Kai Lai - Annual 2012CALIFORRIA
PUBLIC DOCUMENT
Please type or print in ink.
NAME OF FILER (LAST)
Lai
1. Office, Agency, or Court
STATEMENT OF ECONOMIC INTERESTS
Kai
COVER PAGE
(FIRST)
Agency Name
City of Gilroy.
Division, Board, Department, District, if applicable Your Position
Planning Commission Commissioner
► If filing for multiple positions, list below or on an attachment.
Agency:
2. Jurisdiction of Office (Check at least one box)
Position:
� 4 G � tZ c 1,
`��� '1UaR 2013
CaTI CLERKS TV i
(MIDDLE)
❑ State ❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ Multi- County
m City of Gilroy
❑ County of
❑ Other
3. Type of Statement (Check at least one box)
Annual: The period covered is January 1, 2012, through ❑ Leaving Office: Date Left —J I
December 31, 2012. (Check one)
-or-
The period covered is
December 31, 2012.
through O The period covered is January 1, 2012, through the date of
leaving office.
❑ Assuming Office: Date assumed I 1 O The period covered is _
the date of leaving office.
❑ Candidate: Election year
and office sought, if different than Part 1
4. Schedule Summary
Check applicable schedules or "None." III,. Total number of pages including this cover page: 3
through
T,,4t
❑ 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-
❑ None - No reportable interests on any schedule
5. Verification
MAILING ADDRESS STREET CITY STATE ZIP CODE
(
Gilroy CA 95020
DAYTIME TELEPNUNE NUMBER E -MAIL AUURE55 (UPI IUNAL)
( 408 ) 842 -7355 lai @garlic.com
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 acknowledge this is a public document.
I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date Signed Signature
(month, day, year origin statement -0 your Mingoffidet)
FPPC Form 700 (2012/2013)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Nelpline: 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 BUSINESS ENTITY
ni I h �aCAP- 60�
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
'90,41A L "a
FAIR MARKET VALUE
❑ $2,000 - $10,000 $10,001 - $100,000
❑ $100,001 - $1,000,000 ❑ Over $1,000,000
[SNAT RE OF INVESTMENT
tock ❑ Other
(Describe)
❑ Partnership 0 Income Received of $0 - $499
Q Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
/ 12 _/J 12
ACQUIRED DISPOSED
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
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
( ribe)
❑ Partnership Q Income Received of $499
O Income Received 500 or More (Report on Schedule Q
IF APPLICABLE, LIST DATE:
_J_/ 12
ACQUIRED DISPOSED
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
FAIR MARKET VALUE
❑ $2,000 - $10,000
❑ $100,001 - $1,000,000
NATURE OF INVESTMENT
❑ Stock ❑ Other_
❑ Partnership Q income
Q Income
IF APPLICABLE, LIST/
❑ $10,001 - $
❑ Over $1,03
(Describe)
of $0 - $499
of $500 or More (Report on Schedule C)
I 1� 12 _/_ /,,12
ACQUIRED DISPOSED
Comments:
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
FAIR MARKET VALUE
❑ $2,000 - $10,000 $10,001 - $100,000
❑ $100,001 - $1,000,000 ❑Over $1.000,000
NATURE OF INVEST T y
❑ Stock ther
(Describe)
❑ Partnership Income Received of $0 - $499
Q Income Received of $500 or More (Report on Schedule Q
IF APP CABLE, LIST DATE:
l 1,12 _ /_J 12
ACQUIRED DISPOSED
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
FAIR MARKET VALUE
❑ $2,000 - $10,000 $10,001 - $100,000
❑ $100,001 - $1,000,000 ❑ Over $1,000,000
NATURE OF INVESTM T
❑ Stock ❑ er
(Describe)
❑ Partnership Income Received of $0 - $499
Q Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
_J / 12 _J� 12
ACQUIRED DISPOSED
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
e
FAIR MARKET VALUE
❑ $2,000 - $10,000 ❑ $10, $100,000
❑ $100,001 - $1,000,000 ❑ r $1,000,000
NATURE OF INVESTMENT
❑ Stock ❑ Other
(Describe)
❑ Partnership Q Inco Received of $0 - $499
O In a Received of $500 or More (Report on Schedule C)
IF APPLICABLE, L T DATE:
/ Z 1_ 1 12
ACQUIRED DISPOSED
FPPC Form 700 (2012/2013) Sch. A -1
FPPC Advice Email: adviceOfppc.ca.gov
FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov
❑
SCHEDULE B
Interests in Real Property
(Including Rental Income)
►
CITY
FAIR MARKET VALUE J IF APPLICABLE, LIST DATE:
❑ $2,000 - $10,000
❑ $10,001 - $100,000 - ACQUI RED DISPOSED
12 �/-� 12
000,001 - $1,000,000 ACQUIRED
❑ Over $1,000,000
NATO OF INTEREST
MI-Ownership/Deed of Trust ❑ Easement
❑ Leasehold ❑
Yrs. remaining
Other
IF RENTAL PROPERTY, GROSS INCOME RECEIVED
❑ $0 - $499 ❑ $500 - $1,000 ❑ $1,001 - $10,000
$10,001 - $100,000 ❑ OVER $100,000
SOURCES OF RENTAL INCOME: If you own a 10% or greater
interest, list the name of each tenant that is a single source of
income of $10,000 or more.
❑ Non J2 CLA_
e
► ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS
CITY
FAIR MARKET VALUE IF APPLICABLE, LIST DAT
❑ $2,000 - $10,000
❑ $10,001 - $100,000 12 -�--� 12
❑ $100,001 - $1,000,0oo ACQUIR DISPOSED
❑ Over $1,000,000
NATURE OF INTEREST
❑ Ownership /Deed of Trust ❑ Easement
❑ Leasehold ❑
Yrs. r aining Other
IF RENTAL PROPE Y, GROSS INCOME RECEIVED
❑ $0 - $499 ❑ $500 - $1,000 ❑ $1,001 - $t0,0oo
❑ $10,001 - 100,000 OVER $1ao,000
SOURCE OF RENTAL INCOME: If you own a 10% or greater
interes list the name of each tenant that is a single source of
inco of $10,000 or more.
❑ None
" You are not required to report loans from commercial lending institutions 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' I I NAME OF LENDER'
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF LENDER
INTEREST RATE
❑ None
(Months/Years)
HIGHEST BALANCE DURING RE�RTING PERIOD
❑ $500 - $1,000 ❑LS1,001 - $10,000
❑ $10,001 - $100,000 ❑ OVER $100,000
❑ Guarantor, if applicable
Comments:
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF
INTEREST RATE Z TERM (Months /Years)
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500 - $1,000 ❑ $1,001 - $10,000
❑ $10,001 - $100,000 ❑ OVER $100,000
❑ Guarantor, if applicable
FPPC Form 700 (2012/2013) Sch. B
FPPC Advice Email: advice @fppc.ca.gov
FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov