Patricia Bentson - Annual 2017101500115 —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
021054008
Filing ID:
Please type or print in ink.
168587296
NAME OF FILER (LAST)
(FIRST)
(MIDDLE)
Bentson, Patricia
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
City of Gilroy
Division, Board, Department, District, if applicable
Your Position
Parks & Recreation Commission
Commissioner
► 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)
❑
x Annual: The period covered is January 1, 2017, through
December 31, 2017
-or-
The period covered is 01 / 24 1 2017, through
December 31, 2017
❑ Assuming Office: Date assumed I I
❑ Leaving Office: Date Left I
(Check one)
O The period covered is January 1, 2017, through the date of
leaving office.
p 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: 5
Schedules attached
❑
x Schedule A -1 - Investments — schedule attached ❑Q 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 02/06/2018
(month, day, year)
Signature Patricia Bentson
(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
McCormick & Company
GENERAL DESCRIPTION OF THIS BUSINESS
Spices
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:
01 / 01/ 89
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
Bentson, Patricia
► 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
► 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
1209 Bonino Way
CITY
GILROY
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
❑ $2,000 - $10,000
❑ $10,001 - $100,000 09 / 29
❑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
Bentson, Patricia
► 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
101500115 —NFH -0115
SCHEDULE C
Income, Loans, & Business
Positions
(Other than Gifts and Travel Payments)
NAME OF SOURCE OF INCOME
City of Gilroy
ADDRESS (Business Address Acceptable)
7351 Rosanna Street
Gilroy, CA 95020
BUSINESS ACTIVITY. IF ANY OF SOURCE
Municipal government
YOUR BUSINESS POSITION
Retiree
GROSS INCOME RECEIVED ❑ No Income - Business Position Only
❑ $500 - $1,000 X❑ $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 property car, boat, etc.)
Loan repayment
❑ Commission or ❑ Rental Income, list each source of $10,000 or more
FX Other Longevity
(Describe)
(Describe)
Name
Bentsen, Patricia
NAME OF SOURCE OF INCOME
Lane Bryant Outlet
ADDRESS (Business Address Acceptable)
8375 Arroyo Circle
Gilroy, CA 95020
BUSINESS ACTIVITY. IF ANY. OF SOURCE
Retail
YOUR BUSINESS POSITION
Part time sales associate
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
Q 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 property, car, boat, etc.)
Loan repayment
❑ Commission or ❑ Rental Income, list each source of $10,000 or more
❑ 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`
Caliber Home Loans
ADDRESS (Business Address Acceptable)
3701 Regent Boulevard
Irving, TX 75063
BUSINESS ACTIVITY, IF ANY, OF LENDER
Real Estate Lender
HIGHEST BALANCE DURING REPORTING PERIOD
$500 - $1,000
$1,001 - $10,000
$10,001 - $100,000
0 OVER $100,000
Comments:
INTEREST RATE
4 % ❑ None
TERM (Months/Years)
30 Years
SECURITY FOR LOAN
❑ None ❑X Personal residence
❑ Real Property
❑ Guarantor
❑ Other
Street address
City
(Describe)
FPPC Form 700 (2017/2018) Sch. C
FPPC Advice Email: advice @fppc.ca.gov
FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov
101500115 —NFH -0115
SCHEDULE C
Income, Loans, & Business
Positions
(Other than Gifts and Travel Payments)
NAME OF SOURCE OF INCOME
Ca1PERS
ADDRESS (Business Address Acceptable)
400 Q Street
Sacramento, CA 95811
BUSINESS ACTIVITY, IF ANY, OF SOURCE
California Public Employee Retirement System
pension administration
YOUR BUSINESS POSITION
Retiree
GROSS INCOME RECEIVED No Income - Business Position Only
❑ $500 - $1,000 $1,001 - $10,000
RX $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 property, car, boat, etc.)
Loan repayment
❑ Commission or ❑ Rental Income, list each source of $10,000 or more
RX Other Pension
(Describe)
(Describe)
Name
Bentson, Patricia
NAME OF SOURCE OF INCOME
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY. IF ANY OF SOURCE
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 property, car, boat, etc.)
Loan repayment
❑ Commission or ❑ Rental Income, list each source of $10,000 or more
❑ 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 (2017/2018) Sch. C
FPPC Advice Email: advice @fppc.ca.gov
FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov