700 Blakeley 2018 Assuming Office 07.03.2018STATEMENT OF ECONOMIC INTERESTS
COVER PAGE
Please type or print in ink.
NAYS OF FILER tusr) RST)
1.
1. Office, Agency, or Court V
Agency Name (Do not use acronyms)
r�
f
Division oard, Department, District, if a a ' your Position
C L //�
► If filing for multiple position list below or on an attachment. (Do not use acronyms)
Agency:
2. Jurisdiction of Office (Check at least one box)
❑ State n
❑ Multi -County
❑ City of —� [
3. Type of Statement (Check at least one box)
❑ Annual: The period covered is January 1, 2017, through
December 31, 2017.
-or-
The period covered is I through
December 31, 2017.
Assuming Office: Date assumedJ_J
❑ Candidate: Date of Election
Position:
RECEIVED
Gate Initial P lung P=ce!ven
JUL 10 2018
CITY OF rA DUINTA
I.I
NT
❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ County of
❑ Other
❑ Leaving office: Date Left
(Check one)
0 The period covered is January 1, 2017, through the date of
leaving office.
.or-
o The period covered is through
the date of leaving office.
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 – Gifts – schedule attached
❑ Schedule B - Real Property – schedule attached ❑ Schedule E - Income – Gifts – Travel Payments – schedule attached
-or-
F3 None - No
5. Verification S' /r)SA r� Q.L • �rc s ;.- � C.s� 9
MAILING ADDRESS STREET CITY S LATE ZWFCobt
(Business or Agency Address Recommended - Public Document)
I have used all reasonable diligence in preparing this statement I have reviewed this statement and to the best of my k�wledge 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
Date Signed Q �' Signature _
(month, day, year) (Filetheonginllysigned, emerdwrthyourfiNng
FPPC Form 700(2017/2018)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov
SCHEDULE A-1 CALIFORNIA .
m 700
Investments �AIR POLITICAL PRACTICES (-,0mNiistio)N
Stocks, Bonds, and Other Interests Name
(Ownership Interest is Less Than 10%)
Do not attach brokerage or financial statements.
► NAME OF�SIN S ENTITY
GENERAL' ESCRIPTION OF THIS BUSINES
FAIR MARKET VALUE
❑ $2,000 - $10,000 ❑ $10,001 - $100,000
❑ $100,001 - $1,000,000 ❑ Over $1,000,000
NATURE OF INVESTMENT
Stock F-1 Other
(Describe)
[] Partnership O Income Received of $0 - $499
O Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE.
1 17 /. 17
ACQUIRED DISPOSED
► NAME OF BUSINESS
GENERAL DESCRIPTION OF THIS B SINJWS r
FAIR MARKET VALUE
$2,000 - $10,000 $10,001 - $100,000
❑ $100,001 - $1,000,000 [] Over $1,000,000
NATURE OF INVESTMENT
Stock ❑ Other
(Describe)
Partnership O Income Received of $0 - $499
O Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
/ 17 _�` 1 17
ACQUIRED DISPOSED
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE
$2,000 - $10,000 ❑ $10,001 - $100,000
0 $100,001 - $1,000,000 Over $1,000,000
NATURE OF INVESTMENT
Stock Other
(Describe)
Partnership O Income Received of $0 - $499
O Income Received of $500 or More (Report on Schedule Q
IF APPLICABLE, LIST DATE:
/ 17 _/ 17
ACQUIRED DISPOSED
Comments:
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE
❑ $2,000 - $10,000 ❑ $10,001 - $100,000
$100,001 - $1,000,000 Over $1,000,000
NATURE OF INVESTMENT
[] Stock Other
(Describe)
Partnership Q Income Received of $0 - $499
O Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
' 17 / 17
ACQUIRED DISPOSED
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE
❑ $2,000 - $10,000 ❑ $10,001 - $100,000
❑ $100,001 - $1,000,000 E] Over $1,000,000
NATURE OF INVESTMENT
Stock Other
(Describe)
[] Partnership O Income Received of $0 - $499
O Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
ACQUIRED DISPOSED
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE
$2,000 - $10,000 $10,001 - $100,000
$100,001 - $1,000,000 Over $1,000,000
NATURE OF INVESTMENT
E] Stock [] Other
(Describe)
[] Partnership O Income Received of $0 - $499
Q Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
_/_1 17 /_J-17
ACQUIRED DISPOSED
FPPC Form 700 (2017/2018) Sch. A-1
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov
SCHEDULE C
Income, Loans, & Business
Positions
(Other than Gifts and Travel Payments)
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 seff-employed use Schedule A -"L.)
❑ Partnership (Less than 10% ownership. For 10% or greater use
Schedule A-2.)
❑ Sale of
(Real property, car, boat, etc.)
Loan repayment
❑ Commission or C Rental Income, list each source or $10,000 or more
NAME OF SOURC F INCOME
A JT cce t )a)
BUSINESS ACTIVITY, IF ANY, OF SOURCE— A�aaAS-
YOUR BUSINESS POSITION
GROSS INCOME RECEIVED ❑ No Income - Business Position Only
❑ $Soo - $1,000 ❑ $1,001 - $10,000
'$10.001 • $100.000 ❑ OVER 5100.000
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 or 310,000 or more
(Describe)///jam' ,� + (Describe)
F-]OtherOther Sf' J
(Describe) (Describe)
LOANS• ' OUTSTANDING DURING THE REPORTINGPERIOD
* 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)
% ❑ None
ADDRESS (Business Address Acceptable)
SECURITY FOR LOAN
BUSINESS ACTIVITY, IF ANY, OF LENDER
❑ None ❑ Personal residence
❑ Real Property
Scree[ address
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500 - $1,000
City
❑ $1,001 - $10,000
❑ Guarantor
❑ $10,001 - $100,000
❑ OVER $100,000
❑ Other
(Describe)
Comments:
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