700 Blakeley 2015CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
A PUBLIC DOCUMENT
Please type or print in ink.
xt al Flling fZPceived
STATEMENT OF ECONOMIC INTERESTS OF Lr QU1NTA
CALIFORNIA
COVER PAGE
NAME OF FILER n MT) C'i<
1111111111 l
1. Office, Agency, or Court
(FIRST) I S_rrP��
36 FD 29 P41,1)1
rt
Agency Name (Do not use acronyms)
Division
, Department, District, if applicable
► If filing for multiple positions, list below or on an attachment.
Do not use acrony
Agency:
Position.
2. Jurisdiction of Office (Check at least one box)
❑ State
❑ Multi -County
'City of
3. Type of Statement (Check at least one box)
Annual: The period covered is January 1, 2015, through
T� December 31, 2015.
-or-
The period covered is 1 / , through
December 31, 2015.
❑ Assuming Office: Date assumed
❑ Candidate: Election year
❑ Judge or Court
County of
❑ Other
missioner (Statewide Jurisdiction)
❑ Leaving Office: Date Left
(Check one)
Q The period covered is January 1, 2015, through the date of
leaving office.
-or-
o The period covered is
the date of leaving office.
, through
and office sought, if different than. Part 1:
4. , Schedule Summary (must complete ► Total number of pages: including this cover page'
�
Schedules attached. ...r ..
::❑ -Schedule 471 - Investments - schedule attached
❑,.:Schedule -A-2 =''Investments schedule..aiiached
Schedule 13 Real Property -,schedule attached
-or-
E None - No reportable interests on any schedule
5. Verification
Schedule C = lncorne; Loans; .& Business. Positions -`schedule attached' -
,0 Schedule D - Income -;Gifts;-,scheddule •attached:...
❑
Schedule:E,7 -; - income - Gifts Travel: Payments = schedule attached . ,°
,//
MAILING ADDRESS STREET
(Business or Agency Address Recommended - Public Document)
CITY
STATE
ZIP CODE
DAYTIME TELEPHONE NUMBER
c/72-49
Piave used all reasonable diligence in preparing this statement. I have reviewed this statement and to the best of my k . edge 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 that the fo
Date Signed
c 7 e2.9—/4
(month, day, year)
Signature
ng is true and correct.
(File the originally sign edstt/fement with your riling off•+at)
FPPC Farm 700 (2015/2016)
FPPC Advice Emad: advice@fppc.ca.gov
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.
► NAME OF BUSINES : ENTITY
GENERAL DESCRIPTION OF THIS BUSINES
FAIR M • RKET VALUE
❑ $2,000 - $10,000
111 $100,001 - $1,000,000
❑ $10,001 - $100,000
❑ Over $1,000,000
NATURE OF INVESTMENT
❑ Stock ❑ Other
(Describe)
❑ Partnership 0 Income Received of $0 - $499
0 Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
/ 15
AC- QUIRED DISPOSED
II. NAM, OF BUSINESS ENTITY
l "�J7 LLT _Jd
GENERAL DESCRIPTION O THIS BU NESS
FAIR MARKET VALUE
❑ $2,000 - $10,000
❑ $100,001 - $1,000,000
`,$10,001 - $100,000
❑ Over $1,000,000
NATURE OF INVESTMENT
❑ Stock . ❑ Other
(Describe)
❑ Partnership 0 Income Received of $0 - $499
0 Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
15
AC- QUIRED DISPOSED
O. NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE
❑ $2,000 - $10,000
111 $100,001 - $1,000,000
❑ $10,001 - $100,000
❑ Over $1,000,000
NATURE OF INVESTMENT
❑ Stock ❑ Other
(Describe)
❑ Partnership 0 Income Received of $0 - $499
0 Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
/15
AC- QUIRED DISPOSED
CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
Name
I.
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 0 Income Received of $0 - $499
O Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
/__/ 15 t 15
-J
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
• Stock • Other
(Describe)
• Partnership 0 Income Received of $0 - $499
O Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
/_ j 15 /_/ 15
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
• Stock • Other
(Describe)
• Partnership 0 Income Received of $0 - $499
O Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
/_ 15 /15
___/
ACQUIRED DISPOSED
Comments'
FPPC Form 700 (2015/2016) 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)
CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
Name
► 1. INCOME RECEIVED ► 1. INCOME RECEIVED
NAME OF SOURCE OF INCOME
dibtA
ADDRESS (Business Address Acceptable)
BU INESS ACTIVITY, SIF MANY, SOURCE v
a -ii. oze47stc.4J d,-,,Lipt-a&-e-i
YOUR BUSINESS POSITION
GROSS INCOME RECEIVED
❑ $500 - $1,000
❑ $10,001 - $100,000
431$1,001 - $10,000
❑ 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
XCommission or ❑ Rental Income, d each source of $10,000 or ore `
Describe)
ther
(Describe)
NAME OF SOURCE OF INCOME
ADDRESS (Busiltss Adss Acceptable)
4[/"i'pt
BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOUR BUSINESS POSITION
GROSS INCOME RECEIVED
❑ $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
Is Other
(Describe)
► 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
INTEREST RATE TERM (Months/Years)
0 None
SECURITY FOR LOAN
❑ None ❑ Personal residence
❑ Real Property
Street address
City
❑ Guarantor
❑ Other
(Describe)
Comments'
FPPC Form 700 (2015/2016) Sch. C
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov