Domingo Chavez - Assuming 2018101500115 -NFH -0115
Date Initial Filing
Received
CALIFORNIA • - 700 STATEMENT OF ECONOMIC INTERESTS
Official Use Only
POLITICAL FAIR • •
E -Filed
A PUBLIC D. CUMENT
COVER PAGE
013:113:27$
Filing ID:
Please type or print in ink.
167979959
NAME OF FILER (LAST)
(FIRST)
(MIDDLE)
Chavez, Domingo Orlando
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
City of Gilroy
Division, Board, Department, District, if applicable
Your Position
Physically Challenged Board
Boardmember
► If filing for multiple positions, list below or on an attachment.
(Do not use acronyms)
Agency:
Position:
2. Jurisdiction of Office (Check at least one box)
❑ State
❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ Multi- County
❑ County of
❑x City of Gilroy
❑ Other
3. Type of Statement (Check at /east one box)
❑ Annual: The period covered is January 1, 2017, through ❑ Leaving Office: Date Left I I
-or-
December 31, 2017 (Check one)
The period covered is 1 through O The period covered is January 1, 2017, through the date of
December 31, 2017 leaving office.
❑Q Assuming Office: Date assumed 01 1 09 12018 O The period covered is I through the date
of leaving office.
❑ Candidate:Date of Election and office sought, if different than Part 1:
4. Schedule Summary (must complete) P. Total number of pages including this cover page: 3
Schedules attached
❑
x 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
❑
x Schedule B - Real Property — schedule attached ❑ Schedule E - Income — Gifts — Travel Payments — schedule attached
-or-
El None - No reportable interests on any schedule
5. Verification
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business or Agency Address Recommended - Public Document)
Gilroy CA 95020
DAYTIME TELEPHONE NUMBER E -MAIL ADDRESS
(
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 01/14/2018
(month, day, year)
Signature Domingo Orlando Chavez
(File the originally signed statement with your filing official.)
FPPC Form 700 (2017/2018)
FPPC Advice Email: advice @fppc.ca.gov
FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov
101500115 —NFH -0115
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
PG &E
GENERAL DESCRIPTION OF THIS BUSINESS
Stocks
FAIR MARKET VALUE
❑ $2,000 - $10,000 ❑x $10,001 - $100,000
❑ $100,001 - $1,000,000 ❑ Over $1,000,000
NATURE OF INVESTMENT
❑X Stock ❑ Other
(Describe)
❑ Partnership 0 Income Received of $0 - $499
0 Income Received of $500 or More (Report on schedule C)
IF APPLICABLE, LIST DATE:
ACQUIRED DISPOSED
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS
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 0 Income Received of $0 - $499
0 Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
ACQUIRED DISPOSED
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS
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 0 Income Received of $0 - $499
0 Income Received of $500 or More (Report on schedule C)
IF APPLICABLE, LIST DATE:
ACQUIRED DISPOSED
Comments:
Name
► NAME OF BUSINESS ENTITY
Chavez, Domingo Orlando
GENERAL DESCRIPTION OF THIS BUSINESS
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 0 Income Received of $0 - $499
0 Income Received of $500 or More (Report on schedule C)
IF APPLICABLE, LIST DATE:
ACQUIRED DISPOSED
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS
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 0 Income Received of $0 - $499
0 Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
ACQUIRED DISPOSED
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS
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 0 Income Received of $0 - $499
0 Income Received of $500 or More (Report on schedule C)
IF APPLICABLE. LIST DATE:
ACQUIRED DISPOSED
FPPC Form 700 (2017/2018) Sch. A -1
FPPC Advice Email: advice @fppc.ca.gov
FPPC Toll -Free Helpline: 866 /275 -3772 www.fppc.ca.gov
101500115 -NFH -0115
►
SCHEDULE B
Interests in Real Property
(Including Rental Income)
4SSESSOR'S PARCEL NUMBER OR STREET ADDRESS
726 W 9th St
CITY
Gilroy
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
❑ $2,000 - $10,000
❑ $10,001 - $100,000 03 / 30 /_.15
❑X $100,001 - $1,000,000 ACQUIRED DISPOSED
❑ Over $1,000,000
NATURE OF INTEREST
❑
X 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.
❑ None
Name
Chavez, Domingo Orlando
► ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS
CITY
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
❑ $2,000 - $10,000
❑ $10,001 - $100,000 - / -/-
❑ $100,001 - $1,000,000 ACQUIRED DISPOSED
❑ Over $1,000,000
NATURE OF INTEREST
❑ 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.
❑ 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*
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY. IF ANY. OF LENDER
INTEREST RATE
% ❑ None
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
Comments:
NAME OF LENDER*
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY. IF ANY. OF LENDER
INTEREST RATE
% ❑ None
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 (2017/2018) Sch. B
FPPC Advice Email: advice @fppc.ca.gov
FPPC Toll -Free Helpline: 866 /275 -3772 www.fppc.ca.gov