Susan Martin - Assuming Office 2013•or-
❑ None - No reportable interests on any schedule
5. Verification
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business or Agency Address Recommended - Public Document)
DAYTIME TELEPHONE NUMBER E-MAIL ADDRESS (OPTIONAL)
(510 ) 5151` -DI 56
1 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 J :F;,--/I- Signature
(r month, day, year) (Fite Ne aiiary signed statement with your Ming official.)
FPPC Form 700 (2012/2013)
FPPC Advice Email: advice Ofppc. ca. gov
FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov
CALIFORNIA FORm7OO STATEMENT OF ECONOMIC INTERESTS
FAIR POLITICAL COMMISSION
A PUBLIC DOCUMENT
COVER PAGE r
Please type or print in ink.
NAME OF FILER (LAS
(FIRST) (MIDDLE)
1. Office, Agency, or Court
Agency Name
Division, Bo rd, Department, District if applicable
�l G�VIVI t f i a✓1
Yo4Ir Position
P IGt Vl VI t i1 r'i olul cx ef-
► If filing for multiple positions, list below or on an attachment.
Agency:
Position:
2. Jurisdiction of Office (Check at least one box)
❑ State
❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ Multi-County
❑ County of
[� City of ('51 t 11r0SA
❑ Other
3. Type of Statement (Check at least one box)
❑ Annual: The period covered is January 1, 2012, through
❑ Leaving Office: Date Left I I
December 31, 2012.
(Check one)
-or-
The period covered is If I
through O The period covered is January 1, 2012, through the date of
December 31, 2012.
leaving office.
%Assuming Office: Date assumed —71 1 O The period covered is I I through
the date of leaving office.
❑ Candidate: Election year and office sought, if different than Part 1:
4. Schedule Summary
Check applicable schedules or "None."
► Total number of pages including this cover page:
ER 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
(Business or Agency Address Recommended - Public Document)
DAYTIME TELEPHONE NUMBER E-MAIL ADDRESS (OPTIONAL)
(510 ) 5151` -DI 56
1 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 J :F;,--/I- Signature
(r month, day, year) (Fite Ne aiiary signed statement with your Ming official.)
FPPC Form 700 (2012/2013)
FPPC Advice Email: advice Ofppc. ca. gov
FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov
SCHEDULE A -1 FORM 7001
Investments FAIR POLITICAL
Stocks, Bonds, and Other Interests Name
(Ownership Interest is Less Than 10 %) �r/l��✓1 LAG M�
Do not attach brokerage or financial statements.
► NA E QF BUSINESS ENTITY
AT i 'l-
GE(NEERAL DESCRIPTION OF BUSINESS ACTIVITY
FAIR MARKET VALUE
❑ $2,000 - $10,000 g$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
Q Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
I / 12 _/ / 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
(Describe)
❑ Partnership Q Income Received of $0 - $499
Q Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
l 12 1 / 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
(Describe)
❑ Partnership Q Income Received of $0 - $499
Q Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
_/ / 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 INVESTMENT
❑ Stock ❑ Other
(Describe)
❑ Partnership Q Income Received of $0 - $499
Q Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
1 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
(Describe)
❑ Partnership Q Income Received of $0 - $499
Q Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
_I _/ 12 —J 1 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
(Describe)
❑ Partnership Q Income Received of $0 - $499
Q Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
j___1_12 —/_ / 12
ACQUIRED DISPOSED
FPPC Form 700 (2012/2013) Sch. A -1
FPPC Advice Email: advice @fppc.ca.gov
FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov