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Susan Rodriguez - Annual 2016Date al Filing Received • - • - 1 1 STATEMENT OF ECONOMIC INTERESTS nr off al Use 'ronly DOCUMENT FAIR POLITICAL PRACTICES COMMISSION A PUBLIC COVER PAGE Please type or print in ink. NAME OF FILER) (FIRST)�j, - n �pqp f 1. Office, Agenc , or Court Agency Na T a (Do not u acron Gi P� a n vwi rLat cvvL —I$ C, ; 0.,-) e-�- Division, Boar , epartment, District, if applicable--J Your Position P A VI t-11 i hA ► If filing for multiple positibrf list below or on an attachment. (Do not use acronyms) 2. Jurisdiction of Office (Check at least one box) ❑ State ❑ Multi- County ;?,city of �1 3. Type of Statement (Check at least one box) ,P-Innual: The period covered is January 1, 2016, through December 31, 2016. .or- The period covered is �� �, through December 31, 2016. ❑ Assuming Office: Date assumed ❑ Candidate: Election year � Ir =-I- ❑ Judge or Court Commissioner (Statewide Jurisdiction) F-1 County of ❑ Other ❑ Leaving Office: Date Left —J— I (Check one) 0 The period covered is January 1, 2016, through the date of leaving office. .or- 0 The period covered is —J I through the date of leaving office. and office sought, if different than Part 1: 4. Schedule Summary (must complete) ► Total number of pages including this cover page: Schedules attached ❑ Schedule A•1 - Investments – schedule attached ❑ Schedule A -2 - Investments – schedule attached ❑ Schedule B - Real Property – schedule attached .or- El None - No reportable interests on any schedule 'Schedule C - Income, Loans, & Business Positions – schedule attached ❑ Schedule D - Income – Gifts – schedule attached ❑ Schedule E - Income – Gifts – Travel Payments – schedule attached o. verirlcatlon MAILING ADDRESS STREET CITY STATE ZIP CODE (au ss or Agency Address R commended - Public ument) (2 mSn- G� 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. certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. AkIl Date Signed P7– Signature (month, day, year) (File the originally signed statem t Ah your fill oK 'al.) FPPC Form 700 (2016/2017) FPPC Advice Email: advice @fppc.ca.gov FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov IAW OF OF INCO�. SCHEDULE C Income, Loans, & Business Positions (Other than Gifts and Travel Payments) C_ NAME OF SOURCE OF INCOME . Address Acceptable) I I ADDRESS (Business Address Acceptable) OF SOURCE t I I BUSINESS ACTIVITY, IF ANY, OF SOURCE GROSS INCOME RECEIVED ❑ No Income ski iness Position ❑ $Soo - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 AqZVER $100,006 CONS ERATION FOR WHICH INCOME WAS RECEIVED al ry pouse'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 grope* car, boat, etc.) ❑ Loan repayment ❑ Commission or ❑ Rental Income, list each source or $10,000 or more (Describe) YOUR BUSINESS POSITION GROSS INCOME RECEIVED ❑ No Income - Business Position Only ❑ $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 pmpe* car, boat etc.) ❑ Loan repayment ❑ Commission or ❑ Rental Income, list each source or $10,000 or more (Desolbe) ❑ Other I I ❑ Other (Desdrbej ( De—be) a• s •- a � s -e- - •� * 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 Comments: INTEREST RATE TERM (Months/Years) ❑ None SECURITY FOR LOAN ❑ None ❑ Personal residence ❑'Real Property Street address City ❑ Guarantor ❑ Other (Describe) FPPC Form 700 (2016/2017) Sch. C 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) NAME OF SOURCE OF INCOME of 7� SS (Busi ass dress Acceptable) C,��VtacJt/?G�� BUSINESS ACTIVITY IF ANY, SO RCE `- Y U B INESS POSIT10f. t r ]l� I Vk GROSS INCO E RECEIVED ❑ No Income - Business Position Only ❑ $500 - $1,000 ❑ $1,001 - $10,000 $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED glary ❑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 or $10,000 or more (Describe) NAME O SOURCE OF NCOM wrt*vn\A i ie, t6lr,�111_+Imlll BQDRES ( usine ;s Address A�table) BUSrI SS ACTIVITY, IF A N , OF SOURCE YOUR BUSINESS POSITION 0 GROSS INCOME RECEIVED—[] No Income - BusirVss Position Only ❑ $500 - $1,000 1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 C---------O,,,,,, ///NNSIDERATION FOR WHICH INCOME WAS RECEIVED glary ❑ 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 or $10,000 or.more (Describe) ❑ Other I I C] Other (Describe) (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. 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 Comments: INTEREST RATE TERM (Months/Years) % ❑ None SECURITY FOR LOAN ❑ None ❑ Personal residence ❑ Real Property Guarantor ❑ Other Street address City (Describe) FPPC Form 700 (2016/2017) Sch. C FPPC Advice Email: advice @fppc.ca.gov FPPC Toll -Free Helpline:866 /275 -3772 www.fppc.ca.gov Jun 07 17 11:56a Please type or print in ink. NArAE of FILER ILASTI 1. Office, Agency Na (Do not u 6�, Division Boar , partm 0a. hi If filing for multiple po 4Z Court auony� ant. District, if ap, STATEMENT OF ECONOMIC INTERESTS COVER PAGE (FIRST) - PTan wi Your Position list below or on an attachment. (Do not use acronyms) Position Initia. aec "r:1r tx•> orz, pn ,S,LRU,, CA 0t 7-0 C'cr�i SC,i 0-,-) ev— 2. Jurisdiction of Office (Check at least one box) ❑ State ❑ Judge or Cour, Commissioner (Statewide Jurisdiction) ❑ Malti- County ❑ County o` 105ty of ❑ Other 3. Type of Statement (Check at least one box) "PIAnnual: The period covered is January 1, 2015, through -or- December 31, 2016. �I( The period covered is I � through December 31, 2016. ❑ Assuming Office: Cate assumed ❑ Candidate: Election year ❑ Leaving Office: Dave Left I (Check one) O The period covered s :anuary t, 2016, through the date of -or- leaving off ce. O The period covered .s % f through the date of leavirg office. and office sought, if different than Part 1: 4. Schedule Summary {must complete) ► Total number of pages including this cover page: Z _ Schedules aftached ❑ Schedule A -1 - Investments - schedule attached ❑ Schedufe A -2 - Investments - schedule attached ❑ Schedule B - Re21 P,'operty - schedule attached -or- ❑ None - No reportable interests on any schedule ,EEJ1chedule C - Income, Loans, & Susiness Positions - schedule attached ❑ Schedule D - Income - Gifts - schedule attached ❑ Schedule E - Income - Gifts - Travel Payments - schedule attached 5. Verification MAILING ADDRESS STREET CITY STATE Z!P CODE (890#ss Of Agenc,, Aedress P commended - PL;bl c owrnent) DOWTIME ) PHO— / NUMR 7BE1 —7 7� I E. UAL (Z ,I 10-o' 6— I have used all reasonable diligerce in preparing this statement. I have reviewed this staterent 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 documen-. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date Signed `` Signature MWM' cay yeaq (file theodgparty sgred stalem X your ar, al.l FPPCF m 700(2016/2017) FPPC Advice Email: advice @fppc.ca.gov FPPC Toll-Free Helpline: 866 /275 -3772 vrww.fppc.ca.gov Jun 071711:56a p.2 SCHEDULE C • - • - 1' a Income, Loans, & Business ' Positions Name r (Other than Gifts and Travel Payments) -511tso"t /�d►�l NAME OF SOURCE OF INCOME 5�� of u CI evm -I (VY,, ADDRESS (8usi ss dress Aceeptabte BUSINESS ACTIVITY IF ANY, SO RCE _ (_ Y B INESS POSI VU ats GROSS INCOh1E RECEIVED [j No Income - Business Position Only ❑ $500 - $1.000 p $1,001 - $10,000 '10,001 - $100,000 ❑ OVER S100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED alary ❑ Spouse's or registered domestic partner's income (For self- employed use Schedule A -2.) ❑ Partnership (Less than 10% ownership. For 10% or greater use Schedule A -2.) ❑ Sale of ❑ Loan repayment (Reel properly, cot, boat, etc,, ❑ Commission or ❑ Rental Income, lW each source of sf0,000 or more (Desrnbel NAME Of SOURCE OF jNCOME,, DR 5 ($usire: Address 0 table) c 076 BUSiNUs ACTMTY, IF ANY, OF SOURCE _ 1 _ YOUR BUSINESS POS P rION GROSS IN OME RECEIVE ❑ No Inoome Busi. Pcsition Only ❑ $50C - $1,000 '$11001 - S10,000 ❑ $10,001 - $100,000 ❑ OVER $140,000 � CONSIDERATION FOR WHICH INCOME WAS RECEIVED ,,, Salary ❑ Spouse's or reg'stered domestic partner's income (For self -tmployed use Schedule A -2.) ❑ Partnership (Less than 10% ownership. For 10% or greater use Schedule A -2.► ❑ Sale of (Rear propery, ear. boat. etc; ❑ loan repayment ❑ Commission or ❑ Rental income, rsr eacb source oe $10,000 or more (Describe) ❑ Other I I ❑ Other (Describe) i ( Descrbe) 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 (Susiress Address Acceptabfe) .BUSINESS ACTIVITY, IF ANY, OF LENDER HIGHEST BALANCE DURING REPORTING PERIOD ❑ $500 - $1,000 ❑ $1,001 -S10.000 ❑ $10,001 - $100,000 ❑ OVER $100,000 Comments: INTEREST RATE TERM (MonthsiYears) % ❑ None SECURITY FOR LOAN ❑ None ❑ Personal residence ❑ Real Property SL2d address Ob 0 Guaran :or Other ( Descrrbe) FPPC Form 700 (2026/2027) Sch. C FPPC Advice Email: advice @fppe.ca -goer FPPC Toll -Free Helpline: 866 /275.3772 WWW.fppc.ca -gov Jun 071711:56a p:3 SCHEDULE C Income, Loans, & Business Positions (Other than Gifts and Travel Payments) GROSS INCOME RECEIVED [] No Income -NeVk1ness Positio [] $500 - $1,000 [] $1,001 - S1o.000 ❑ S10.001 - $100,000 -�VVER $100,000 CONS FOR WHICH INCOME WAS RECEIVED Glary use's or registered domestic partner's income U (For self- employed use Schedule A-2.) LJ Pannership (Less than 10% ownership. For 10% or greater use Schedule A -2.) ❑ Sale of (Rea'praperry, Cdr, boat etc,} Loan repayment ❑ Commission or ❑ Rental Income, rsr each source of S10,000 or more BUSINESS ACTIVITY, IF ANY, OF SOURCE YOUR BUSINESS POSITION GROSS INCOME RECEIVED No tncome - Business Position Only ❑ $500 - $1,000 a $1,001 - $10,000 $10,001 - 5100,000 OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary E] 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.) Rental .Income, list each scume or S 10.000 or more (Describe) Other (Describe) * You are not required to report loans from commercial fending 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 Q OVER $100,000 Comments: INTEREST RATE % [] None TERM (Months/Years) SECURITY FOR LOAN El None 0 Personal residence Real Property SUearaaaless ❑ Guarantor ❑ Other Croy (Describe) FPPC Form 700 (201612M7) Sch. C FPPC Advice Email: advice @fppc- ca.gov FPPCTall -Free Helpline:866/2753772 www.fppc.ca.gov