Loading...
CA Form 700 Statement of Economic Interests - Brooks . Date Initial Filing Received CALIFORNIA FORM 700 STATEMENT OF ECONOMIC INTERESTS <ffk;le Use c.);,iv FAIR POLITICAL PRACTICES COMMISSION A PUBLIC DOCUMENT COVER PAGE Please type or print in ink. NAME OF FILER (LAST) (FIRST) (MIDDLE) Brooks Susan M. 1. Office, Agency, or Court Agency Name (Do not use acronyms) City of Rancho Palos Verdes Division,Board,Department, District, if applicable Your Position City Council Mayor/Member/Commissioner ► If filing for multiple positions, list below or on an attachment. (Do not use acronyms) Agency: See Attached Exhibit A Position: 2. Jurisdiction of Office (Check at least one box) ❑State ❑Judge or Court Commissioner(Statewide Jurisdiction) ❑Multi-County ❑County of 0 City of Rancho Palos Verdes ❑Other 3. Type of Statement (Check at least one box) 0 Annual: The period covered is January 1, 2017,through ❑ Leaving Office: Date Left—lam December 31, 2017. (Check one) -or- The period covered is—J J ,through 0 The period covered is January 1,2017,through the date of December 31,2017. leaving office. -o r- ❑ Assuming Office: Date assumed—_J--I 0 The period covered is______L______J ,through the date of leaving office. ❑ Candidate: Date of Election and office sought, if different than Part 1: 4. Schedule Summary (must complete) ► Total number of pages including this cover page: Schedules attached chedule A-1 -Investments—schedule attached ❑Schedule C-Income, Loans, &Business Positions—schedule attached chedule 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- 0 None - No reportable interests on any schedule 5. Verification MAILING ADDRESS STREET CITY STATE ZIP CODE (Business or Agency Address Recommended-Public Document) 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. © ©l Si nature Date Signed r 9 ( ------ (month,day,year) (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 • Exhibit A 2017 STATEMENT OF ECONOMIC INTERESTS — FORM 700 COVER PAGE ATTACHMENT FOR EXPANDED STATEMENT Mayor Susan Brooks Agency: Palos Verdes Transit Authority (Leaving) Sanitation Districts (Dist. No. 5 & So. Bay San. Dist.) Position title: Board Member (Annual) 1 SCHEDULE A-I CALIFORNIA FORM700 Investments FAIR POLITICAL PRACTICES COMMISSION Stocks, Bonds, and Other Interests Name (Ownership Interest is Less Than 10%) Do not attach brokerage or financial statements. ► NAME OF BUSINESS ENTITY ► NAME OF BUSINESS ENTITY , , ,, / 79"P/X-f2.- elAill ...—• Allad&w........:-Alt— GENERAL DESCRIPTION OF THIS BUSINESS GENERAL DESCRIPTION O THIS BUSINESS AIR MARKET VALUE) 4.. FAIR MARKET VALUE 2($2,000-$10,000 [1]$10,001 -$100,000 $2,000-$10,000 0$10,001 -$100,000 111 $100,001 -$1,000,000 1=1 Over$1,000,000 El$100,001 -$1,000,000 ❑Over$1,000,000 FATURAT RE OF INVESTMENT E OF INVESTMENT Stock ❑Other tock I:]Other (Describe) (Describe) ❑ Partnership 0 Income Received of$0-$499 ❑ Partnership 0 Income Received of$0-$499 O Income Received of$500 or More(Report on Schedule C) 0 Income Received of$500 or More(Report on Schedule C) IF APPLICABLE, LIST DATE: IF APPLICABLE,LIST DATE: I(' 1_1_1 17 _______/_/ 17 Xt I, / 17 �� 17 ACQUIRED DISPOSED QUIRED DISPOSED ► NAME OF BUSINESS ENTITY ► NAME OF BUSINESS ENTITY GENERAL DESCRIPTION OF THIS BUSINESS GENERAL DESCRIPTION OF THIS BUSINESS FAIR MARKET VALUE FAIR MARKET VALUE 0$2,000-$10,000 0 $10,001 -$100,000 0 $2,000-$10,000 ❑$10,001 -$100,000 ❑$100,001 -$1,000,000 ❑ Over$1,000,000 ❑ $100,001 -$1,000,000 ❑Over$1,000,000 NATURE OF INVESTMENT NATURE OF INVESTMENT ❑ Stock ❑Other ❑ Stock ❑Other (Describe) (Describe) ❑ Partnership 0 Income Received of$0-$499 ❑ Partnership 0 Income Received of$0-$499 Q Income Received of$500 or More(Report on Schedule C) 0 Income Received of$500 or More(Report on Schedule C) IF APPLICABLE,LIST DATE: IF APPLICABLE,LIST DATE: __/__/ 17 _jam 17 ___/__/ 17 _J__/ 17 ACQUIRED DISPOSED ACQUIRED DISPOSED I. NAME OF BUSINESS ENTITY ► NAME OF BUSINESS ENTITY GENERAL DESCRIPTION OF THIS BUSINESS GENERAL DESCRIPTION OF THIS BUSINESS FAIR MARKET VALUE FAIR MARKET VALUE 0$2,000-$10,000 0 $10,001 -$100,000 0$2,000-$10,000 0$10,001 -$100,000 ❑$100,001 -$1,000,000 ❑Over$1,000,000 ❑$100,001 -$1,000,000 ❑Over$1,000,000 NATURE OF INVESTMENT NATURE OF INVESTMENT ❑ Stock ❑Other ❑ Stock ❑Other (Describe) (Describe) ❑ Partnership 0 Income Received of$0-$499 ❑ Partnership 0 Income Received of$0-$499 Q Income Received of$500 or More(Report on Schedule C) 0 Income Received of$500 or More(Report on Schedule C) IF APPLICABLE,LIST DATE: IF APPLICABLE,LIST DATE: __/ j17 __/_j17 _J j17 _______/_____/ 17 ACQUIRED DISPOSED ACQUIRED DISPOSED Comments: 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 SCHEDULE A-2 CALIFORNIA FORM 700 Investments, Income, and Assets FAIR POLITICAL PRACTICES COMMISSION Name of Business Entities/Trusts (Ownership Interest is 10% or Greater) tc..0714-4.0. ► 1.BUSINESS ENTITY OR TRUST ► 1. BUSINESS ENTITY OR TRUST te. J Name "Name Address(Business Address Acceptable) Check one Check one ❑ Trust,go to 2 .-Business Entity, complete the box, then go to 2 0 Trust,go to 2 0 Business Entity, complete the box, then go to 2 GENERAL DESCRIPTION OF THIS BUSINESS GENERAL DESCRIPTION OF THIS BUSINESS FAIR MARKET VALUE IF APPLICABLE, LIST DATE: FAIR MARKET VALUE IF APPLICABLE,LIST DATE: ❑$0-$1,999 ❑$0-$1,999 Di4 '1‘$2,000-$10,000 / 0 17 / /17 ❑$2,000-$10,000 / /17 ___j_/17 ''S3410,001 -$100,000 ACQUIRED DISPOSED ❑$10,001 -$100,000 ACQUIRED DISPOSED $100,001 -$1,000,000 ❑ $100,001 -$1,000,000 ❑ Over$1,000,000 ❑Over$1,000,000 NATURE OF INV TMENT NATURE OF INVESTMENT ❑Partnership I'1 le Proprietorship ❑ Other El Partnership ❑Sole Proprietorship ❑ Other YOUR BUSINESS POSITION e1 :l C YOUR BUSINESS POSITION ►2.IDENTIFY THE GROSS INCOME RECEIVED(INCLUDE YOUR PRO RATA ► 2. IDENTIFY THE GROSS INCOME RECEIVED(INCLUDE YOUR PRO RATA SHARE OF THE GROSS INCOME TO THE ENTITY/TRUST) SHARE OF THE GROSS INCOME TO THE ENTITY/TRUST) ❑ $0-$499 ❑ $10,001 -$100,000 ❑$0-$499 ❑$10,001 -$100,000 ❑ $500-$1,000 ❑ OVER$100,000 ❑$500-$1,000 ❑OVER$100,000 ❑ $1,001 -$10,000 ❑ $1,001 -$10,000 ► 3. LIST THE NAME OF EACH REPORTABLE SINGLE SOURCE OF ► 3. LIST THE NAME OF EACH REPORTABLE SINGLE SOURCE OF INCOME OF$10,000 OR MORE(Attach a separate sheet if necessary.) INCOME OF$10,000 OR MORE(Attach a separate sheet if necessary.) ❑ None or ❑ Names listed below ❑None or • Names listed below ►4.INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD OR ►4. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD OR LEASED BY THE BUSINESS ENTITY OR TRUST LEASED BY THE BUSINESS ENTITY OR TRUST Check one box: Check one box: ❑ INVESTMENT ❑ REAL PROPERTY ❑ INVESTMENT ❑ REAL PROPERTY Name of Business Entity,if Investment,or Name of Business Entity,if Investment,or Assessor's Parcel Number or Street Address of Real Property Assessor's Parcel Number or Street Address of Real Property Description of Business Activity or Description of Business Activity or City or Other Precise Location of Real Property City or Other Precise Location of Real Property FAIR MARKET VALUE IF APPLICABLE, LIST DATE: FAIR MARKET VALUE IF APPLICABLE,LIST DATE: 0$2,000-$10,000 ❑ $2,000-$10,000 1717 ❑$10,001 -$100,000 _/_/ 17 _f_/17 ❑ $10,001 -$100,000 / / i / ❑$100,001 -$1,000,000 ACQUIRED DISPOSED ❑ $100,001 -$1,000,000 ACQUIRED DISPOSED ❑Over$1,000,000 ❑ Over$1,000,000 NATURE OF INTEREST NATURE OF INTEREST ❑Property Ownership/Deed of Trust ❑ Stock ❑ Partnership ❑ Property Ownership/Deed of Trust ❑Stock ❑Partnership ❑Leasehold ❑ Other ❑ Leasehold ❑Other Yrs.remaining Yrs.remaining ❑Check box if additional schedules reporting investments or real property ❑ Check box if additional schedules reporting investments or real property are attached are attached FPPC Form 700(2017/2018)Sch.A-2 Comments: FPPC Advice Email:advice@fppc.ca.gov FPPC Toll-Free Helpline:866/275-3772 www.fppc.ca.gov