement and checking "Schede le completed cam leis this statement attaetling the approprtatb scnedulef§! from the orevi av,4 nothing to report. and attached" above, Blease discard those 5cned!aley an which you h , VERIF]CAT1C71'+1 I declare under penalty of perjury that I have used all `reasonable 'dil'igence in, preparing this statement and to the best of my know ledge ;it is true and complete. Executed pn. , '19 at, - , California. 6-1e'ig afore Filing this stat9rrtent may not refloat yep of the pbligatic �tol i rider t C& tofafntf a or a . oilier a encyf GaneU,t ourfilin g Y g off'icec or Oe Fair Politica! Fractions Cornmissibn. , AIi of the irdarmaticn required by this Farm is mandatory; is ruiced by the provisions of the Political liefotm .pct, Government Cd ''S'L ections 811700, ersaq and will be availatil® to ami member of°the pubic.iipcn request, This infcrfnaton is to, used to re�reaF to pudic scrutiny cen:ain ftaancial interests of public officialsih ordertodisclos.e potential conflicts of interests andto aid In th6preventionofac:uab conflicts of interests. , PJOl>r,YO AGE yGtES. (Vi`ake:and retain espies of all Statements Filed with•you and forward;the ari`ginata within Five days et the Filing deadlirxe lar if !fled late'; v±rit}sin flus days of rt?Cil�pt9 tp: Tho rairpalitica -Practices Cammtssion,'lergal C) vision,,p:0, Box $A7, $s cramento, art904, (9181322-644t, California ,.,. 790, , Statement, o ono- mic; Intore8t dor ':De signaled, mplyp 1, Please read the Instruction Manual for Designated Employees and your disclotture j r category to determine the disclosure requirements applicable to your position, 2. If ,you need more space, please attach supplemental schedules which can be obtained ; torn y.ou,# filing officer. � For Orltarat use only Pl&M" 7YP-0 Or Prin# /n Ink` _,. .., ,... POSIT10N ;TATS' EPARTI�/QIY ANO irNlT tSR LtTCJ1L AGENCY _y /' % TH EPnCNQ hUM6dR 1. Since your position is a "designated position, "you are required to file a Statement of Economic Interesse reporting all interests defined by your disclosure category, Check the appropriate box: INITIAL STATEMENT: The Conflict of interest Code for your agency became effective on You must file within 30 days after the effective date of your Conflict of Interest Code disclosiny your interests held on the effective date. On the initial statement yqu are not required to disclose income or gifts. Cj AMMING OFFICE S('ATEMENT FOR PERSONS NEWLY APPOINTED OR ELECTED TO OFFICE: You have been �ewl' ❑ y appointed to a Civfl 'Service Position tom; appointed to a Non•Civil Servk Position or (� elected to office and swill assume office aril in _ Persons assuming a civil service position or elective office .ere within 30 days of assuming office, Per= sons assuming rich- civil service positions fie within 10 days after assuming office. On the assuming office statement you are not required to disclose income or gifts. G'ANNUAL STATEMENT: You 'are required "to file annually a Statementof wconolmic Interests no, later than Theperiod coverers by this statement is from � �through `T >� q;, y .. a.. qA =09 :- M, Q•. owY rawer ./ D LEAVING 0Ft:ICE, STATE Mt NT: You are leaving or,have left the above -wanted position as of Your statement is due within 30 da s after ieav'n g p Y g your deli nated alit on. The period covered by thi7 statement is from ` through tlA. OAY YaAR Mq. OAY TRAM FAQMR AtOTl , . TO ALL iL RS: In the Pvent you are given an assignmenrwhich may reflect your financial interests You snc;u(d Grins ilt your agency`s Conflict a! Interest C'.ode for guidance concerning disqualification: , It you ha1.ve any' questions, need technical or legal lnterprera;tion per#ar`rtr'ng to the' Political Retorrt� Act or " the Corr/lict of Intl � 3t Cade for yowr agency, contact the ftlirt,g otficer, �eao�ss■mom.. - :, ... _. . u.._.�..,,,,,...:_„_ _ ROL 10' ` G SUiY�r 'Y' WST RE COMPL,E ._.._........r.......�.......... �..,_.....� 5CllEDULE A • Investments over 5l,doq Schedula a:ompieted attached No reportab o Interests SCHEDULE B — Interests In Real Property over s1,00q Schddule completed &,attachedLR No roPartabie interestx $Y nAU FMEk s �i--*'^�� �Isc(osulrencatega�ryabie to my t.l Schedule `not agpllcable to my dlKlosure;category SCHEDULE C • Invewrients anis Interests in RQ Proporry Held by IJu,$jness (rntfties or Trusts l..d Schadule completed b attached No nmortable Interests Q Schedule not applicable to my d%4losure category SCHEDULE: O • Income aggregating $250 or monm q `Schedule completed &,.attached No reportable. Interests Schedule hedule not appilcable to this type of ' statement or to my disclosure, caternry SCHEDULE E • Gifts aggregating $25 or more ❑ Schedule completed & attached No reportable interestshedule not applicable to this type of L ! tatentent ar to my disclosure category SCHEDULE EE -- Honoraria -- includes paymentsreceived for speaking at any event, iparticiPatillig in a.panel or seminar or similar events Q Schedule completed & attached No reportable interests Schedule not applicable' to this type of'. statement or to my dlsclosure.catagory SCHEDULE F -Income of a Business Entity in which you, your spWta and dependent children own a -10% or greater interest l Sdiedule completed & attached No reportab,:t erestx Schedule not applicable to this type of statement or to my disclosure c tegorIy SCHEDULE G • Employment and Management Pasitions n gusimus Entitles 'Schedule corrtpleted & attached \' No reportable interests ❑ Schedule not anollcable to, my as closure category l4OTE Filers who 'havo interests to report on. schedules but 'Nhose reportable interests' have not Changed since 4 previously filed annual statement may comple4e ttie statement' by attaching previous Schedules. VER.MCArnOiV X t1ealCPe itner' penalty of j?p!'Jt1ly that X RQL'e used all 1'La5Dtlable diligence In Preparing thl5 Stater,"!t'lLt Grid tQ the best of my knowledge it is true and complete, ,. 'xecutecl an 19 at -r— T ` lay SIGNATURE x m FOR iNFOI�fv1ATId 14E QUIRFD'TO SE PROVIDED TO' YOU PUBS .IAN T`TO THE IFORiViATION PRACTiC' ACT OF 1977, P►..EASE 5i E THc kMANUAL FOR be: 61(IN Atto EMPLO` E'83 , n Page 2 , t o 17:g Investnenta (of the type cribed in- the Conflict of rAtzmst ) ppvtxed by the fuer, de'endent spouse and chil ren aggregating $1,000 or more, CNI[CK ONR A7UR....;L, 1 /.j111 a VALVA ggMkO "OT taa2CQsa 310,000 NK Op It ITRA21rSTS, R,O,r t gNNOH; tPgr.K. PAATN$ASI11P'NTIARR9T RTC, :' VAILUk or, Cl OSAR.NAV 009404111'"9K Op SUSINRSS ACTIVITY' DATR _ Oona hav S+ti2a2Ad" SIOO,AOOUT - .CDWIiIKD AlRParKc1 VALUR RISGSQRtOi100;000 NALfiw':; app ANTITY - - VMLillt"4iiKS NOT QXCSKO 510;040 NATU1tt 0p UdTRNRSTI, Q.4,v CONMOH.,STOG7I,, :. pAATTiK.pSNIP'H'�"..jiii:J4�` VAS,ud 4x,dxu to 510,666 sus D..00KS N(OT" R?CC.Y 7/;nS100000 ". . '. "NXJQAL Ot;CAIP'nOH.OP rWtlwBtilS"ACTtvr'TY'. `. I.:OAT7t •�•••»^,• ACgWR6YI I, . _ OI11WgrtD � .._ �" 51Q0.wo �r14;,GN RNTIT';I' CDIi_Ctt aNR;RVAL.)ial[QOis MA7UNIS or INTURRSTS9 R.4., CONMOH STaCK.-PAATTIKIIRMIP I r4TRAR9Tr..R7C.- VALUK Caux Nov QxC2tltn "Si10.000 vALUR sixrsa� b■ X10, OAur bats KGAIPTIO H oP ®u3INt3s Acr2vm ORNKgA6 OQ ACOUTARn (`OATK rlGT Q7CCR8'n 5100,009 .VALUR sxCYtnM 5100;000 ' NANIC_ Op ENTITY CMRCX•ONR'. VALUt! GOQa NOT R7t:CAELI S 10000 "ATUNK OP IhTRARS7II.I Q.G. C.aMMON.3TOC AATNKA - e K.P . _. SNIP Iw72tA1tST,1R TC. ,�J) - VALUK CXCRROIS St0.000 Sur " QCX,9_ NOT QXCStQD 5100 OD0` ORNR)/AL ORSCRI►'T10N Op SURIN1iAS �ACTSVI7Y ❑ ACgU1IUD I-.OATR otalPo�R4 1 VALUX XXCRtbY g100.oC SCR= ULE B.:-. =PESTS TN RPAOPERT'Y Intemsts in Rea. Noperty (of the type described in the C,'anflict of Interest iC'ode sn which the f9ler spouse and' dependent children have an aggregate, interest of $1,000 or more. (Princedl place of re ide:ice jSr nal portdbleJ 3TRRRT AO001CSS On PRRCISB WCATION Op/ rP.ROM II T'M CNRCJi: ONR - ... / ALuR not„ V _+ q'lyRStCSRt9S+0.000 NATUIV:K OP IMTRARST,aL.Oy RgiJITYI Or•"TSOII ,• - „ ,. ❑ VALUt XJCCXXO 3.' SI6. 000't9 u? """" '— ("1 baR� NqT RXCSBD 5100,000 1..,.� ACQU1RQt7 OAT7[-. VAWC Kx-RRbti 5100.000 '3'TRXZT "004:12 OR' P.RXCISA ULICAT20 N Op PRtiPRATY �. . • DCR3 Near "CM*a $10.dW VALUa1 - ` '. AATU R1t Op iNT2tAXST. R,3.v SOU17Yy QTTfON � `1 ' vALUx txC;Stns �I Cr tour OCSSNaY6%CQtD CA7R .l Ac041i.7iD. { . LF: inlraaela :. 11 VAS:iler'ItxGXXti3 52.00,0.00 ' STAiIxT ApOr1R3A Ort PR.K0332 LOCATION Op PR0AIKATY . .. CMSGX Orin - I N"ATUR3 OP INTRAXSTO St. A„ ROWme, OPTSON ', .. ,. Q VA COXS r1Gr kxt: 550,000 VA cc C%'CuZASS1O.000 SUT ❑ Q AC01:IA it n OATS OORS :1aT tXCSCO S1Q0.OQo vALUn1 szcsane SIOO.C6tj Ctlnf2r2 rued on rrlter7e side) Pace' i t TT E r. OLLOWTG SI7iY1 uRy MUST BE COMPLrI y ALL r=RS SCHEDULE A;- investments over $1,000 Schedule completed & attached No "reportable Interests Schedule no dl5closure cacgory te-gorcable to my � SCHEDULE 8 Intera.r-ts in Reel Property over $1,000 Q Scl?tdule completed &attached No reportable Interests Schedule riot applicable to my dlsclosure category SCH1;DULI» C:- Investments and Irrtarests 1n Heal Property Held by Business Entities or Trusts Schodula completed & attached No reportable interests ® Schedule not applicable to my disclosure category SCHebULE D- Income aggregating $250 or more Schedule completed & attached No reportable interests Schedule not applicable to this type of r7statement or to my disclosure category SCHEDULE i- : Gifts aggregating $25 at more r - "Schedule comNo reportable Interests pleted & attached< Schedule not applicable to this type of ❑ statement or to my disclosure category SCHEDULE EE — Honoraria - includes payments received for speaking at any event, participating in a panel at sarninar or similar events LJ Schedule completed & attached! No reportable Intera:ts Schedule not applicable to this type of statement or to my;alsclosure category SCHEDULE F - Income of a Business Entity in whit y,u, yaur "spouse and dependent children own a 101/0 or greater interest Schedule completed & attached � No reportable Interests Q Schedule nal applicable to this type of statement onto my disclosure category SCHEDULE G Employment and Management Positions in Business Entities ® Schedule completed & attached No reportable Interests p Q Schedule not applicable to my aisciosure category NOTEc Filers who `have interests to report on st:hedules but whose "reportable interests have not changed since a previously filed annual statement may complete the statement by attaching previous schedules. VERIFICATION I declare under penalty of perjury that I have used all reasonable diligence in preparing this statement and to :the best of my hnotvled�it i true and cornplete. �/ Executed ons, � - � 19 at �.�. WGNATUiZE / - L.� FOP. INFORMATION REQUIR80 TO BE PRQ, V1DED TO YOU PURSUANT TO THE, iN"FORMATION" r'RACTiC ACT`:017 1977; PLEASE 5"E)= THS MANUAL "rUR'©E5IGNATED EMPLOYEES. _:Face 2 Ah SCHEDULE A - n ST'itifENTS Investments(of the type described in the ConflL-t of Interest Code) ovm.ed by the fuer, spouse and dependent dh, 9dren agg e-gating 11,000 or more, NAhi 15 "O R,4NTYYY �� ,�. . CHKCK ON4 _, .�. rrwworurr.se,uwr�. VAWic DORR Iwo axCRrz4 310,000 ., COMMON ST NATURa.OR INTK.II,Y1Tf. K. O:C14, PAk.YryxkSNIP INTBLItClT. CtC, VA UK QXCxxpri i510.000 guy 09MURALD4SCkIM, ON Or bUSInIYS1 ACTt.VITY" DAI'K - POR'1 Mal a. 4aleD $IOi?1000 ACOU1R61? DIS3MlI+ID VALUR aXC1¢x41 $,100,000- "&AM Gw,. KNT1T'Y,. CNKCK'gNlt VAtUIZ DOW11 MOT RXCICICD .'$10,000 MATuAs OP INTiiNm3T1, SW2., COMMON STOCK, PAATNRRINIP INTERRST, CTC, VALUa ax.CIGx4R $.10;000 OUt - 00s1 HOT xxCxxD,$ 1001000: OW aU11NKS1 ACV11 Q I bATx OIANRRAI. ax"CRIP't'tON Ti ACOUIkKD bI1VOSKD `.'. VALUI,t KXCRKOA. S 100.000 ... NAM4 ORTGt1TIT7...__. _.�- ". _. _ .. . GHCCKON4 �a�w�.maeNiwmrrawy VAY.UR 604.70 NO? RXC1r1CD- ',�ID,Of�O NATURK OP INTKR.KST1 M413.. COMMON sT 1 OCK, PApTNRRII.MIP INY611KSY, ATC. VALUa xXC M134 510.000 'Sur, Doss nos cXcxx&'.5100.000 tiQN4RALiq KSCII.IPtIDn OP *U211t tS3N AG71Y17Y ACgU1R4A i PAtx . 9319"X40 _;. j '. _.. VALUC CXCKIC4D $d0o.00Q' M A M K OF K"T IT Y.:. ❑ VALUC DOSS NOT IC.XCSKD 'S 10,0081 NATURa Or INtCIIElT1. C.6., COMMON 9TO:C Ky PA1tM4RSF11P inTRgP6Xt, VA KX CKKD! 510.000 eduT . DOLUC K3 NOT EX,CKKD 7100,000 G4NRAAL:OKlCRII!'TION OP OU■INRs/ AC71� VITY D ACCUIRKD I DATK OISPONKO VALUK ccesmaa .1.100.000 SC=T.1E B — h1'I'ENESTS IN RZAL. PROPERTY Interests in Real ;Property (of the type described in the Conflict of Interest Code) in which Mer, er, spouse and dependent children have an aggregate interest of 51,000 or morei (Pt ncipal place of residence is not reportable) STRKKT'AOORKl1":iOR PRx:CIix LOCATION O.� PROP.RAtY CNKCK.ONK VALUC DOR! MOT x.XCS6DS' 10,000 NATUR R O F INTICRCST, C.O.. KOUTTY, O 10� VALUK xXCxxa1 5"10.000 our mors KOT zxazza .$100.000 Q ACOU IRKD DATIR c Of1PO1C4 l .. 1':. I VALUC CXCY64! $;100.Ooi:, _..... _ , TTRKxT ADOR4]1 OR PRCfCISS LOCATION OC PROP6:AtY CNKCK 27Nx `' ' - VALUwe Doei Nor xzcaxa 510;000 nATURK OR INTR ASST. Z43., SOUITY, OPTIOn ,.. � VALUK ZXCCRDI $10 0'6, it T. a boat � NOT" K ccxsD ,000 100. AC17UYRKD C DATE I OIIPOIRD 1 "VALUC KXCKxL11 S"100,000 STMUCT AODRCSI:OR PR4'C33C LOCATION OP PROPMATY'CM _ itCk O%lK _. ,_ ... �.. �' ... I VALtJ IC CfOCY. ROT CXCx7K4 SIO*000. .. NA, TURK OK INTCA&XT, x.4.. COUiT7, omott DVALYd6 cxcz cD! StQ.000 RiaT Do YOT tXCxx4 5'100,600 i Aa0Y1Rx4 CATK Y D1a�eisKn 1 VALur. uXcsx4s SQ0;000, , (corci:trtied on re'rse sicieJ Page 3 ORM i3o Statement ®f�- ! � � � terests F®r Designated Employees, � 1 lease s�s.l. the lr1struction Manual for Designated Employees And your disclosure r category to deter►*Z,kle the disclosure requirements appilcable to your position. y p pP 2 from'youedarp� ider,p, please attach su iemantal schedules which can be obtained Fir c�rlh��al filing i' Use only k�t+�tio Typo arprfndlh irik .,..._,..,.....» _ _ POSITION �r��l•AnaQ+r,�r,o uNrr as roc,u ncENC:Y--,-.._._..- '=A F-13 _ r r2 % CrTM-pil"ChF Rugs+ �..r`r r yf C,r,,,� , � ��, � a � � . F Since your position is a "dQs/gnated positionyou are required to file a Statement of Econi�mic: Interests reporting all intere,ts defined by your disclosure cate o _. Check the 3 9 rS/ ppropriate ;❑ INITIAL STATEMENT; Th'eConflict of Interest Code for your agency became effective on You must filewithin 30 d zys after the effective data of ?r our Conflict of interest Code disclosi ig your interests held on the effective date. On the initial statement you are not. required to-discic�sa income or gifts, _ ❑ ASSUMING OFFICE STATEMENT FDF? PERSONS NEVIft,Y OFFICE: APPOINTED OR ELECT :D TO You have been newly appointed to a Civil Service Position.000inted to a Non -Civil Service Position or [ elected to Office and will assume office on Persons assurt in a civil serviceelect�� -----. 9 position or ive office file within 30 days of assuming office, Per- sons assuming non -civil service positions file within 10 da!,�s after assuming office. On the as:urning office statement you are not required to disclose income or gifts. ANNUAL STATr:,M You are required to fife annually a Staterrtent of Fcoriomic Interests no later'than scr'r� r The period covered by this statement is frcm7 QA/ 1!A/1 through LEAVING.OFFICE STATEMENT: You are leaving or have• left the above-n'I ned position as of ti, our statement is due withirs0 days after leaving your designated position. The period covered by this s<�atement;is from' � _ theoughh «a, 644 Ir ratiw rq, qtr Ri r!R Nance TO ALL F1LFRrS: In the event you are given art assignment which may affect your financial interests you sh'ouldr consult y0 agency's Conflict of Interest Code for guicance concerning disqualification, ttt.hE Cr4'.. MBE=s it Qu h3Ye a YOU fry.questirns, need technical;or legal interpretation pertainirJg to the Poilffcal Reform4ct tlr. the Gpnllr'ct_of /nr%rest'C, tor' your agency, 06ntact the Wing officer. ` N THE FOLL G SmaIAay MUST )38CGiViPL". 13Y ALL PIC.ERS SCHEDULE A « Investments over $_1,000' `•, Schedule completed &attached Na reportable Interests.Sch%Oulo not appplicable to my dl,ciosure 'ca Pgory SCHEDULE 0 Interests in Heal Property over $1,000 - Schedule completed completed&attached ❑No raportabip Interests Q schedule applicable to my lt - category SCHEDULE C • Investments and Interests in RealyProperty Bald by Business Entitles or Trusts, Schedulo completed & attach Na re s portable -Interest Schedule not applicabia to my disciosurq category !kHEAULE D , Income aggregating 5250 or more [� Schedule completed & altached No reportable Intarests Schedule not applicable to this type of 'or lJ statamant, to my disclosure category, SCHEDULE E • Gifts aggregating $25 or more Sthedulis completed & attached ®' No reportable Interests Schedule not applicable to this type of � statement or to my disclosure category SCHEDULE EE -- Honoraria -- Includes payments received for speaking at any avant, particlpating In a panel dr seminar or similar events xhedule completed & attached No reportable interests o Schedule not appllcable to thls'type of statement or to my disclosure category SCHEDULE F . Income of a Business Entity in which you, your spouse and dependent children. own a 10% or greater interest Sc7edule completed & attached' + No reportable. Interests Schedule not applicable to this type of statement or to my'dlsclosure category SCHEDULE G Employment and Management Positions In Business,Entitles Schedule completed & attached No reportable inteiests Schedule not applicable to my t}isclosure category NOTE: Filers who 'have interests to report on schedules but Whose reportable interests have not changed since a previously filed annual statement may complete the statement` fay attaching previous schedules, VERIFICATION I declare under penalty of perjury thatI Rave used all reasona'diIlgence in preparing, this statement and to the best o f my hnowleav it is trite and complete. Executed on19 .-` 'SIGNATURE Com./ C --c. � - l'`"�'�-ch-�..Y-r�+,-�-`• � FOR,INF0RNjATlCN } EQUJ�REO `T9 5E` PROVIDE❑ TO `(0�.1 PURSUANT I O THE INFORMATION PRACTiC ACT OF 1917; PLEA58 SEETHEr MANUAL FOR 0E51GNATEDEMPLO`rcE3. SCHEDULE A . DMEMIV EN S Investments (of the type described in the Conflict of Interest Code) owned by the Filer, spouse and dependent children aggregating $1,000 or more. CHKC}C ONK - Y VAWIl Doug NO'!-ffixcxa f $104000 :MATURR OP INTanusTs,:K. .. COMMON ATO--I11. PARTTIKRDNIP INTKRIIDTI XTC. - ('''� VALUK FlIXCffiKDs IS10,000 MUT' IJ Doffiffi NOT ffi.xc:xxzl 3 top;060'.OUNKRAL 042CMPTION.: OP 1541WIN, D0 ACTIVITY : ACOUIRffiD OATS - pIr1PCAKR! 1 VALUK %XC7IKDD $1064600. "AUX OJT "TITY CNffiClC ONK vALUat tides NOT mkoxicoS14.om _.KATURK OP INT711RKDTsp.111.0:, CQ&4MON DTOCK,V PAX77411RICNIP I14TtlIffi3T...KTC. VALU19 KXCSSDs $110.000 BUT . El - + Does NOT KxCxxu C1QO,QOO OK- . . ACOUIR .. ( N6AAM1. DfID1.A1PT10N OM KU11NK9K ACt.IVM RDQ.ATK� OIOPOf KD 1 VALUK IC 1SCffi KD O.StOO,AW. ' . , . NAM4 OP KNTITT - - (CHmCN OMK - -. VALUIt 930NIS NOT KXCffiICD Stl)j= :NATUAIK OP IMTRRKSTsj.ffi.0., COMMON STOCK, PART"aus"AP INTKRSAT,...aTC. - ' ❑VAWK ItXr-XKDK SIO.OW ■UT Cams Nr T mxcz*ri 5100/060 OKMKRAI. OKDCRIPTION GP KU3INK3111 ACTIVITYACQ DATK clarbsmO ( - VALUK VcxCKffiDq s100,000 , NAMK OP ENTITY - - affi VAI.UR Ooks NOT exctKD S 110,00'0 MATURK"OP INT1911193Tg„'11.0„:'00"1106 :STOCK, PARTNmRSNIP INTa893T, ETC..- - .. , VALu1S 11XC9IcM!1 Isto,60'0-;OUT OOm3 NOT xxCRa0 5100.0W ,. OKNKRAL 0IS3CR,IPTION OP MU41NR39 ACTIVITY _ ;M ACQUIMKO I OATS D19►03KI7 - VALUm 11 XCKKD3.�16d,000 ... SC REDUCE B — TiMRESTS IN REAL PROPERTY Interests in Real Property (of the type described in the Conflict of Interest Code) in which the filer, sponse and dependent children haveaggregate interest of S1,OOp or _an moire. (Principal place of residence is ndt reportable) STR11K 111RT - CHRCIC ONtt TAOOAR33 OR Pp.6 C13K LOCATION PR�� w � I' VX4U.x 0047 NOT 'CXC>teDS IQ.GOO., .: NATUMM;OP INT61113T, A.G., rQUITY, OPTION VALux KXCSItos $14.000 OUT '_ .' -eMaD: s1o00 ., .. DOX3 NOT 4;0 ncoillRffiD 1 DaT>” Q , 619ro7Ka i :: _ vALUx xxt:x*Od$10'0.QCO xTiqzzT,AjaoRz3s,Ow PRK413K' LOCATION OP P11OPMUTY CHRCIG..ONm a VALU2 Oo $1'0,000. pcs Na�T'excicKD + ':M ATUMa'.OP INTBR113T, 11;4., 11OUITT, OPTION ,.❑VALUK YXCa S3t1, SItX:i AVT oOs3 Nbr'axeamD 1Gq,QCa a ACOU112D� I 0AT11 . I' C119P A C aD3 �-5 VALUtt y Kx tt n ICo.A90 3TR4XT AOOMK7A OR PR11CI3G La tATIgN.OP PMOT7IRTY T CH11CX ONK I,n _ _ VALUK 00a3 116T IDXCZ>e0,. 5(0.060 �MA''rj;41 OM INTKR113T, K.4.. GOUITY, OPTION 660 ;NiNT . DOLL344ot' XCje*O !S SIQO,Ot]d C,3 AOgU/Almo - -DATA O19*as RO._' ).,. .; ..,. ... ,.VALu* R,ZC31 bo StI1o:OOCt tcontultc d,on reverse side) Paye