CA Form 700 Statement of Economic Interests - Misetich RECEIVED
CITY OF RANCHO PALOS VERDES
Date o� il"Co ivec
CALIFORNIA FORM700 m� _a-..
STATEMENT OF ECONOMIC INTERESTS
FAIR POLITICAL PRACTICES COMMISSION
A PUBLIC DOCUMENT COVER PAGE
............._
CITY CLERKS OFFICE
Please type or print in ink.
NAME OF FILER (LAST) (FIRST) (MIDDLE)
MISETICH ANTHONY
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 COUNCILMEMBER
► If filing for multiple positions, list below or on an attachment. (Do not use acronyms)
Agency: SEE ATTACHED Position:
2. Jurisdiction of Office (Check at least one box)
❑State ❑Judge or Court Commissioner(Statewide Jurisdiction)
❑Multi-County ❑County of
Q City of RANCHO PALOS VERDES ❑Other
3. Type of Statement (Check at least one box)
❑ Annual: The period covered is January 1,2016, through ZLeaving Office: Date Left 12 / 05 / 2017
December 31, 2016. (Check one)
-or-
The period covered is______L_____/ ,through ® The period covered is January 1, 2016,through the date of
December 31, 2016. -or-leaving office.
❑ Assuming Office: Date assumed_J____J 0 The period covered is J ,through
the date of leaving office.
❑ Candidate: Election year and office sought, if different than Part 1:
4. Schedule Summary (must complete) Total number of pages including this cover page:
Sched s attached
Sc edule A-1 -Investments—schedule attached chedule C-Income, Loans, &Business Positions—schedule attached
Schedule A-2-Investments—schedule attached 111Schedule D-Income—Gifts—schedule attached
❑ Schedule B-Real Property—schedule attached ❑Schedule E-Income—Gifts—Travel Payments—schedule attached
-or-
111 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
-2
....S..... (1
Date Signed Signature 1111101104
(month,day,year) (File the originally ement with your filing official.)
FPPC Form 700(2016/2017)
FPPC Advice Email:advice@fppc.ca.gov
FPPC Toll-Free Helpline:866/275-3772 www.fppc.ca.gov
2017 STATEMENT OF ECONOMIC INTERESTS—FORM 700
COVER PAGE ATTACHMENT FOR EXPANDED STATEMENT FOR
COUNCILMAN ANTHONY MISETICH
AGENCY:Sanitation Districts(District No.5 and South Bay Sanitation District)
POSITION:Alternate
AGENCY:South Bay Cities Council of Governments(SBCCOG)
POSITION: Delegate
SCHEDULE A-1 CALIFORNIA F700ORM
ORM
. Investments FAIR POLITICAL PRACTICES COMMISSION
Stocks, Bonds, and Other Interests Nam-
(Ownership Interest is Less Than 10%) bagdofi
5if
Do not attach brokerage or financial statements.
► N F BUS ENTITY IJV
► NAME OF BUSINESS ENTITY
0
1
GENERAL DESCRI TION OF THIS BUSINESS GENERAL DESCRIPTION OF THIS BUSINESS
PETTOLE0/11 P) 3dflo3
.13
FAIR MARKET VALUE FAIR MARKET VALUE
0$2,000-$10,000 Ifl<001 -$100,000 0$2,000-$10,000 0$10,001 -$100,000
El$100,001 -$1,000,000 D Over$1,000,000 ❑$100,001 -$1,000,000 El Over$1,000,000
NATURE OF INVESTMENT NATURE OF INVESTMENT
O Stock El Other 0 Stock ❑Other
(Describe) (Describe)
O Partnership 0 Income Received of$0-$499 0 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 APPLICAF E, LIST DATE: IF APPLICABLE, LIST DATE: •
LISA_ -_/ 16 _L_____/ 16 _____J______J 16
ACQUIRED DISPOSED ACQUIRED DISPOSED
N. 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
0$100,001 -$1,000,000 0 Over$1,000,000 0$100,001-$1,000,000 El Over$1,000,000
NATURE OF INVESTMENT NATURE OF INVESTMENT
El Stock 0 Other 0 Stock ❑Other
(Describe) (Describe)
O Partnership 0 Income Received of$0-$499 0 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:
__/_/ 16 _j_ j 16 _____/____/ 16 _j_/ 16
ACQUIRED DISPOSED ACQUIRED 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 0$10,001 -$100,000
0$100,001 -$1,000,000 fl Over$1,000,000 El$100,001 -$1,000,000 0 Over$1,000,000
NATURE OF INVESTMENT NATURE OF INVESTMENT
O Stock El Other Ill Stock 0 Other
(Describe) (Describe)
0 Partnership 0 Income Received of$0-$499 El 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:
__/_J16 /___/ 16 _/_J16 ____/_____/ 16
ACQUIRED DISPOSED ACQUIRED DISPOSED
Comments:
FPPC Form 700(2016/2017)Sch.A-1
FPPC Advice Email:advice@fppc.ca.gov
FPPC Toll-Free Helpline:866/275-3772 www.fppc.ca.gov
•
e ,
SCHEDULE A-2 CALIFORNIA FORM 700
Investments, Income, and Assets FAIR POLITICAL PRACTICES COMMISSION
of Business Entities/Trusts ligillgellj
(Ownership Interest is.10% or Greater) rI
► 1. BUSINESS ENTITY OR TRUST ► 1. BUSINESS ENTITY OR TRUST
d5 03114C. CO Co $)LTIN4r' Tiki e.
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
USJNi Co, SUL1Jr)&
.
FAIR MARKET VALUE IF APPLICABLE, LIST DATE: FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
❑$0-$1,999 ❑$0-$1,999
1:1$2,000 16$10,000 / / / /16 1:1$• 2,000 $10,000 /_/16 /-/16
❑$1 -$100,000 ACQUIRED DISPOSED ❑$10,001 -$100,000 ACQUIRED DISPOSED
100,001 -$1,000,000 El$100,001 -$1,000,000
❑Over$1,000,000 ❑Over$1,000,000
NATURE OF INVESTMENTNATURE OF INVESTMENT
❑ Partnership 0 Sole Proprietorship I ('OR J1e ?),) Partnership 0 Sole Proprietorship
Other Other
YOUR BUSINESS POSITION PR 1.6/01.-- YOUR BUSINESS POSITION
► 2. IDENTIFY THE GROSS INCOME RECEIVED (INCLUDE YOUR PRO RATA ► 2. IDENTIFY THE GROSS INCOME RECEIVED (INCLUDE YOUR PRO RATA
SHARE OF THE GROSS INCOME TO THE ENTITY/TRUST) SHARE OF THE GROSS INCOME TO THE ENTITY/TRUST)
111$o-$499 El$10,001 -$100,000 ❑$• 0-$499 ❑$10,001 -$100,000
El$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 I. 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 A necessary.)
El None or ❑ Names listed below ❑ None or • Names listed below
I.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:
_.-El 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:
❑$2,000-$10,000 El$2,000-$10,000
❑$10,001 -$100,000 _/_ _
/ 16 /_ 16 / /16/16 ❑$10,001 -$100,000 / /
❑$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 El 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 El C• heck box if additional schedules reporting investments or real property
are attached are attached
Comments:
/ CoviEsa '�� FRO� FPPC Form 700(2016/2017)Sch.A-2
u ,
FPPC Advice Email:advice@fppc.ca.gov
i/V rrif 0 litE. i).( DiCT)09 FPPC Toll-Free Helpline:866/275-3772 www.fppc.ca.gov
•
SCHEDULE C CALIFORNIA FORM 700
Income, Loans, & Business FAIR POLITICAL PRACTICES COMMISSION
Positions N-A- e
111
(Other than Gifts and Travel Payments) V i■0 (MIS
► 1. INCOME RECEIVED ► 1. INCOME RECEIVED
NAME OF SOURCE OF INCOME NAME OF SOURCE OF INCOME
CN6/41 k C tais Cc5Ti & a
ADDRESS(Business Address Acceptable) ADDRESS(Business Address Acceptable)
RPVBUSINESS ACTIVITY, IF ANY,OF SOURCE BUSINESS ACTIVITY,IF ANY, OF SOURCE
C),ii �� C
YOUR BUSINESS POSITION YOUR BUSINESS POSITION
f2,565 f ti
GROSS INCOME RECEIVED ❑No Income-Business Position Only GROSS INCOME RECEIVED ❑No Income-Business Position Only
0$500- ,000 ❑$1,001 -$10,000 ❑ $500-$1,000 ❑$1,001 -$10,000
10,001 -$100,000 ❑ OVER$100,000 ❑ $10,001 -$100,000 ❑ OVER$100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED CONSIDERATION FOR WHICH INCOME WAS RECEIVED
❑Salary 0 Spouse's or registered domestic partner's income ❑Salary ❑Spouse's or registered domestic partner's income
(For self-employed use Schedule A-2.) (For self-employed use Schedule A-2.)
❑ Partnership(Less than 10%ownership. For 10%or greater use 0 Partnership(Less than 10%ownership. For 10%or greater use
Schedule A-2.) Schedule A-2.)
❑ Sale of ❑Sale of
(Real property,car,boat,etc.) (Real property,car,boat,etc.)
❑ Loan repayment ❑ Loan repayment
❑ Commission or ❑ Rental Income,list each source of$10,000 or more ❑ Commission or ❑ Rental Income,list each source of$10,000 or more
(Describe) (Describe)
❑ Other ❑Other
(Describe) (Describe)
► 2. LOANS RECEIVED OR OUTSTANDING DURING THE REPORTING PERIOD
* 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-ENDER* - INTEREST-RATE- TERM-(Months/Years) -
% ❑ None
ADDRESS(Business Address Acceptable)
SECURITY FOR LOAN
BUSINESS ACTIVITY,IF ANY, OF LENDER 0 None ❑ Personal residence
❑ Real Property
Street address
HIGHEST BALANCE DURING REPORTING PERIOD
❑$500.-$1,000
City
0$1,001 -$10,000
❑ Guarantor
0$10,001 -$100,000
0 OVER$100,000 ❑ Other
(Describe)
Comments:
FPPC Form 700(2016/2017)Sch.C
FPPC Advice Email:advice@fppc.ca.gov
FPPC Toll-Free Helpline:866/275-3772 www.fppc.ca.gov