'i
&
Los Angeles City Ethics Commission
October 30, 2015
The Honorable City Council c/o Holly Wolcott, City Clerk 200 North Spring Street City Hall - 3rd Floor Los Angeles CA 90012
Council File Number 15-1233Re:Appointment of Brian Pendleton to the Board of Fire and Police Pension Commissioners
FOR COUNCIL CONSIDERATION
Dear Councilmembers:
Brian Pendleton was appointed by the Mayor to Board of Fire and Police Pension Commissioners on October 15, 2015. The Ethics Commission received Mr. Pendleton’s preconfirmation financial disclosure statement on October 29, 2015. In compliance with Los Angeles Municipal Code § 49.5.10, a copy of Mr. Pendleton’s financial disclosure statement is enclosed.
If you have questions, please feel free to contact me at (213) 978-1960.
Sincerely,
U.
Alexandria Latragna Senior Ethics Analyst
lr
Enclosures:CA Form 700 CEC Form 60 \
Mayor Eric Garcetticc:
200 North Spring Street, Suite 2410 • Los Angeles CA 90012 • phone (213) 978-1960 » fax (213) 978-1988 • ethics.lacity.org
LOS ANGELES CITYETHI<§£i§OiUM48Sa0N
0-- U, . OnyCALIFORNIA FORM 700 STATEMENT OF ECONOMIC INTERESTSOCT 2 9 2015FAIR POLITICAL PRACTICES COMMISSION
A PUBLIC DOCUMENT COVER PAGEP/ease type or print in ink. RFCEIVED
(FIRST) (MIDDLE)NAME OF FILER
Pendleton(LAST)
Brian
1. Office, Agency, or CourtAgency NameBoard of Fire and Police Pension Commissioners
Your Position Commissioner
Division, Board, Department, District, if applicable
► If filing for multiple positions, list below or on an attachment.
Position:Agency:
2. Jurisdiction Of Office (Check at least one box)
F] State
[H Multi-County_______ _________________________
M City of
□ Judge or Court Commissioner (Statewide Jurisdiction)
□ County of_________________________ ________
□ Other_____________________________________Los Angeles
3. Type Of Statement (Check at least one box)
□ Annual: The period covered is January 1, 2013, through December 31, 2013,
The period covered is _December 31, 2013.
CH Assuming Office: Date assumed
□ Leaving Office: Date Left (Check one)
O The period covered is January 1, 2013, through the date of leaving office.
O The period covered is__the date of leaving office.
y.
-or-J_____ L through
7. y. throughy. y.
Pre-confirmation (Date appointed or reappointed)
4. Schedule SummaryCheck applicable schedules or "None. ► Total number of pages including this cover page:__________
§fl Schedule C - Income, Loans, & Business Positions - schedule attached
Q] Schedule D - Income - Gifts - schedule attachedl~1 Schedule E - Income - Gifts - Travel Payments - schedule attached
§§ Schedule A-1 - Investments - schedule attached
§5 Schedule A-2 - Investments - schedule attached
□ Schedule B - Reai Property - schedule attached
-or-□ None - No reportable interests on any schedule
5. VerificationSTATEMAILING ADDRESS CITYSTREET
(Business o, Agency Address Recommended - Public DocumentIZIP CODE
E-MAIL ADDRESS (OPTIONAL)DAYTIME TELEPHONE NUMBER
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. ! acknowledge this is a public document.
I certify under penalty of perjury under the laws of the State of California that tl
IQ iZLrdJZ(month, day year)
SignatureDate Signed
FPPC Form 700 (2011/2012) FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
r 700SCHEDULE A-1CALIFORNIA FORM
InvestmentsStocks, Bonds, and Other Interests (Ownership Interest is Less Than 1 D%) Do not attach brokerage or financial statements.
inc*i practicf: ccmmvmn
j__ Name
<BLUE> is a required field
NATURE OF INVESTMENT fS&teer from dlxp 4mm but
if''other* 40iU>.iba)if APFtlCAQlE. UST DATE
(romfc‘,V2014)/aoutinsfi raspoetoGENERiV. tiESCRIPTjr*.- OF
THIS BUSINESS ACTIVITYFA'R. MARKET VALUE
(Safest hvm rfivv rtown bat)NAJffi OF BUSINESS ENTITY
Energy LP - ATLAS ENERGY GROUP LLC
'StoclT'------------ —'------ '
Stock"- Am£ET£aNAIRrs'^ffOUP INC ' "Tt^TOgyr3TffANmS,igNHLDlK?g----------~'Stock'- hcah3lBTWS§TnS^H2"3loaraBS?r<SROT^-------------------^K5r-'WWe<5HPKIEW-------------------~------------------tdoanaasrercoKP-------------—---------St^ckVMAi(5UAR^7N^^mCCTuRrd3^......Stock - ALPHS'g^f iRSS'HS"£t/T"" * ~ "-^srm^snmmrsiymrm:............Preflrred Start VbYfi ifA^Atf ? YftusTl N*d "gtR’r ■E&’TBfiEe---------------------------CUM REDMBLE PFD STK 6.625% PERPETUAL
61r^rar>re-PropeItyTCasuaI^CUM 6.625% REDEEMABLE PFD STKTveferr^S -SSuffY* CO(Tl7617^Arfhr^TfirRBfTb^-----------------------------5.75% AUG 01 2042"Preferred *§ toctr^nRSTREPOBDCIS?^S^lQ?5Kt^anlS^?eglonar-'0S " n*"v'n" nj'~ CUM PFD STK 6.20% PERPETUALT^arrw?‘5todc-'PPt!’fiXPI1XL‘Pt]TJ51WgTFKr^giyB>JUNIOR SUB NOTES 5.9% DUE 4730/2073__________________________________Prefe7re?Stock"TQW£sT'CGRTJ£jRSr)Cii\J $2S"PSKS1? felecommuntcatlons ^^”^”NOTES 7.0% DUE APRIL 1 2052 _ __________________________________"Preferred'St6tic-SdE"TRUST"l'l"PFDJ§Ti<^5^iO'6^r33jrt38ltH^"Reguiated"SectncJ01 2049 ............. ........................................................................ .................................^re^erreiT2ioci(TAfepEN fNSuRahiGr. HLKG' LTD" 5e R frisurance^elnsLirenc^^** PFD STKPreferred Slock’’ENTERGY Mr^SiSSlPpHNiT6!00%T PFD STK
CUM RFDMBLF PFD STK 6.00% PERPETUAL
Energy 52,000 - £10,000 stockfmrmsss Stock"
Building Materials ""£]^"lrom^*XTnOusfnaT(^roduc1s"
Sars,’Trucks" "auTo’part iT"*'*' "™' ""*" ........
"ntransmfssions-"uS.T5elenseuu,,w r r H eallhffa reServices """"""" n""
T2wrmMT "StocT'Stock*
SiOT'TTfOTTC--------gtocK$lft,"0"6ln-ir6ft?00 StockTOgTTiSCT------- SEEK
’Stock"'TTaooTTftoOT *StodT
' ReafEstaTe’ X Investment" iraswrmm ’Stock"(nTofmatiocrfechn'ology msffrzM'ffi—SEcETPIorTieTfnpfovefneinErBulOrr^^procfij^S 'llwwi—Stoss—AT rportsAirServices jmsrrmsr Start
“doogle" "'SariI<s^SlDbaI
lW56T^W5t533 Stock*mxrmm~ssssRITO’oo'i|Yfi 5’5oH Slock'
Stacir
lio ,(56T - IiBo.doo Stock"
^TOTTIOTft------ SI33T
TITOoTWOTI------- SKkUlitriies-’Biversified"
Htt.WMMdto Stock
Si"o?o15T-'"$ioo,ooo........ Stock"
SmoSrST66r,oOfIr Stock"
wsJfrrnssOT
'vmrmm—§t5TStock'Utilities^ Diversified
10, He
SHARES SERIES S 5.90% CUM PERPETUALmt^rasr tmrrmrm Stoctr
-------- grorsgCT—staff'siaoo^^imooo siocF
Preferred Slock - DDF "PreferredStockT $EK isi 151E PFD SHRS NON-CUM 5.375% PERPETUAL >re(ene0Sto^'^^FIXED TO FLTG NON CUM 5.50% SERIES J PERPETUAL
CUM PFD STK 5.625% PERPETUAL
'mssrmm—'Capital Markets’
msffrrrass—§tsar
----------£i3W"Ti<5OT--------Stock*"Preferred" Slock -PFD SHRS 06.500% PERPETUAL
’mwrm:tw ■rar
tilities- Diversifiesferret
"Stock*Teferr latec trieSUB DEBENTURES 05.250% DEC 01 2062
'^rssT^iSKrrgs^SUBORDINATED VAR% PERPETUALito^riKiTMmg^^mrnTOTr-"
’ A irports & X ir’S e rvi ce s ***“vBal^"Kegi^^
’InS^at^lGKSstreanv rsfaturafijas*
ws?rriTO?jo^Ttoci<5ToriSiTlTt58^o3S Stock
fTOTTOTW—StartHoarStock
Tf?e?Srr€^rss3r:'BTOT^?^n^mjsTiNcrr.s5%—PERPETUAL PFD STK CUM REDEEMABLE SERIES E
0
rofp's^’TMroR^riixsfranR—SUBORDNTD SER R GLB VAR% PERPETUAL____________TrefeiTedd'toc'k’ - ‘A RCH CAPlTAUGR’OljP LTD’"SE"R’Cf ”Tnsu"ranca-Rein suran ce" NON CUM PFD STK 6.75% PERPETUAL<Vp Bond -WrBANK eflftPOKATIdKI JRSUBORDNTD SER E GLO VAR% PERPETUAL
^referrgTSlock - "SCg'TftUfffTjTgg'p F^STK'"'
"San^SioGaT ITB^TOOT 'Stack'
^TOT Stock
’Banits-’RegTonaTTIS ’ Sfoclt"
iTo?o6T-"fioo?oo6 StockOTH5OT StockLP Energynoi
SrrSTgSTn^i^oriRSTSKffnwjsiRRJcsircnjsr fio.ooT^TicCooS stoctTEnergy
FPPC Form 700<Z014/Z015t Sch. A-1*FPPC Toll Free Helpline: 866/ASK-FPPC www.fppc.ca.jov
SCHEDULE A-1 700CALIFORNIA FORMInvestments
Stocks, Bonds, and Other Interests
(Ownership Interest is Less Than 10%)Do not attach brokerage or financial statements.
MM n I MM! MkCtl f
Name
J
<BtU€> b a required field
NATURE OP INVES VH.-NT (Stded (mm drop drnvn '
IF APH -ASLE, UST RA'IE tm rfdd/2014)
ClNEFU’ CotSCi.IPTiON OF THIS BUSINESS ACTIVITY
FiMlS IiViRKET VALUE (Seiua fmin drop down lid)
OF BUSINESS ENTITYif "0<her* deaenbe' •'iOQUtRi I*
Slock - LAMAR ADVERTISING CO-A “Corp Bond - (^'h"mi7§AClT^T^©u^TNSSUBORDINATED SER M VAR% PERPETUAL
--------- --SUBORDNTD SER V GLR VAR% PERPETUAL
-----------------------------------------------WewiFi'WKgmmm ptorstp— ■ST^“v^AF3Nr^^^r(5TH?i’ADR------^0 rgy'l. p‘-^^LAR TTJ^^frfrTERsTP^^^"
Outdoor advertising-billboards £10,001 - $100,000 StockCapital Markets TfOTTSTORS *§Tock"
,'^Baril<s~(jloKar~^’ TT3^TTO5}T^i^r
"dom'putefT^oiiimuri icafion' $TolA0T -”JTd6"6Sd “StocirJia 53^335Energy Stock*
'Stock"fio.oonroOT "STock"Energy
ifocS f* Retail
SUBORDINATED VAR% PERPETUAL?FaeTsaraocr-"wai:sFLOATING RATE 5.85% NON-CUM PERPETUAL^cTWEFifHlTOfreS
"P ~ne Fgy ’ ’ l™T,w-rjiru’Jvur-
’^anj^TfegionalTO^'TI^SJfTTRiS^ISJy Stock""......TOSSTinKJOT—StSSC----------
TiWf-Tfi5o,oG5' Stock
$nroyr$TTO3<r §ssrCredit ServicesSTir53T^f3tn582r----StoSt
’RSTBSSSTsiflSf ITOJoT^TSiTSSiJ Stocklac
SER J GLB VAR% PERPETUALTapitaTTvfarketT $i6,60T-'$Y6fl^63ir "Slock
fROrSTJBSfiBWgE m.m-Mhm' Stocktanks- jalM VAR% PERPE1UAL
STo0^5'l'^TT3o^i3o StockEnergyEnergy*I'neTgy'L^-T.N^S Y m"NSmr£'SuiW L F STcolooT'-Tto® 'dad stock
CorpBonci - MOr G AhSTAiNL£Y*3E^Odo~0 ZERO% AUG 15 2016 .
Capital Markets ’ 5T0 o", 0 oT-s iTTrtoToott Stock
"StockCommodities Prec Metals
'SlwY”SCG?i§"ST3KiAlYSrMSfACS’'iN^'^neVgy'LP-^I^INS^fi'HLB^LP........"
"Stock - ALL^^NPL^r^^^^
?rodu^s^i1iccci’”fvTeia; ~rror$2,000 -$10,000ib^Cft'-Ti'didOd
"Stock"Energy””™”*”””’BiversilieHTnduslnais
Slock /'T7/T■$2rK5S^Tfa5o5'$'looo'""Sio"(Wt5'l^ldaTYlol'Wi'
"StoclT"^ 4/1 fl/TS*Media 4 Technology* S/24/15'"Stock"
""Stock" "S/SfilTPharmaceutical (Sonsumer packaged"food", bev Zero’s pace£ 13 efeTise"""'""'™ ”
sT/fanuf
rrnnrlr2,ooo"-¥i'6;ooo"TOSTTfOTr
"Slock"StocT wwrrr
toe 3
wrrAerospace'S Befe nse "*
wwuw~^e?nicori,d ul^ors^ ™nrr" ‘wrormw'—seek "SHMS-----------------------
'""47i37i§—------------- -^tSdT^A£KA^iW2Tfi"RP am?RiCa "Slock “ KrtSCf Tn lTcla ss a"
Packaging "4 Containers ......’Bus inessfServ ice s-"Siobaf Index"
TOW^TOST 7|bcT"Si’ock"
TTTTo/iT
"Credit Semces $10,001 - $100,000 Slock
" ~v'Ti oocTr-Tfoo,ooo
)/-\rii,
"Sfock - TWENTY^RrSt^NTURyTSx Tn5"2laSS”b XlednY~cfiversiiied "SiSr^MSTd r6"la S6lu ti'Bns "in £'
"4/WI5T/Ta'iS”
Slock'^mm'uniStidn'iquFpmenr'’Sysi^r^’^ign'^naE^er^Yr^fuiioris Tii515CT^W57ro?r "SlociT
"SlocT ~mmr”jon )ci>
'WedlcaTSaVe' Trar^TOK---------StorT nmwMltod
Stock - wCnCiTS'CO COM ~ $ Ob.OffO Stock" WfTR e";tau rants "SloucTDala'S’ervices" 'fn'ergy......... ” '$T5','tX51'-“$1 ti'tf.'OOO".nt Stock '?/S?15"
UNITS'SiocY"‘^AF$R' MfW VC'^T/etrar^Rr rfOT^TTOTlot
)emorLiving Communities tooIi n e"'g yY P' - "P LA I N’S 'A L'l A tAE’RKi "Pl’PL L P’ Energy" ^^g^WlVjjOQlOOQ ̂ Slock'
" toot y^a"5^i Stock1■ "JlO'.^l^WoloSS Stock"
"4)1 OiTh"Jiversifiec
"Stoc^hllRcT^RA^N^SYlfJ^^flS----———nmiSY-^uia^d^lrlc’Slock"'-Af&f’ INC
--------------------------------Energy"Stock"- YA’SSAr^SSuSSE'sTORPV^6MTfK
—*----------------- ----’Pncrgyl'P^ n0 §W('EftE'R'GY r'™r™ ” '
SUBORDNTD SER C GLB VAR% PERPETUAL "SectorTGrid^3UFf AND PHELpS"SEl ECT EnHP'GV Energy MLP FD INC
Telecom Services $TolooT-$m£iM' "Si 0 ,o"oT’$”6616155" "$10,001 -flooloSo"wsrwror
"Stock" '4/Q/T5"‘m*?Stock
"SlociToUnSaTMid stream 8/6/15"Stsar "m$7rrITancesl etc.
TTnergy"”'"Sre^iT’ServiceT
'nTu5ST"S7J5155?’ ------------------TOffTTOffOT
’Stock""S^ocT
"57W1Timw
STSlooT $io510oo SiocF '6/3S/T5'
FPPC Form 700 (2014/2015) 5ch. A-1*FPPC Toll Free Helpline: 866/ASK-FPPC www.fppc.ce.gow
700SCHEDULE A-1 iCALIFORNIA FORMr*ai»<H<nou p**ci'cficcn*5fwInvestments
Stocks, Bonds, and Other Interests (Ownership Interest is Less Than 10%) Do not attach brokerage or financial statements.
LName
<BLUE> is a required field
NATURE OF INVESTMENT IP APPLICABLE, LIST DATE (mmMdF2tH4>GENERAL DESCRIPTION Of
THIS BUSINESS ACTIVITYFAS < MARKET VAL1T5
(Seteci from drxjfj down i m.NAME OF BUSINESS ENTITY tSateol from time cfoew teIf "Other" describe} ACQUIRED r SPOQEO
Sector Fund - FIRST TR NEW OPPORTUNITIES MLP Energy AND EN
$10,001 -$100,000 Slock 7/8/15
Energy~------------~~——irrdi5,i53rTr63i5^—sis-E—-—-------~
FD INC
"Stocir trm?:n<
'SiZSSjSoTi'6oo750o stock'’TfOTTTOTffiS—
TnergyTJS FinanciaTsorvice’s"S'ecior'st^^feir^pa^iTfitTrifr
FPPC Form 700 12014/2015) Sch. A-lxFPPC Toll-Free HalpllriB: B66/A5K-FPPC www.fppc.cs.gov
700Investments, Income, and Assets
of Business Entities/Trusts(Ownership Interest is 10% or Greater)
SCHEDULE A-2 CALIFORNIA FORMFAIR POLITICAL PRACTICES COMMISSION
<BLUE> is a required field Name
* Select from drop down list
3. Sources of Income of $10,000 ©t more
2 Grcas Income Received
4. investments or Interests In Real Property Meld by tbe Business Entity or Trust (Use a separate fine foi each investment real property interest.)
1 business Entity or Trust
INCLUDE YOUR PRO RATA SHARE OF
CROSS INCOME
NAME AND ADDRESS OF BUSINESS ENTITY OR TRUST
('Business Address Acceptable)(If Trust, go to 2)
LIST DATEFAIR MARKET ACQUIRED OR __
DISPOSED (mm/dd/2014) U
NATURE OFINVESTMENT YOUR BUSINESS
(it "other," describe)*
LIST SINGLE SOURCES OF
INCOME OF 510,000 OR MORE
INVESTMENT-BUSINESS
REAL PROPERTY- LIST PRECISE
LIST DATEFAIR MARKET ACQUIRED OR *
VALUE*
NATURE OF INTEREST (if "other," describe)*
GENERAL DESCRIPTION OF
BUSINESS ACTIVITYor
VALUE* POSITION FNTI1Y/NAME, AND LOCATION OF REAL BUSINESS ACTIVITY
DISPOSED p (mm/dd/2014) UTO PROPERTY
ENTITY/TRUST*
"B’ria7)'Pen3Teton"£ Chad ColHrn an Trust
$0-$499
iHoi dTngCompany^fiverH igH FIVa Group" IncT "3tock" "’"PresidenT GrrTmF orceH ol ding”,'
LLC - Holding Company
Holding Company
"Sver"”**”*’*$1,000,000
fvtern’bership"interest$1,000,000
■joTSnfraraor:Holding Company Over"OmniForce Holdings, LLC 6vernrnn,nr$1,000,000
MembershipInterest
President MembershipInterest$1,000,000
PresidentMembershipInterest
Over$100,000 Members)Interest
tine /er)mni Force, CauseForce, LLC - Fundraising, Consulting Services
RaceFarcerbt-^-~^Fundraising, Consulting Services
S$5 f^ro3uctSo n sTTric ” Video Production Service
>ver$1,000,000 $1,000,000
4.rHoldm"gTom"pany*,J,5ver' Tvfernbership'Interest
*OverTf55',Q^5'TSmniPorce'LLc" President' Members)Interest
X$1,000,000 $1,000,000
TloIHjng^ompany "CveT ’ M"erfiHership"vut""Presiden tInterest
TJveT'n^*"$1,000,000
Stock"TSrnmTorceTrLcr I$1,000,000 !
1° "ProjeSISpbririLUC *
Fundraising, Consulting Services
TToTdTfi g "Co mpany Over "KTernBersKip^ ” ~FresidenT Interest
"PfaceKorce! lL"£.... "Over$1,000.000
iml irsfl Interest$1,000,000
iTlSTdmg^brnpany^Sver-RaceForce," LLC* Pacific Shoreline
Marathon, LLCOver$1,000,000
MembershipInterest
PresidentMembershipInterest$1,000,000
FPPC Form 700 (2014/2015) Sch. A-2xFPPC Toll-Free Helpline: 866/A5K-FPPC www.fppc.ca.gov
700SCHEDULE CIncome, Loans, & Business
Positions
(Other than Gifts and travel Payments)
CALIFORNIA FORMFAIR POLITICAL PRACTICES COMMISSION
Name
"You are not required to report loans from commerciai 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:
<BI.UE> is a required field
* Select from drop down list
1 Income Received 2 Loans Received or Outstanding
NAME AND ADDRESS OF
LENDER’' (Business Address Acceptable) AND
GUARANTOR, IF ANY
CONSIDERATION FOR WHICH INCOME WAS
RECEIVED’(if "other," describe)
GROSSINCOME
RECEIVED’
INTERESTRATE
SECURITY FOR LOAN REAL PROPERTY ADDRESS/OTHER
INFORMATION*
NAME AND ADDRESS OF SOURCE
BUSINESS ACTIVITY, IF ANY
YOUR BUSINESS POSITION
BUSINESS ACTIVITY, IF ANY
HIGHESTBALANCE’
TERM(Mos/Yrs)
(%)
CauseForce, LLC,7080 Hollywood Blvd Consulting# 4, Los Angeles, CA Services90028 _____ _______________CauseForce, LLC,7080 Hollywood Blvd Consulting# 4, Los Angeles, CA Services 90028
Fundraising, President (Brian) Over$100,000
Salary
^hief^reative' Officer (Chad)
Fundraising, Over$100,000
Spouse's or registered
domestic partner's
income
FPPC Form 700 (2014/2015) Sch. Cx
FPPC Toll-Free Helpline: 866/ASK-FPPC www.fppc.ca.gov
Restricted Source Financial Disclosure Statement
CEC Form 60
City Ethics Commission 200 N Spring Street City Hall — 24th Floor Los Angeles, CA 90012 Mail Stop 129 (213) 978-1960
fellitElected City officials, general managers and chief administrative officers of City agencies, members of City boards and commissions, and individuals nominated to positions subject to City Council approval must file this form in conjunction with the state Form 700. Please refer to the attached instructions for additional information.
0 Original Filing Q Amended Filing (original filed on____ /____ /20.2
Total Pages:_____---------LOO ANGELES CITY
ETHICS COMMISSIO JName:(Last, First, Middle)
Pendleton, BrianOCT 2 9 Z0I5| Position:Agency: CommissionerBoard of Fire and Police Pension Commissioners
RECEIVEDEmail:Phone:
/ 20 151510□ Pre-confirmation
[~~l Assuming Office
l~~1 Annual H Leaving Office
Date of nomination:
First day in position:
____ /_____ / 20_
Last day in office:
Type of Statement:15/ 20.
14 through December 31, 20 ^4
_/____/20.____
I had the following interests associated with restricted sources during this reporting period:
□ 1. REAL PROPERTY
The following interest in real property was leased from or to, co-owned by, purchased from, or sold to a restricted source.
Name of restricted source: ___________________________________________________________________________
Address of restricted source: _____ ____________________________________________________________________
Address or assessor's parcel number of real property:______________________________________________________
Interest co-owned/purchased/sold by/leased by or to: □ Me □ My spouse/registered domestic partnerH My dependent child
Interest was: □ Leased □ Co-owned □ Purchased (date:___/___ / 20___ ) □ Sold (date:___ /___ / 20___ )
Nature of interest: □ Ownership/Deed or Trust □ Easement □ Leasehold (years remaining:.[~l Other:______________________________________________________
Value of interest: □ $2,000-$10,000 □ $10,001—$100,000 □ $100,001-$1,000,000 □ Over $1,000,000
Do you have additional real property interests to report? □ No □ Yss, and
□ 2. INVESTMENTS
The following investments (other than real property) were co-owned by, purchased from, or sold to a restricted source.
Name of restricted source: ___________________________________________________________________________
Address of restricted source: _________________________________________________________________________
Name of investment: ________________________________________________________________________________
Nature of investment: CD Stock □ Partnership □ Other____________________________________________
Investment co-owned/purchased/soid by: □ Me □ My spouse/registered domestic partner CD My dependent child
Investment was: CD Co-owned CD Purchased (date:___/___ / 20___ ) CD Sold (date:___ /___ / 20___ )
Value of investment: □ $2,000—$10,000 □$10,001—$100,000 □$100,001—$1,000,000 □ Over $1,000,000
Do you have additional investments to report? Dno OYes, and
additional pages are attached.
additional pages are attached.
April 2014 Los Angeles Municipal Code §§ 49.5.2, 49.5.9, 49.5.10 Page 1 of 2
Restricted Source Financial Disclosure Statement
CEC Form 60
City Ethics Commission 200 N Spring Street City Hall — 24th Floor Los Angeles, CA 90012 Mail Stop 129 (213) 978-196C
Hi fin Ini11ifii »ir
fellliJ□ 3. INCOME
The following income was received from a restricted source.
Name of restricted source: ________________________________________________________________
Address of restricted source: ______________________________________________________________
Business activity of source: ______ __________________________________________________________
Your business position: ___________________________________________________________________
Income received by: □ Me i iMv spouse/registered domestic partner CD My dependent child
$500—$1,000 □$1,001—$10,000 □$10,001—$100,000 Dover $100,000
Income was: □ Salary/Commission □ Loan repayment □ Rental income □ Sale of_________
□ Other: ________________________________
Do you have additional income to report? DNo □ Yes, and
Value of income:
(e.g., car, boat, etc.)
additional pages are attached.
□ 4. GIFTS
The following gifts cumulatively valued at $50 or more were received from a restricted source.
Name of restricted source:__________________________________________________ _
Address of restricted source:_________________________________________________________
Business activity of source:___________________________________________________________
Gifts received by: QMe DMy spouse/registered domestic partner QMy dependent child
Value of gifts:_____________/ 20. / 20.Dates received: __
Description of gifts:
Do you have additional gifts to report? QNc □ Yes, and additional pages are attached.
□ 5. BOARD POSITIONS
The following position was held on the board of a restricted source.
Name of restricted source: _________________________________________________________
Address of restricted source: ______________________________ _________________________
Position title: _____________________________________________________________________
Position held by: □ Me □ My spouse/registered domestic partner □ My dependent child
Do you have additional positions to report? □ No QYes, and additional pages are attached.
0 6. NO INTERESTS
I had no reportable interests in real property, investments, income, gifts, or board positions associated with restricted sources during this reporting period.
Certification
I declare under penalty of perjury under the laws of the City of Los Angeles and the state of California that I have read the instructions for this form, and
fo-^rr~Date
April 2014 Los Angeles Municipal Code §§ 49.5.2, 4S.5.9, 49.5.1 G Page 2 of 2