Jolie Houston - Annual 2004
STATEMENT OF ECONOMIC INTERES
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COVER PAGE /r;
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A Public Document RJ
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CALIFORNIA FORM 7 0 0
FAIR POLITICAL PRACTICES COMMISSION
Please type or print in ink
NAME
(LAST)
(FIRST)
CITY
1. Office, Agency, or Court
Name of Office, Agency, or Court:
California Joint Powers Risk Management Authority
Division, Board, District, if applicable:
. (
If filing for multiple positi s, list additional age y(ies)/
(Attach a separ~te heet if necessary.)
Agency:
Position:
2. Jurisdiction of Office (Check at least one box)
o State
o County of
o City of
~ Multi-County
o Other
3. Type of Statement (Check at least one box)
o Assuming Office/lnitial
Date: ---1---1_
[8] Annual: The period covered is January 1, 2004,
through December 31, 2004.
-or-
a The period covered is ---1---1_, through
December 31, 2004.
o Leaving Office Date Left: ---1---1_
(Check one)
a The period covered is January 1, 2004, through the
date of leaving office.
-or-
a The period covered is ---1---1_, through
the date of leaving office.
o Candidate
STATE
(MIDDLE)
--
~~
q S-U :3
4. Schedule Summary
(Check applicable schedules or "No reportable interests. "
- During the reporting period, did you have any reportable
interests to disclose on:
Schedule A-1 0 Yes - schedule attached
Investments (Less than 10% Ownership)
Schedule A-2 0 Yes - schedule attached
Investments (10% or greater Ownership)
Schedule BOYes - schedule attached
Real Property
Schedule C rv<-es - schedule attached
Income, Loans, & ~~ess Positions (Income Other than Gifts and
Travel Payments)
Schedule 0 (Eliminated - report loans on Schedule C)
Schedule E
Income - Gifts
DYes - schedule attached
Schedule F 0 Yes - schedule attached
Income - Travel Payments
-or-
- 0 No reportable interests on any schedule
Total number of pages L-
completed including this cover page:
5. Verification
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 certify under penalty of perjury under the laws of the State
of California that the foregoing is true and correct.
Date Signed
~ it / 7.liJC;
(month, day, ~ear)
~Wilh your filing official.)
Signature
FPPC Form 700 (2004/2005)
FPPC Toll-Free Helpline: 866/ASK-FPPC
SCHEDULE C
Income, Loans* & Business
Positions
(Other than Gifts and Travel Payments)
CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
> 1. NAME OF SOURCE OF INCOME
A~uev ~
BUSINESS ACTIVITY, IF ANY, OF SOURr~ . 11 L i<+r ri':1
-h-~ 13~l{ ~ l ~'t"Ltbv
YOUR BUSINESS POSITION ~ U ~ cA Cr {II ')
_p<Vte~bv~r\rlY' --- I I
GROSS INCOME RECEIVEDIHIGHEST BALANCE DURING
REPORTING PERIOD, IF LOAN
o $500 - $1,000 0 $1,001 - $10,000
0$10,001 - $100,000 ~VER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
Il1 Salary 0 Spouse's income 0 Loan repayment
o Sale of
(Property, car, boat, etc.)
o Commission or 0 Rental Income, list each source of $10,000 or more
o Other
(Describe)
o LOAN RECEIVED (complete box 2)
~e'tf-V\;t~
> 1. NAME OF SOURCE OF INCOME
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOUR BUSINESS POSITION
GROSS INCOME RECEIVED/HIGHEST BALANCE DURING
REPORTING PERIOD, IF LOAN
o $500 - $1,000 0 $1,001 - $10,000
0$10,001 . $100,000 0 OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
o Salary 0 Spouse's income 0 Loan repayment
o Sale of
(Property, car, boat, etc.)
o Commission or 0 Rental Income, list each source of $10,000 or more
o Other
(Describe)
o LOAN RECEIVED (complete box 2)
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOUR BUSINESS POSITION
GROSS INCOME RECEIVED/HIGHEST BALANCE DURING
REPORTING PERIOD, IF LOAN
o $500 - $1,000 0 $1,001 - $10,000
0$10,001 - $100,000 0 OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
o Salary 0 Spouse's income 0 Loan repayment
o Sale of
(Property, car, boat, etc.)
o Commission or 0 Rental Income, list each source of $10,000 or more
o Other
(Describe)
o LOAN RECEIVED (complete box 2)
INTEREST RATE
TERM (MonthslYears)
% 0 None
SECURITY FOR LOAN
o None 0 Personal residence
o Real Property
Street address
City
o Guarantor
o Other
(Describe)
* 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.
Comments:
FPPC Form 700 (2004/2005) Sch. C
FPPC Toll-Free Helpline: 866/ASK-FPPC