HomeMy WebLinkAboutDon Gage - Candidate 2012J�
STATEMENT OF ECONOMIC INTERESTS SUP 20te Received
l( CLERKF r
COVER PAGE
Please type or print in ink.
NAME OF FILER (LAST) (FIRST) (MIDDLE)
1. Office, Agency, or Court
Agency Name
01-re
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
❑ Multi- County
Xcity of (21 GAO V
❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ County of
❑ Other
3. Type of Statement (Check at least one box)
❑ Annual: The period covered is January 1, 2011, through ❑ Leaving Office: Date Left — I
December 31, 2011. (Check one)
-or-
The period covered is I through O The period covered is January 1, 2011, through the date of
December 31, 2011. leaving office.
❑ Assuming Office: Date assumed I 1 O The period covered is t. through
the date of leaving office.
ay 2k Candidate: Election Year � Office sought, if different than Part 1: m4 Yb Q
4. Schedule Summary
Check applicable schedules or "None. " ► Total number of pages including this cover page:
❑ 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 CODE
(Business or Agency Address Recommended - Public Document)
_ w
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 foregoi ' true and correct.
Date Signed a Q ' 3'. I ?' Signature .4. 946,5-�
(month, day, year) (File the originally signed statement with yo r ing 01160
FPPC Form 700 (2011/2012)
FPPC Toll -Free Helpline: 866 /275 -3772 www.fppc.ca.gov
SCHEDULE B
Interests in Real Property
(Including Rental Income)
► ASSESSOR'S PARCEL NUMBER OR STREET
CITY
G LRnY. C'A
4's0zo
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 9 $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.
< 4601 r #aN 10212 1 AMAEfr
Name
W&) 6AC115
► ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS
CITY
FAIR MARKET VALUE
❑ $2,000 - $10,000
❑ $10,001 - $100,000
❑ $100,001 - $1,000,000
❑ Over $1,000,000
NATURE OF INTEREST
❑ Ownership /Deed of Trust
❑ Leasehold
IF APPLICABLE, LIST DATE:
ACQUIRED DISPOSED
❑ Easement
LE
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.
* 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 TERM (Months /Years)
% ❑ None
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 (201112012) Sch. B
FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov