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HomeMy WebLinkAboutDon Gage - Assuming Office 201219/2G12 /11i1N 11:03 AM FA's No, STATEMENT OF ECONOMIC INTERESTS COVER PAGE P. 1. r IAI 2v'e .� �¢n1 r�is Please type or print In Ink. NAME OF FILER (LAST) (FIRST) (MIDDLE) Go' -AGE ow c t) 1. Office, Agency, or Court Agency Name Division, Board, Department, District, if applicable Your Position ■ If filing for multiple positions, list below or on an attachment. Agency: Position: 2. Jurisdiction of Office (check at least one box) ❑ State [j Judge or Court Commissioner (Statewide Jurisdiction) ❑ Multi- County _ ❑ County of City of L ❑ Other — 3. Type of Statement (Check at least one box) ❑ Annual: The period covered is January 1, 2011, through © Leaving Office: pate Left I I December 31, 2011. (Check one) -er• The period covered is I I through O The period covered Is January 1, 2011, through the date of December 31, 2011. leaving office, Assuming Office: Date assumed 71 012 O The period covered is I I through the date of leaving office. ❑ Candidate: Election Year Office sought, if different than Part 1, 4. Schedule Summary Check applicable schedules or "None." 10- Total number of pages including this cower page: z' Q 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- El None - No reportable interests on any schedule 5. Verification MAILING ADDRESS STREET CITY STATE ZIP GODE (Business or Agency Addrass Re00nlmended - PuWle Owumeni) DAYTIME TELEPHONE NUMBER E -MAIL ADDRESS (OPTIONAL) ( ) 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 tinder penalty of porjury under the laws of the State of California that the foregoing Is true and correct. Date Signed �` ( Signature pwih, ak yeaQ (Ella i6a ong nsky:igned itefelnant a+f y it 6N� lNcl &.) FPPG Farm 700 (2011/2012) FPPG Toll -Free Helpllne: 8661275 -3772 www.fppc.ca.gov NOV/ 19'2012AlON 11:03 AM FA's Pdo, P. 002 SCHEDULE B Interests in Real Property (including Rental Income) ► ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS 844D i� %IcJL CITY FAIR MARKET VALUE IF APPLICABLE, LIST DATE: Il $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 X $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. CALIFORNIA FOPm 700 FAIR POLII ICAL PRAUIICFS COMMISSION F ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS CITY FAIR MARKET VALUE ❑ szo00 - $10,000 ❑ $10,001 . $104,000 ❑ $100,001 • $1,000,000 ❑ Over $1,000,000 NATURE OF INTEREST ❑ Ownership /heed of Trust IF APPLICABLE, LIST OATS, ACQUIRED DISPOSED ❑ Easement ❑ Leasehold ❑ Tra. 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, 6:55 J A) /0910' mjnq r I I-- k 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 (SuSiness AddreSS ACC&PhWa) BUSINESS ACTIVITY, IF ANY, OF LENDER INTEREST RATE TERM (Moiiths/Yeara) 95 ❑ None HIGHEST BALANCE DURING REPORTING PERIOD ❑ $500 - $1,000 ❑ $1,001 - $10,D00 ❑ $10,001 - $100,000 Q OVER $100,000 ❑ Guarantor, If applicable Commonts: NAME OF LENDER' ADORES'$ (eUsmess Address AccoptaAle) BUSINESS ACTIVITY, IF ANY, OF LENDER INTEREST RATE TERM (Months/YCars) % ❑ None -- HIGHEST BALANCE DURING REPORTING PERIOD $500 - $1,000 ❑ $1,001 - $10,000 ❑ $1o,001 - $1oo,0oo ❑ OVER $100,000 [] Guarantor, If applicable FPPC Form 700 (201112012) Sch. B FPPC loll -Free Halpllne: 8615/275 -3772 www.fppc.ca.gov