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Ermelindo Puente - Assuming Office 1992 FORM 721 STATEMENT OF ECONOMIC INTERESTS A Public Document 1990/91 PLEASE TYPE OR PRINT IN INK 'i ~ Dat~ Received by FPPC NAME Ermelindo Puente, Jr. STREET OFFICE HELD OR SOUGHT (Check One): o STATE OF CALIFORNIA OFFICE: o JUDICIAL BRANCH COUNTY: t?'l lBa1.) CITY ~LL q ;)O,~O ZIP CODE COURT: CHECK ONE: o JUDGE o COURT COMMISSIONER o COUNTY OFFICE: f] CITY OFFICE: Planning Commissioner TYPE OF STATEMENT (Check the Appropriate Box(es)): [x ASSUMING OFFICE STATEMENT (For Newly-Elected and Newly-Appointed Officials ONL Y)* o ELECTED OFFICIAL (Other than elected state officers assuming office in December or January). File no later than 30 days after assuming office. Date Assumed Office mo. day yr. APPOINTED OFfICIAL Not subject to confirmation by the State Senate or the Commission on Judicial Appointments. File no later than 10 days after assuming office. Date .6.ssumed Office 1-1-92 mo, day yr, o APPOINTED OFFICIAL Subject to confirmation by the State Senate or the Commission on Judicial Appointments. File no later than 10 days after appointment or nOrT)ination. Date Appointed o ANNUAL STATEMENT State officers and all judges and court commissioners file between January 1 and March 1. State and local officials and employees who manage public investments, and city and county officials file between January 1 and April 1. PERIOD COVERED: Disclose all reportable interests held or received during the period from January 1, 1990 through December31, 1990. mo, day yr D LEAVING OFFICE STATEMENT File no later than 30 days after leaving office. The period covered is January 1, 19 , through the date of leavi ng office which was: - mo. day yr. D CANDIDATE STATEMENT File no later than the finaUiling date for your declaration of candidacy. COUNTY: CITY: City of Gilroy SCHEDULES TO BE COMPLETED Complete Schedules A, B, C-1 and C-2 disclosing investments and interests in real property held on the date of assuming office. In addition, on Schedules D, E, F, G and H-1 through H-3, report income received during the 12 months prior to the date you assumed office. Complete Schedules A. B, C-1 and C-2 disclosing . investments and interests in real property held on the date of assuming office. In addition, on Schedules 0, E, F, G and H-1 through H-3, report income receIved during the 12 months prior to the date you assumed office. Complete Schedules A,-B, C-1 and C-2 disclosing investments and interests in real property hela on the date of filing. In addition, on Schedules 0, E, F. G and H-1 through H-3, report income received during the 12 months prior to the date you assumed office. Complete all schedules disclosing investments and !nterests inr,eal property held a,nd income received at any tIme dUring the period covered by the statement. Complete all schedules disclosing investments and Interests in real property held and income received at any time during the period covered by the statement. " Complete Schedules A, B, C-1 and C-2 disclosing I investments and interests in real property helaon the date of filing. "INCUMBENT OffICEHOlDERS WHO ARE RE-ElECTEO OR RE-APPOINTED WITHOUT A BREAK IN SERVICE SHOUlD NOT COMPLETE AN ASSUMING OFFICE STATEMENT. Form 1 (12/90) , J \ " NAME G/me..//nDo ~h-fG re. The Following Summary Must Be Completed By All Filers DO NOT COMPLETE THIS SUMMARY PAGE UNTIL YOU HAVE CARE FULL Y REVIEWED ALL SCHEDULES AND THE INSTRUCTIONS FOR EACH SCHEDULE. " Schedule A - INVESTMENTS SCHl~~llrl~~~k5TED NOI~~~~:lABLE (Which Are N!!1 Held Through A Business Entity Or Trust) 0 0' Y Schedule B - INTERESTS IN REAL PROPERTY (Which Are Not Held Through A Business Entity Or Trust) o B' ~ W ISchedule C-1 - INTERESTS IN REAL PROPERTY HELD BY A BUSINESS ENTITY OR TRUST YSchedule C-2 - INVESTMENTS HELD BY A BUSINESS ENTITY OR TRUST o o Schedule D - INCOME (Other Than Loans, Gifts And Honoraria) ff o Schedule E - LOANS (Received Or Outstanding During The Reporting Period) o ~ Schedule F - GIFTS o 0---- Schedule G - HONORARIA o 2r Schedule H - COMMISSION INCOME, INCOME AND LOANS TO BUSINESS 0 ENTITIES OR TRUSTS AND INCOME FROM RENTAL PROPERTY ~ NOTE: AFTER THE SUMMARY PAGE HAS BEEN COMPLETED, PLEASE DISCARD THOSE SCHEDULES ON WHICH YOU HA VE NO REPORT ABLE INTERESTS. VERIFICA TION I have used all reasonable diligence in preparing this statement. I have reviewed the statement and to the best of my knowledge the information contained herein and in the 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. I /1 Executed on , at , ./ /' I ".1 J- ' '- J C ''t..... y <..... I . (city and state) ~ (/" <.:" C ,~(, ,...1 C '-... SIGNATURE Form 2 (12/90) '" .' ... NAME~mGI//) 1)0 ~t'nfe..... Schedule D -- Income (Other Than Loans, Gifts And Honoraria) (SEE PAGES 20 AND 21 OFTHE INFORMATION MANUAL FOR INSTRUCTIONS AND EXAMPLES) GROSS INCOME RECEIVED: NAME OF THE SOURCE OF INCOME ADDRESS D $250-$1,000 D $1,001-$10,000 Dover $10,000 NATURE OF BUSINESS ACTIVITY, IF ANY DESCRIPTION OF THE CONSIDERATION FOR WHICH INCOME WAS RECEIVED NAME OF THE SOURCE OF INCOME DESCRIPTION OF THE CONSIDERATION FOR WHICH INCOME WAS RECEIVED D $250-$1,000 o $1,001-$10,000 !;] Oller $10,000 ADDRESS NATURE OF BUSINESS ACTIVITY, IF ANY NAME OF THE SOURCE OF INCOME NATURE OF BUSINESS ACTIVITY, IF ANY D $250-$1,000 D $1,001 -$10,000 D Over$10,000 ADDRESS DESCRIPTION OF THE CONSIDERATION FOR WHICH INCOME WAS RECEIVED o If additional space is needed, check box and attach an additional Schedule D. Form 7 (12/90) ,. (Type or Print in Ink) NAME OF FILER Ermelindo Puente, Jr. NAME OF AGENCY Communit MAILING ADDRESS A PUBUC DOCUMENT 1990/91 FORM 730 . Statement of Economic'lnterests For Designated Employees POSITION TITLE Plannin Commissioner DAYTIME TELEPHONE NUMBER <4oY1t CJ3/P CHECK THE APPROPRIATE BOX(ES): ASSUMING OFFICE STATEMENT: (Check the box below if you have recently assumed a position designated in your agency's Conflict of Interest Code.) Gl You have assumed your position on 1-1-92 . You must file a statement no later than 30 days after this date, You must disclose on Schedules A, B, C-1, C-2, and G all reportable investments, interests in real property and business positions required by your disclosure category, held on the date you assumed your position. In addition, you must disclose on Schedules D, E, F, H-I, H-2 and H-3 income from all reportable sources received during the 12 months Drior ~ the date you assumed office. ANNUAL STATEMENT: (Required to be filed for each year that you hold your designated position.) o You are required to file a statement no later than disclosing all reportable investments, interests in real property and ~usiness positions held and-income received during the period from January " 1990 through December 31, 1990. (See page 2 of the Manual for exceptions to the reporting period.) LEAVING OFFICE STATEMENT: (Required to be filed when you leave your designated position.) o You are leaving or have left your position on and must file a statement no later than 30 days after that date. You must disclose all reportable investments, interests in real property and business positions held and income received durj ng the period from January 1, 1990 through the date you leh your designated position. INITIAL STATEMENT: (Check the box below ONLY if your position has been recently designated or if you are filing under a ~ Conflict of Interest Code for your agency.) o The conflict of interest code for your agency became effective or your position was newly designated on You must file a statement no later than 30 days after this date. You must disclose on Schedules A, B, C-1, C-2 and G all reportable investments, interests in real property, and business positions held on the date your agency's code or your designation became effective. In addition, you must disclose on Schedules D, E, F, and H-I, H-2 and H-3 income from all reportable sources received during the 12 months Drior to the date your agency's code or your designation became effective. CANDIDATE STATEMENT: (If required by the conflict of interest code of the jurisdiction in which you are seeking elective office.) o The conflict of interest code specifies the types of interests you must disclose. You may be required to complete Schedules A, 8, C-1, C-2 and G. Form 1 -- STD 730 (12/90) 'rHE FOLLOWING SUMMARY MUST BE COMPLETED BY ALL FILERS , (Do not complete this summary until you have. carefully reviewed the instructions for each schedule on pages 9 through 27 of-the information manual) .. SCHEDULE A-- INVESTMENTS (Which Are Not Held By A Business Entity Or Trust) o COMPLETED AND ATTACHED GtNo REPORTABLE INTERESTS 0 SCHEDULE DOESNOTAPPLY TO MY DISCWSURE CATEGORY SCHEDULE B -- INTERESTS IN REAL PROPERTY (Which Are Not Held By A Business Entity Or Trust) o COMPLETED AND ATTACHED ~O REPORTABLE INTERESTS 0 SCHEDULE DOESNOTAPPLY TO MY DISCWSURE CATEGORY SCHEDULE C-I-- INTERESTS IN REAL PROPERTY HELD BY A BUSINESS ENTITY OR TRUST o COMPLETED AND ATTACHED ~O REPORTABLE INTERESTS 0 SCHEDULE DOESNOTAPPLY TO MY DISCWSURE CATEGORY SCHEDULE C-2 - INVESTMENTS HELD BY A BUSINESS ENTITY OR TRUST o COMPLETED AND ATTACHED ~ REPORTABLE INTERESTS 0 SCHEDULE DOES NOT APPLY TO MY DISCWSURE CATEGORY SCHEDULE D -- INCOME (Other Than Loans And Gifts) ~PLETED AND ATTACHED D NO REPORTABLE INTERESTS D SCHEDULE DOES NOT APPLY TO MY DISCWSURE CATEGORY SCHEDULE E -~INCOME - LOANS (Received Or Outstanding During The Reporting Period) D COMPLETED AND ATTACHED ~ REPORTABLE INTERESTS D SCHEDULE DOESNOTAPPLY , TO MY DISCWSURE CATEGORY SCHEDULE F:; INCOME - GIFTS D COMPLETE~ AND ATTACHED ~EPORTABLE INTERESTS D SCHEDULE DOES NOT APPLY TO MY DISCWSURE CATEGORY SCHEDULE G -- BUSINESS POSITIONS o COMPLETED AND ATTACHED ~ REPORTABLE INTERESTS D SCHEDULE DOES NOT APPLY TO MY DISCWSURE CATEGORY SCHEDULE H.- COMMISSION INCOME, INCOME AND LOANS TO BUSINESS ENTITIES OR TRUSTS AND INCOME FROM RENTAL PROPERTY o COMPLETED AND ATTACHED ~EPORTABLE INTERESTS D SCHEDULE DOES NOT APPLY TO MY DISCWSURE CATEGORY VERIFICATION I have used all reasonable diligence in preparing this statement. I have reviewed the statement and to the best of my knowledge the information contained herein and in the 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. Executed on , 19 , at SIGNATURE ~~~~7 (City and State) Form 730 (12/90) NAME Schedule A ..~Investments (Which Are Not Held By A Business Entity Or Trust) (SEE PAGES 9 & 10 OF THE INFORMATION MANUAL FOR INSTRUCTIONS AND EXAMPLES) NAME OF BUSINESS ENTITY VALUE o $1,000-$10,000 NATURE OF INVESTMENT, E.G" COMMON STOCK, PARTNERSHIP INTEREST o $10,001-$100,000 If Acquired Or Disposed During The o Over$loo,ooO Reporting Period You Must Indicate Month, Day And Year: Ownership Interest GENERAL DESCRIPTION OF BUSINESS ACTIVITY Date Acquired: o Less than 10% Date Disposed: o 10% or greater* NAME OF BUSINESS ENTITY VALUE o $1,000-$10,000 NATURE OF INVESTMENT, E,G.. COMMON STOCk. PARTNERSHIP INTEREST o $10,001-$100,000 If Acquired Or Disposed During The o Over$loo,Ooo Reporting Period You Must Indicate Month, Day And Year: Ownership Interest GENERAL DESCRIPTION OF BUSINESS ACTIVITY Date Acquired: o Less than 10% Date Disposed: o 10% or greater* NAME OF BUSINESS ENTITY VALUE -- o $1,000-$10,000 - NATURE OF INVESTMENT, E,G,. COMMON STOCk. PARTNERSHIP INTEREST o $10.001-$100,000 If Acquired Or Disposed During The o Over$loo,OOO Reporting Period You Must Indicate Month, Day And Year; Ownership Interest GENERAL DESCRIPTION.9F BUSINESS ACTIVITY Date Acquired: o Less than 10% Date Disposed: o 10% or greater* NAME OF BUSINESS ENTITY VALUE o $1,000-$10,000 NATURE OF INVESTMENT, E,G.. COMMON STOCK, PARTNERSHIP INTEREST If Acquired Or Disposed During The 0$10,001-$100,000 o Over$loo,ooO Reporting Period You Must Indicate Month, Day And Year: Ownership Interest GENERAL DESCRIPTION OF BUSINESS ACTIVITY Date Acquired: o Less than 10% Date Disposed: o 10% or greater* NOTE: YOU MAY BE REQUIRED TO REPORT ON SCHEDULE D ANY SALARY, COMMISSION, D1STRlBUnON OR OTHER INCOME ($250 OR MORE) FROM ANY INVESTM~NT LISTED ON SCHEDULE A RECEIVED BY YOU OR YOUR SPOUSE. * If you have checked this box, you must report on Schedules C-1 and C-2 any interests in real property and investments held by the business entity. In addition, if your pro rata share of the gross income from anyone source was $10,000 or more, you must report the name of that source on Schedule H-2. o If additional space is needed, check box and attach an additional Schedule A. Form 3 -- STD 730 (12190) NAME j Schedule B -- Interests lit Real Property (Which Are Not Held By A Business Entity Or Trust) (SEE PAGES 11 AND 12 OFTHE INFORMATION MANUAL FOR INSTRUCTIONS AND EXAMPLES) STREET ADDRESS OR PRECISE LOCATION OF PROPERTY CITY FAIR o $1,000-$10.000 MARKET o $10,001-$100.000 NATURE OF INTEREST, E.G., OPTION, OWNERSHIP. LEASEHOLD, DEED OF TRUST VALUE o Over$100.000 If Acquired Or Disposed During The Date Acquired: If Rental Property. o less than 10% Reporting Period You Must Indicate Date Disposed: Ownership Interest Is o 10% or greater* Month. Dav And Year: STREET ADDRESS OR PRECISE LOCA nON OF PROPERTY CITY FAIR 0'$1,000-$10.000 NATURE OF INTEREST. E,G., OPTION, OWNERSHIP, LEASEHOLD. DEED OF TRUST MARKET o $10,001-$100.000 VALUE o Over$loo.000 If Acquired Or Disposed During The Date Acquired: If Rental Property, o Less than 10% Reporting Period You Must Indicate Date Disposed: Ownership Interest Is o 10% or greater * Month, Day And Year: STREET ADDRESS OR PREOSE LOCATION OF PROPERTY CITY FAIR o $1,000-$10,000 MARKET o $10,001-$100,000 NATURE OF INTEREST, E.G., OPTION, OWNERSHIP,LEASEHOLD, DEED OF TRUST VALUE o Over$100.000 - If Acquired Or Disposed During The Date Acquired: If Rental Property. o Less than 10% Reporting Period You Must Indicate Date Disposed: Ownership Interest Is o 10% or greater * Month. Dav And Year: STREET ADDRESS OR PRECISE LOCATION OF PROPERTY CITY FAIR o $1,000-$10,000 NATURE OF INTEREST, E.G., OPTION, OWNERSHIP,LEASEHOlD, DEED OF TRUST MARKET o $10.001-$100,OOC VALUE o Over$loo.000 If Acquired Or Disposed During The Date Acquired: If Rental Property, o less than 10% Reporting Period You Must Indicate Date Disposed: Ownership Interest Is o 10% or greater* Month. Day And Year: NOTE: YOU MAYBE REQUIRED TO REPORT ON SCHEDULE D INCOME ($250 OR MORE) FROM RENTAL PROPERTY LISTED ON SCHEDULE B RECEIVED BY YOU OR YOUR SPOUSE. *If you have a 10% or greater interest in a rental property, you may have additional reporting requirements on Schedule H-3. o If additional space is needed, check box and attach an additional Schedule B. Form 4 -- STD 730 (12190) NAME Schedule (-1 --Interests In Real Property Held By A Business Entity Or Trust STREET ADDRESS OR PRECISE lOCATION OF PROPERTY CITY FAIR D $1,000-$10,000 NATURE OF INTEREST, E.G., OPTION,OWNERSHIP,lEASEHOLD, DEED OF TRUST MARKET D $10,001-$100,000 VALUE D Over$100,ooO If Acqulreo Ur ulsposeo DUring Date Acquired: The Reporting Period You Must Indicate Date Disposed: Month, Day And Year: STREET ADDRESS OR PRECISE LOCATION OF PROPERTY CITY FAIR D $1,000-$10,000 NATURE OF INTEREST, E.G., OPTION,OWNERSHIP, LEASEHOLD, DEED OF TRUST MARKET D $10,001-$100,000 VALUE D Over $100,000 If Acquired Or Disposed During Date Acquired: The Reporting Period You Must Indicate Date Disposed: Month Dav And Year: STREET ADDRESS OR PRECISE LOCA nON OF PROPERTY CITY ~ D $1,000-$10,000 FAIR NATURE OF INTEREST, E,G" OPTION,OWNERSHIP, LEASEHOLD, DEED OF TRUST MARKET D $10,001-$100,000 VALUE D Over$100,OOO If Acquired Or Disposed During Date Acquired: The Reporting Period You Must Indicate Date Disposed: Month Day And Year: STREET ADDRESS OR PRECISE LOCATION OF PROPERTY CITY FAIR D $1,000-$10,000 NATURE OF INTEREST, E.G" OPTION,OWNERSHIP, LEASEHOLD, DEED OF TRUST MARKET D $10,001-$100,000 VALUE D Over$100,OOO If Acquired Or Disposed During Date Acquired: The Reporting Period You Must Indicate Date Disposed: Month Day And Year: STREET ADDRESS OR PRECISE LOCA nON OF PROPERTY CITY FAIR D $1,000-$10,000 NATURE OF INTEREST, E.G., OPTION,OWNERSHIP, LEASEHOLD, DEED OF TRUST MARKET D $10,001-$100,000 VALUE DOver $ 1 00,000 If Acquired Or Disposed During Date Acquired: The Reporting Period You Must Indicate Date Disposed: Month Day And Year: STREET ADDRESS OR PRECISE LOCATION OF PROPERTY CITY FAIR D $1,000-$10,000 NATURE OF INTEREST, E.G., OPTION,OWNERSHIP, LEASEHOLD, DEED OF TRUST MARKET D $10,001-$100,000 VALUE D Over $100,000 If Acquired Or Disposed During Date Acquired: The Reporting Period You Must Indicate Date Disposed: Month, Dav And Year: (SEE PAGES 13 AND 14 OFTHE INFORMATION MANUAL FOR INSTRUCTIONS AND EXAMPLES) INTERESTS IN REAL PROPERTY HELD BY: (Name Of Business Entity Or Trust Holding The Real Property)* .Your investment in this business entity must be reported on Schedule A-Investments o If additional space is needed, check box and attach an additional Schedule C-1. Form 5 -- STD 730 (12/90) NAME , 'Schedule (-2 --Investments Held By A Business Entity Or Trust (SEE'PAGES13 AND 140FTHEINFORMATION MANUAL FOR INSTRUCTIONS AND EXAMPLES) INVESTMENTS HELD BY: (Name Of Business Entity Or Trust Holding The Investment(s))* NAME OF BUSINESS ENTITY 0 $1,000-$10.000 NATURE OF INVESTMENT. E.G., COMMON STOCK. PARTNERSHIP If Acquired Or Disposed Durin~ The VALUE 0 $10,001-$100.000 Reporting Period You Must In icate 0 Over $ 1 00,000 Month, Day And Year: GENERAL DESCRIPTION OF BUSINESS ACTIVITY Date Acquired: Date Disposed: NAME OF BUSINESS ENTITY 0 $1,000-$ 1 0.000 NATURE OF INVESTMENT. E.G., COMMON STOCK. PARTNERSHIP If Acquired Or Disposed Durin3 The VALUE 0 $10.001-$100.000 Reporting Period You Must In icate 0 Over $ 100.000 Month. Day And Year: GENERAL DESCRIPTION OF BUSINESS ACTIVITY Date Acquired: Date Disposed: NAME OF BUSINESS ENTITY 0 $ 1.000-$ 10.000 NATURE OF INVESTMENT, E.G., COMMON STOCK, PARTNERSHIP If Acquired Or Disposed Durin~ The VAI:.UE 0 $10,001-$100.000 Reporting Period You Must In icate 0 Over $100.000 Month, Day And Year: GENERAL DESCRIPTION OF BUSINESS ACTIVITY Date Acquired: - Date Disposed: NAME OF BUSINESS ENTITY 0 $1.000-$10.000 NATURE OF INVESTMENT. E.G., COMMON STOCK, PARTNERSHIP If Acquired Or Disposed Durin3 The VALUE 0 $10.001-$100.000 Reporting Period You Must In icate 0 Over $ 1 00.000 Month, Day And Year: GENERAL DESCRIPTION OF BUSINESS ACTIVITY Date Acquired: Date Disposed: NAME OF BUSINESS ENTITY D $1,000-$ 1 0.000 NATURE OF INVESTMENT, E.G., COMMON STOCK, PARTNERSHIP If Acquired Or Disposed Durin3 The VALUE D $10,001-$100,000 Reporting Period You Must In icate D Over $ 100.000 Month, Day And Year: GENERAL DESCRIPTION OF BUSINESS ACTIVITY Date Acquired: Date Disposed: NAME OF BUSINESS ENTITY D $1.000-$ 10.000 NATURE OF INVESTMENT. E,G., COMMON STOCK, PARTNERSHIP If Acquired Or Disposed Durin9 The VALUE D $ 10.001-$ 1 00.000 Reporting Period You Must In icate D Over $100.000 Month. Day And Year: GENERAL DESCRIPTION OF BUSINESS ACTIVITY Date Acquired: Date Disposed: *Your investment in this business entity must be reported on Schedule A-Investments. D If additional space is needed, check box and attach an additional Schedule (-2. Form 6 -- STD 730 (12/90) NAME IMPORTANT Effective'January 1, 1991,'new prohibitions and limitations will be imposed on gifts and honoraria received by elected state and local officials, state agency officials, members of state boards and commissions, and certain employees of state agencies. These new provisions are discussed at the front of the 1990-91 Information Manual for Form 730 in the section entitled U 1991 legislative Changes. U WARNING: These new prohibitions and limitations do not affect the requirements for disclosinq gifts and honoraria received. Schedule 0 -- Income (Other Than Loans And Gifts) (SEE PAGES 15 AND16 OFTHE INFORMATION MANUAL FOR INSTRUCTIONS AND EXAMPLES) GROSS INCOME RECEIVED: NAME OF T ADDRESS o $2S0-$1,OOO o $1,001-$10,000 o Over$10,OOO NAME OF THE SOURCE OF INCOME ADORESS 0 $250 - $ 1,000 0 $1,001-$10,000 0 Over $ 10,000 NATURE OF BUSINESS ACTIVITY, IF ANY DESCRIPTION OF THE CONSIDERATION FOR WHICH INCOME WAS RECEIVED NAME OF THE SOURCE OF INCOME DESCRIPTION OF THE CONSIDERATION FOR WHICH INCOME WAS RECEIVED 0 $250 - $ 1,000 0 $1,001 -$10,000 0 Over $ 1 0,000 ADDRESS NATURE OF BUSINESS ACTIVITY, IF ANY o If additional space is needed, check box and attach an additional Schedule D. Form 7 -- STO 730 (12/90) NAME Schedule E -- Income - Loans (Received Or Outstanding During The Reporting Period) (SEE PAGES 17 AND 180FTHE INFORMATION MANUAL FOR INSTRUCTIONS AND EXAMPLES) AMOUNT OF HIGHEST BALANCE DURING THE REPORTING PERIOD: NAME OF LENDER D $250 - $ 1,000 ADDRESS D $1,001 -$10,000 NATURE OF BUSINESS ACTIVITY, IF ANY WAS THE ENTIRE LOAN 0 YES D Over $10,000 REPAID DURING THE REPORTING PERIOD 0 NO SPECIFIC SECURITY FOR LOAN INCLUDING GUARANTOR (If Real Property, Provide Address) INTEREST RATE D 0 NONE NONE NAME OF LENDER D $250 - $ 1,000 ADDRESS D $1,001-$10,000 NATURE OF BUSINESS ACTI\I.lTY, IF ANY WAS THE ENTIRE LOAN 0 YES 0 Over $10,000 - REPAID DURING 0 THE REPORTING PERIOD NO SPECIFIC SECURITY FOR lOAN INCLUDING GUARANTOR (If Real Property, Provide Address) INTEREST RATE 0 0 NONE NONE NAME OF LENDER - 0 $250 - $ 1,000 ADDRESS D $1,001-$10,000 NATURE OF BUSINESS ACTIVITY, IF ANY WAS THEENTIRE LOAN 0 YES 0 Over $ 1 0,000 REPAID DURING THE REPORTING PERIOD 0 NO SPECIFIC SECURITY FOR LOAN INCLUDING GUARANTOR (If Real Property, Provide Address) 0 INTEREST RATE NONE D NONE NAME OF LENDER 0 $250 - $ 1,000 ADDRESS D $1,001 -$10,000 NATURE OF BUSINESS ACTIVITY, IF ANY WAS THE ENTIRE LOAN 0 YES 0 Over $ 1 0,000 REPAID DURING THE REPORTING PERIOD 0 NO SPECIFIC SECURITY FOR LOAN INCLUDING GUARANTOR (If Real Property, Provide Address) D INTEREST RATE NONE D NONE o If additional space is needed, check box and attach an additional Schedule E. Form 8 - STD 730 (12190) NAME IMPORTANT Effective January 1, 1991, new prohibitions and limitations will be imposed on gifts and honoraria received by elected state and local officials, state agency officials,' members of state boards and commissions, and certain employees of state agencies. These new provisions are discussed at the front of the 1990-91 Information Manual for Form 730 in the section entitled "1991 Legislative Changes." WARNING: These new prohibitions and limitations do not affect the requirements for disclosinq gifts and honoraria received. Schedule F -- Income - Gifts (SEE PAGES 19 AND 20 OFTHE INFORMATION MANUAL FOR INSTRUCTIONS AND EXAMPLES) NAME OF DONOR ADDRESS - NATURE OF BUSINES~ AClIVITY, IF ANY NAME OF DONOR ADDRESS - NATURE OF BUSINESS ACTIVITY, IF ANY NAMEOFOONOR ADDRESS NATURE OF BUSINESS ACTIVITY, IF ANY NAME OF DONOR ADDRESS NATURE OF BUSINESS ACTIVITY, IF ANY NAME OF DONOR ADDRESS NATURE OF BUSINESS ACTIVITY, IF ANY DA TE(S) RECEIVED: VALUE(S): DESCRIPTION OF GIFT(S): D If additional space is needed, check box and attach an additional Schedule F. Form 9 -- STD 730 (12/90) . r NAME Schedule G - Business Positions (SEE PAGE 21 OFTHflNFORMATIONMANUAlFOR INSTRUCTIONS AND EXAMPLES) NAME OF ENTITY ADDRESS OF ENTITY DESCRIPTION OF BUSINESS ACTIVITY YOUR JOB TITLE OR POSITION POSITION HELD THROUGH ENTIRE REPORTING PERIOD? IFNO POSITION COMMENCED ON DYES o NO PLEASE INDICATE: POSITION TERMINATED ON NAME OF ENTITY ADDRESS OF ENTITY DESCRIPTION OF BUSINESS ACTIVITY YOUR JOB TITLE OR POSITION POSITION HELD THROUGH ENTIRE REPORTING PERIOD? IF NO POSITION COMMENCED ON DYES o NO PLEASE INDICATE: POSITION TERMINATED ON NAME OF ENTITY ADDRESS OF ENTITY DESCRIPTION OF BUSINESS ACTIVITY YOUR JOB TITLE OR POSITION POSITION HELD THROUGIj.ENTIRE REPORTING PERIOD? IF NO POSITION COMMENCED ON DYES o NO PLEASE INDICATE: POSITION TERMINATED ON NAME OF ENTITY ADDRESS OF ENTITY DESCRIPTION OF BUSINESS ACTIVITY YOUR JOB TITLE OR POSITION - POSITION HELD THROUGH ENTIRE REPORTING PERIOD? IF NO POSITION COMMENCED ON DYES o NO PLEASE INDICATE: POSITION TERMINATED ON NAME OF ENTITY ADDRESS OF ENTITY DESCRIPTION OF BUSINESS ACTIVITY YOUR JOB TITLE OR POSITION POSITION HELD THROUGH ENTIRE REPORTING PERIOD? IFNO POSITION COMMENCED ON DYES o NO PLEASE INDICATE: POSITION TERMINATED ON NAME OF ENTITY ADDRESS OF ENTITY DESCRIPTION OF BUSINESS ACTIVITY YOUR JOB TITLE OR POSITION POSITION HELD THROUGH ENTIRE REPORTING PERIOD? IFNO POSITION COMMENCED ON DYES o NO PLEASE INDICATE: POSITION TERMINATED ON o If additional space is needed, check box and attach an additional Schedule G. Form 10 -- $TD 730 (12/90) :. ,- ... NAME Schedule H (SEE PAGES 21 THROUGH 23 OFTHE INFORMATION MANUAL FOR INSTRUCTIONS AND EXAMPLES) Schedule H-1 Commission Income Received By Brokers, Agents And Salespersons NAME OF BUSINESS ENTITY NAMES OF SOURCES OF INCOME Schedule H-2 Income And Loans To A Business Entity Or Trust NAME OF BUSINESS ENTITY OR TRUST ADDRESS OF BUSINESS ENTITY OR TRUST NATURE OF BUSINESS ACTl\lHY, IF ANY - NAMES OF SOURCES OF INCOME AND LOANS TO THE BUSINESS ENTITY OR TRUST - Schedule H-3 Income From Rental Property You must disclose the name(s) of any renter(s) who made rent payments, provided that your pro rata share of such receipts from anyone renter was $10,000 or more. ADORESS OF RENTAL PROPERTY CITY NAMES OF RENTERS ADDRESS OF RENTAL PROPERTY CITY NAMES OF RENTERS o If additional space is needed, check box and attach additional schedules. Form 11 -- STD 730 (12/90)