Susan Rodriguez - 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
010:20:98
Filing ID:
Please type or print in ink.
170179810
NAME OF FILER (LAST)
(FIRST)
(MIDDLE)
Rodriguez, Susan Elizabeth
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
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.
(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 / 1 through
December 31, 2017
❑ Assuming Office: Date assumed I I
❑ Leaving Office: Date Left I 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: 2
Schedules attached
❑ 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
❑ 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 03/26/2018
(month, day, year)
Signature Susan Elizabeth Rodriguez
(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 C
Income, Loans, & Business
Positions
(Other than Gifts and Travel Payments)
NAME OF SOURCE OF INCOME
Santa Clara Valley Medical Center
ADDRESS (Business Address Acceptable)
751 S Bascom Ave
San Jose , CA 95128
BUSINESS ACTIVITY. IF ANY OF SOURCE
Acute Care Hospital
YOUR BUSINESS POSITION
Respiratory Therapist
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
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)
Name
Rodriguez, Susan Elizabeth
NAME OF SOURCE OF INCOME
Good Samaritan Hospital
ADDRESS (Business Address Acceptable)
2425 Samaritan Dr
San Jose , CA 95124
BUSINESS ACTIVITY, IF ANY, OF SOURCE
Acute Care Hospital
YOUR BUSINESS POSITION
Respiratory Therapist
GROSS INCOME RECEIVED
❑ No Income - Business Position Only
❑ $500 - $1,000
❑ $1,001 - $10,000
❑ $10,001 - $100,000
MX OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
Salary Q 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