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HomeMy WebLinkAboutChristianson - Form 700 - 08-06-14RE:g��IWe+c , ied . EMENT OF ECONOMIC INTERESTS °3 -`� AUG 06 2W COVER PAGE SLO CITY C _RK Please type or print in ink NAME OF FILER (LAST) (FIRST) RAIDDLE) Christianson Carlyn Rae 1. Office, Agency, or Court Agency+ Name (Do not se a ronyms) / / /- 1,ti 0 CtVI Ll.11rS �(�15�� Ct� lOflVlCI ✓�1L�1^�tJP/V� Division, Boar 6, Department, District, if applicable Your P. If filing for multiple positions, list below or on an attachment (Do not use acronyms) Agency 2. Jurisdiction of Office (Check at least one box) Position ❑ State ❑ Judge or Court Commissioner (Statewide Jurisdiction) ❑ multi- County ❑ County of 9Crty of ay\ U Li s 1 S P o ❑ Other 3. Type of Statement (check at feast one box) ❑ Annual The period covered Is January 1, 2013, through ❑ Leaving Office Date Left—�� December 31, 2013 (Check one) -or- The period covered Is O The period covered Is January 1, 2013, through the date of _J� , through December 31, 2013 leaving office ❑ Assuming Office- Dale assumed _lam O The period covered Is through the date of leaving office Candidate Election year �b Lf and office sought, If different than Part 1 4. Schedule Summary 3 Check applicable schedules or 'None." ►Total number of pages including this cover page: ❑ Schedule A -1 - Investments – schedule attached 0 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- F-1 None - No reportable Interests on any schedule 5. Verification MAILING ADDRESS STREET CITY STATE ZIP CODE (Elusmess or Ageucy..4ddress Recommended - Pudic Documem) ) San Luls Obispo CA 93401 ( 1 1 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 penury under the laws of the State of California that the foregoing Is true and correct. 6;LL49 Date Signed Signature (mmlh, day. year) IFd orymelly signed sia:emeni xdh your ft oficial ) FPPC Form 700 (201312014) FPPC Advice Email: advice @fppc ca.gov FPPC Toll -Free Helpline. 866/275 -3772 www -fppc ca.gov SCHEDULE B Interests in Real Property (including Rental Income) D ASSESSOR'S FARCEL i•:uMBER OR STRECI ADDRESS 3960 S Hlguera #101 %ITY San Luis Obispo =AIR MARKET "AL UE ❑ <_2.000 - s10 000 0 S,o 00. - S100030 ❑ si0o,00t - 51000 @J0 ❑ Over s1,000,0?0 NATURE OF 11T. -EREST ❑ Own :shlpFPee^ C' , Trust ❑ Leasehold \rs rema.mrr3 IF A ^PLICAeL= LIST OAT= 10 122 f 13 _/ / 13 ACQUIRED DISPOSED ❑ c3semen, 91 Mobile Home Oster 1= DENTAL PPOPEP,TY GROSS VC01AE RECEIVED ❑ so - s4g3 ❑ sseo -,s1 Dori [Z st oo1 - S10,0oo ❑ 510,001 - sit0,om ❑ O./E4 ,°.100,000 SOURGES OF REIITAL INCOME If you own a to% or arealer Interest, list the name of each tenant that Is a single source of income of $10,000 or more Z F,-one FORM Name Carlyn Christianson V ASSESSOR'S PARCEL r (UMBER OP STREET ADDRESS CITY FAIR 1,4APKET VALUE ❑ S -2,000 - Sio o00 ❑ si0.001 - si00000 ❑ $100.001 - S1,000 , 0C•o Over Si 000000 NATURE O= II:?ER =ST ❑ ow,�rsh,00eed of Tnis: LIST DATE 13 _�� 13 ACQUIRED DISPOSED ❑ Easement ❑ Leas=ehold ❑ 'rrs mmairtim c trr IF RE -ITAL PRO °EF.TY, G =OSS INCOME RECIFNED ❑ so - s.90 ❑ ZKV - si 000 ❑ st aw - s10.0co ❑ 510,001 - Silk0 E) O`.eR 5100000 SOURCE? O= 0=1'TAL 0-COn4E If you own a 10°m' or greater Interest. list the name of each tenant that is a single source of Income of S10 000 or more ❑ None 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 I&mness Ad're >s 4ccepiac:e) BUSIN_SS ACTIVITY 1= ANY, 0= LEODE If1TEREST RATE TERM (Mon,iis, ie= s) [� None HIGHEST BALANCE DUFVG RE= ORTIPG PERICD ❑ s 0e - 51 X00 ❑ s1.001 - MOW ❑ sio.co1 - St0000? ❑ OVE? 5100,U00 ❑ Guarantor, i spoll:atte Comments: MAME 0= LENDER' ADDRESS (Buswzss addr=ess Accar :ab:a) BuSIt IESS ACTIVITY IF ANY. OF LEi'DE R INTEREST RATE <: ❑ Mon_ TE=Fi (MomnsNears) HIGHEST BALANCE DU4LdG REPORTING PERIOD ❑ S500 - S1 000 ❑ S%001 - sto,0r0 ❑ St0001 . 5700,000 ❑ C4ER 510^000 ❑ Gu_r>n,or I: aopllcabta FPPC Form 700 12013/20141 Sch. B - FPPC Advice Email- advice @fppc.ca gov FPPC Toll-Free Helpline 866 /275 -3772 wwwfppc -ca -gov SCHEDULE C Income, Loans, & Business Positions (Other than Gifts and Travel Payments) NAME OF SOURCE OF INCOME Coastal Anesthesiology Medical Associates ADDRESS (Business Address Acceptable) P O Box 1185, San Luis Obispo, CA 93406 BUSINESS ACTIVITY IF ANY OF SOURCE Medical practice YOUR BUSINESS POSITION Practice Administrator GROSS INCOME RECEIVED ❑ S500 - $1,000 ❑ S1,001 - S10,000 S10,001 - S100,000 ❑ OVER S100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ✓❑ Salary ❑ Spouse's or registered domestic partner's income ❑ Loan repayment ❑ Partnership ❑ Sale of (Real property wr boat, etc) ❑ Commission or ❑ Rental Income, bsr each source of $10 000 or more ❑ Other (Describe) Name Carlyn Christianson NAME OF SOURCE OF INCOME ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY. IF ANY, OF SOURCE YOUR BUSINESS POSITION GROSS INCOME RECEIVED ❑ S500 - s1,000 ❑ S1,001 - S1o.000 ❑ S70,001 - 5100,000 ❑ OVER 5100,000 CONSIDERATION FOR WHICH INCOME \VAS RECEIVED ❑ Salary ❑ Spouse's or registered domestic partner's income ❑ Loan repayment ❑ Partnership ❑ Sale of (Peal ompery car boac etc) ❑ Commission or []Rental Income, list each source or 510.000 or more ❑ Other (Describe) * 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 LENDER* Mary R Kmetovlc Trust ADDRESS (Business Address Acceptable) 38 Country Club Gate, Pacific Grove, CA BUSINESS ACTIVITY, IF ANY OF LENDER retired HIGHEST BALANCE DURING REPORTING PERIOD ❑ S500 - S1.000 ❑ S1,001 - S10.000 0 S10,001 - stoo 000 ❑ OVER 5100,000 INTEREST RATE 6 y, ❑ None TERM (MonthsNears) SECURITY FOR LOAN ❑ None © Personal residence ❑ Real Property p Guarantor ❑ Other Smm: eddress Oty ( Descebe) Comments: Loan from mother for personal residence (stock cooperative, not real property) FPPC Form 700(2013/2014) Sch. C FPPC Advice Email. advice @fppc.ca gov FPPC Toll -Free Helpline. 866/275 -3772 wwwAppc.ca gov