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HomeMy WebLinkAboutMARX, JAN HOWELL 87200 - FORM 700 2007-2015D yet' STATEMENT OF ECONOMIC INTERESTS orro;�,; U',k, 10f.."', 3 COVER PAGE FEB 1 1 2015 J-D Please type or print in ink. NAME OF FILER (LAST) (FIRST)M1I CLERK t MARX JAN HOW " 1. Office, Agency, or Court Agency Name (Do not use acronyms) City of San Luis Obispo Division, Board, Department, District, if applicable Your Position Mayor ► 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) ❑ State ❑ Multi- County ✓❑ City of San Luis Obispo 3. Type of Statement (Check at least one box) ❑ ✓ Annual: The period covered is January 1, 2014, through December 31, 2014. .or- The period covered is _ (_ J December 31, 2014. ❑ Assuming Office: Date assumed _ i 1 Position: ❑ Judge or Court Commissioner (Statewide Jurisdiction) ❑ County of ❑ Other - ❑ Leaving Office: Date Left) (Check one) through O The period covered is January 1, 2014, through the date of leaving office. O The period covered is — the date of leaving office. ❑ Candidate: Election year and office sought, if different than Part 1- Schedule Summary Check applicable schedules or "None." FV1 Schedule A -1 - Investments – schedule attached Fs'] Schedule A -2 - Investments – schedule attached F Schedule B - Real Property – schedule attached through ► Total number of pages including this cover page: � ❑✓ Schedule C - Income, Loans, & Business Positions – schedule attached ❑ Schedule D - Income – Gifts – schedule attached ❑ Schedule E - Income – Gifts – Travel Payments – schedule attached .or- ❑ None - No reportable interests on any schedule 5. Verification MAILING ADDRESS STREET CITY STATE ZIP CODE (Business or Agency Address Recommended - Public Document) San Luis Obispo CA 93401 O YT'sh�= TELEPHONE NUMBER TE-M-IALADDRE SS arx @slocity.org 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. Date Signed 02/08/2015 (month, day, year) Signature ( FPPC Form 700(2014/2015) FPPC Advice Email: advice @fppc.ca.gov FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov SCHEDULE A -1 _ SION Investments FAIR POLITICAL PRACTICES COMMIS Stocks, Bonds, and Other Interests Name (Ownership Interest is Less Than 10 %) Jan Howell Marx Do not attach brokerage or financial statements. 1 NAME OF BUSINESS ENTITY Palo Alto Networks GENERAL DESCRIPTION OF THIS BUSINESS stock in computer firewall company FAIR MARKET VALUE ❑ $2,000 - $10,000 Q $10,001 - $100,000 ❑ $100,001 - $1,000,000 ❑ Over $1,000,000 NATURE OF INVESTMENT Q Stock ❑ Other (Describe) ❑ Partnership O Income Received of $0 - $499 O Income Received of $500 or More (Report on Schedule C) IF APPLICABLE, LIST DATE: 08/01) 14 114 ACQUIRED DISPOSED ► NAME OF BUSINESS ENTITY GENERAL DESCRIPTION OF THIS BUSINESS FAIR MARKET VALUE ❑ $2,000 - $10,000 ❑ $10,001 - $10o,000 ❑ $100,001 - $1,000,000 ❑ Over $1,000,000 NATURE OF INVESTMENT ❑ Stock ❑ Other -- (Describe) ❑ Partnership O Income Received of $0 - $499 O Income Received of $500 or More (Report on Schedule c) IF APPLICABLE, LIST DATE: �/ 14 14 ACQUIRED DISPOSED ► NAME OF BUSINESS ENTITY GENERAL DESCRIPTION OF THIS BUSINESS FAIR MARKET VALUE ❑ $2,000 - $10,000 ❑ $10,001 - $100,000 ❑ $100,001 - $1,000,000 ❑ Over $1,000,000 NATURE OF INVESTMENT ❑ Stock ❑ Other (Describe) ❑ Partnership O Income Received of $0 - $499 O Income Received of $500 or More (Report on Schedule c) IF APPLICABLE, LIST DATE: / 14 —J 14 ACQUIRED DISPOSED Comments: ► NAME OF BUSINESS ENTITY GENERAL DESCRIPTION OF THIS BUSINESS FAIR MARKET VALUE ❑ $2,000 - $10,000 ❑ $10,001 - $100,000 ❑ $100,001 - $1,000,000 ❑ Over $1,000,000 NATURE OF INVESTMENT ❑ Stock ❑ Other (Describe) ❑ Partnership O Income Received of $0 - $499 O Income Received of $500 or More (Report on Schedule c) IF APPLICABLE, LIST DATE: 14 14 ACQUIRED DISPOSED ► NAME OF BUSINESS ENTITY GENERAL DESCRIPTION OF THIS BUSINESS FAIR MARKET VALUE ❑ $2,000 - $10,000 ❑ $10,001 - $100,00o ❑ $100,001 - $1,000,000 ❑ Over $1,000,000 NATURE OF INVESTMENT ❑ Stock ❑ Other (Describe) ❑ Partnership O Income Received of $0 - $499 O Income Received of $500 or More (Report on Schedule C) IF APPLICABLE, LIST DATE: � / 14 14 ACQUIRED DISPOSED ► NAME OF BUSINESS ENTITY GENERAL DESCRIPTION OF THIS BUSINESS FAIR MARKET VALUE ❑ $2,000 - $10,000 ❑ $10,001 - $100,000 ❑ $100,001 - $1,000,000 ❑ Over $1,000,000 NATURE OF INVESTMENT ❑ Stock ❑ Other (Describe) ❑ Partnership O Income Received of $0 - $499 O Income Received of $500 or More (Report on Schedule C) IF APPLICABLE, LIST DATE: / 14 14 ACQUIRED DISPOSED FPPC Form 700 (2014/2015) Sch. A -1 FPPC Advice Email: advice @fppc.ca.gov FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov SCHEDULE A -2 Investments, Income, and Assets of Business Entities /Trusts (Ownership Interest is 10% or Greater) 0- 1. BUSINESS ENTITY OR Steven and Jan Howell Marx Living Trust dtd 1/30/05 Fame Address (Business Address Acceptable) Check one ® Trust, go to 2 ❑ Business Entity, complete the box, then go to 2 GENERAL DESCRIPTION OF THIS BUSINESS FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $0 - $1,999 ❑ $2,000 - $10,000 /14 /14 ❑ $10,001 - $100,000 ACQUIRED DISPOSED ❑ $100,001 - $1,000,000 ❑ Over $1,000,000 NATURE OF INVESTMENT ❑ Partnership ❑ Sole Proprietorship ❑ Other YOUR BUSINESS POSITION SHARE OF -• SS INCOME TO THE ENTITYtTRUST) ❑ $0 -$499 ❑✓ $10,001 - $100,000 ❑ $500 - $1,000 ❑ OVER $100,000 ❑ $1,001 - $10,000 P 3. LIST THE NAME OF •- TABLE SINGLE SOURCE OF INCOME OF 1 1 1 1 OR • ❑ None or ❑✓ Names listed below The Vanguard Group (mutual funds) 1- 4. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD .- .- Check one box: ❑ INVESTMENT ❑✓ REAL PROPERTY Name of Business Entity, if Investment, Qr Assessor's Parcel Number or Street Address of Real Property Vanguard Group mutual funds Description of Business Activity pj City or Other Precise Location of Real Property FAIR MARKET VALUE IF APPLICABLE, LIST DATE: $2,000 - $10,000 $1o,001 - $100,000 4 n $100,001 - $1,000,000 ACQUIRED DISPOSED Over $1,000,000 NATURE OF INTEREST Q Property Ownership /Deed of Trust ❑ Stock ❑ Partnership ❑ Leasehold ❑ Other ... �. Yrs. remaining ❑ Check box if additional schedules reporting investments or real property are attached CALIFORNIA FORM 700 IFAIR POLITICAL PRACTICES COMMISSION 1- 1. BUSINESS ENTITY OR TRUST Name Address (Business Address Acceptable) Check one ❑ Trust, go to 2 ❑ Business Entity, complete the box, then go to 2 GENERAL DESCRIPTION OF THIS BUSINESS FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $0 - $1,999 ❑ $2,000 - $10,000 1 1 14_ -1--1 14 ❑ $10,001 - $100,000 ACQUIRED DISPOSED ❑ $100,001 - $1,000,000 ❑ Over $1,000,000 NATURE OF INVESTMENT ❑ Partnership ❑ Sole Proprietorship ❑ - lher YOUR BUSINESS POSITION SHARE OF -• SS INCOME TO THE ENTITY/TRUST) ❑ $0 - $499 ❑ $10,00l - $100,000 ❑ $500 - $1,000 ❑ OVER $100,000 ❑ $1,001 - $10,000 OF ••- TABLE SINGLE SOURCE OF INCOME OF $10,000 OR •- None or Names listed below P 4. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD OR LEASED BY THE BUSINESS ENTITY OR TRUST Glrack one box: ❑ INVESTMENT ❑ REAL PROPERTY Name of Business Entity, if Investment, gl Assessor's Parcel Number or Street Address of Real Property Description of Business Activity pf City or Other Precise Location of Real Property FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 ❑ $10,001 - $100,000 _j 114 _ J__/ 14 ❑ $100,001 - $1,000,000 ACQUIRED DISPOSED ❑ Over $1,000,000 NATURE OF INTEREST ❑ Property Ownership /Deed of Trust ❑ Stock ❑ Partnership ❑ Leasehold ❑ Other Yrs, remaining ❑ Check box if additional schedules reporting Investments or real property are attached FPPC Form 700 (2014/2015) Sch. A -2 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) ► ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS 265 Albert Drive CITY San Luis Obispo CA 93405 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 Yrs remaining IF APPLICABLE, LIST DATE: )_j 14 _ J_ j 14 ACQUIRED DISPOSED ❑ Easement 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. ❑ None Name Jan Howell Marx ► ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS 1515 Warm SDrinas Road #17 CITY Ketchum Idaho 83340 FAIR MARKET VALUE ❑ $2,000 - $10,000 ❑ $10,001 - $100,000 ❑✓ $100,001 - $1,000,000 ❑ Over $1,000,000 NATURE OF INTEREST ❑i/ Ownership /Deed of Trust F] Leasehold IF APPLICABLE, LIST DATE: __j JU --I--j _t4 ACQUIRED DISPOSED ❑ Easement 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. ❑ None Julie Berry II * 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' NAME OF LENDER" ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF LENDER BUSINESS ACTIVITY. IF ANY OF LENDER INTEREST RATE TERM (Months /Years) INTEREST RATE TERM (MonthsNears) ❑ None --- -- ........_..___ -_ % ❑ None _ HIGHEST BALANCE DURING REPORTING PERIOD HIGHEST BALANCE DURING REPORTING PERIOD ❑ $500 - $1,000 ❑ $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 ❑ Guarantor, if applicable ❑ Guarantor, if applicable Comments: . FPPC Form 700 (2014/2015) Sch. B FPPC Advice Email: advice @fppc.ca.gov FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov SCHEDULE C Income, Loans, & Business Positions (Other than Gifts and Travel Payments) NAME OF SOURCE OF INCOME City of San Luis Obispo ADDRESS (Business Address Acceptable) 990 Palm Street San Luis Obispo CA BUSINESS ACTIVITY, IF ANY, OF SOURCE municipal government YOUR BUSINESS POSITION Mayor GROSS INCOME RECEIVED ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑✓ $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑✓ Salary ❑ Spouse's or registered domestic partner's income (For self -employed use Schedule A -2.) ❑ Partnership (Less than 10% ownership. For 10% or greater use Schedule A -2.) ❑ Sale of (Real property, car, boat, etc.) ❑ Loan repayment ❑ Commission or ❑ Rental Income, list each source of $10,000 or more ❑ Other (Describe) (Describe) Name Jan Howell Marx NAME OF SOURCE OF INCOME San Luis Obispo Council of Governments ADDRESS (Business Address Acceptable) 1114 Marsh Street San Luis Obispo CA BUSINESS ACTIVITY, IF ANY, OF SOURCE metropolitan planning organization YOUR BUSINESS POSITION Board Member GROSS INCOME RECEIVED ❑✓ $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary ❑ Spouse's or registered domestic partner's income (For self - employed use Schedule A -2.) ❑ Partnership (Less than 10% ownership. For 10% or greater use Schedule A -2.) ❑ Sale of .. (Real properly, car, boat, etc.) ❑ Loan repayment ❑ Commission or ❑ Rental Income, list each source of $10,000 or more (Describe) stipend ❑d 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" INTEREST RATE TERM (MonthsNears) ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF LENDER HIGHEST BALANCE DURING REPORTING PERIOD ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 Comments: F] None SECURITY FOR LOAN ❑ None ❑ Personal residence ❑ Real Property Street address city ❑ Guarantor ❑ Other . (Describe) FPPC Form 700 (2014/2015) Sch. C FPPC Advice Email: advice @fppc.ca.gov FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov SCHEDULE C Income, Loans, & Business Positions (Other than Gifts and Travel Payments) NAME OF SOURCE OF INCOME San Luis Obispo Regional Transportatio Agency ADDRESS (Business Address Acceptable) 179A Cross Street San Luis Obispo CA 93401 BUSINESS ACTIVITY, IF ANY, OF SOURCE mass transit YOUR BUSINESS POSITION Board Member GROSS INCOME RECEIVED ❑✓ $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary ❑ Spouse's or registered domestic partner's income (For self -employed use Schedule A -2.) ❑ Partnership (Less than 10% ownership. For 10% or greater use Schedule A -2.) ❑ Sale of (Real property, car, boat, etc.) ❑ Loan repayment ❑ Commission or ❑ Rental Income, list each source of $10,000 or more stipend ❑✓ Other (Describe) (Describe) Name Jan Howell Marx I NAME OF SOURCE OF INCOME San Luis Obispo Air Pollution Control District ADDRESS (Business Address Acceptable) 3433 Roberto Court San Luis Obispo CA 93401 BUSINESS ACTIVITY, IF ANY, OF SOURCE prevention of air pollution YOUR BUSINESS POSITION Board Member GROSS INCOME RECEIVED ❑✓ $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary ❑ Spouse's or registered domestic partner's income (For self - employed use Schedule A -2.) ❑ Partnership (Less than 10% ownership. For 10% or greater use Schedule A -2.) ❑ Sale of (Real property, car, boat, etc.) ❑ Loan repayment ❑ Commission or ❑ Rental Income, list each source of $10,000 or more Q Other stipend (Describe) (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' INTEREST RATE TERM (MonthsNears) ❑ None ADDRESS (Business Address Acceptable) SECURITY FOR LOAN BUSINESS ACTIVITY, IF ANY, OF LENDER ❑None ❑Personal residence HIGHEST BALANCE DURING REPORTING PERIOD ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 Comments: ❑ Real Property ❑ Guarantor ❑ Other Street address city (Describe) FPPC Form 700 (2014/2015) Sch. C FPPC Advice Email: advice @fppc.ca.gov FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov SCHEDULE C Income, Loans, & Business Positions (Other than Gifts and Travel Payments) NAME OF SOURCE OF INCOME Cal Pers Pension ADDRESS (Business Address Acceptable) PO Box 942716 Sacramento CA 942716 BUSINESS ACTIVITY, IF ANY, OF SOURCE pension fund YOUR BUSINESS POSITION spouse is receiving pension GROSS INCOME RECEIVED ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑ i/ $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary ❑ Spouse's or registered domestic partner's income (For self -employed use Schedule A -2.) ❑ Partnership (Less than 10% ownership. For 10% or greater use Schedule A -2.) ❑ Sale of (Real property, car, boat, etc.) ❑ Loan repayment ❑ Commission or ❑ Rental Income, list each source of $10,000 or more Name I Jan Howell Marx I NAME OF SOURCE OF INCOME Social Security Administration (Western Center) ADDRESS (Business Address Acceptable) PO Box 310120 Jamaica NY 1143 -0120 BUSINESS ACTIVITY, IF ANY, OF SOURCE government retirement fund YOUR BUSINESS POSITION retiree GROSS INCOME RECEIVED ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑✓ $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary ❑ Spouse's or registered domestic partner's income (For self - employed use Schedule A -2.) ❑ Partnership (Less than 10% ownership. For 10% or greater use Schedule A -2.) ❑ Sale of (Real property, car, boat, etc.) ❑ Loan repayment ❑ Commission or ❑ Rental Income, list each source of $10,000 or more (Describe) (Describe) ❑ Other ❑ Other retirement benefits (Describe) (Describe) s- 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 LENDER' ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF LENDER HIGHEST BALANCE DURING REPORTING PERIOD ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 Comments: INTEREST RATE TERM (MonthsNears) % ❑ None SECURITY FOR LOAN ❑ None ❑ Personal residence ❑ Real Property ❑ Guarantor ❑ Other Street address city (Describe) FPPC Form 700 (2014/2015) 5ch. C FPPC Advice Email: advice @fppc.ca.gov FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov Date Received STATEMENT OF ECONOMIC INTERESTS FEB .11-4,H14, COVER PAGE Please type or print in ink. NAME OF FILER (LAST) (FIRST) (MIDDLE) Manx Jan Howell 1. Office, Agency, or Court Agency Name (Do not use acronyms) City of San Luis Obispo Division, Board, Department, District, if applicable Your Position Mayor ► If filing for multiple positions, list below or on an attachment. (Do not use acronyms) Agency: Air Pollution Control District 2. Jurisdiction of Office (Check at least one box) Position: Board Member ❑ State ❑ Judge or Court Commissioner (Statewide Jurisdiction) ❑ Multi- County ® County of San Luis Obispo ® City of San Luis Obispo ❑ Other 3. Type of Statement (Check at least 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 I I through O The period covered is January 1; 2013, through the date of December 31, 2013. leaving office. ❑ Assuming Office: Date assumed O The period covered is I I through the date of leaving office. © Candidate: Election year 2014 and office sought, if different than Part 1 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) 990 Palm Street San Luis Obispo CA 93401 DAYTIME TELEPHONE NUMBER E -MAIL ADDRESS ;(JFTi' I•! ,L ( jmarx @slocity.org 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 FPPC Form 700 (2013/2014) FPPC Advice Email: advice @fppc.ca.gov FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov California Form 700 Attachment to Cover Page 1. Agency San Luis Obispo Council of Governments San Luis Obispo Regional Transportation Agency LOSSAN Rail Corridor Agency Jan Marx Board Member Board Member Alternate Board Member SCHEDULE A -9 CALIFORNIA FORm Investments FAIR POLITICAL PRACTJCES COMMISSION Stocks, Bonds, and Other Interests Name (Ownership Interest is Less Than 10 %) ,-1A 1'J Do not attach brokerage or financial statements. NAME OF BUSINESS ENTITY Palo Alto Networks GENERAL DESCRIPTION OF BUSINESS ACTIVITY computer firewall prograrns FAIR MARKET VALUE X❑ $2,000 - $10,000 ❑ $1 0,001 - $100,000 ❑ $100,001 - $1,000,000 ❑ Over $1,000,000 NATURE OF INVESTMENT Q Stock ❑ Other (Describe) ❑ Partnership Q Income Received of $0 - $499 Q Income Received of $500 or More (Report on Schedule C) IF APPLICABLE, LIST DATE: 8 ( 1 _I _Xl? f.� ACQUIRED DISPOSED NAME OF BUSINESS ENTITY GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE ❑ $2,000 - $10,000 ❑ $100,001 - $1,000,00o NATURE OF INVESTMENT ❑ Stock ❑ Other _ ❑ Partnership Q Income Q Incon/ ❑ $10,001 - wo,Wa ❑ Over , oo,= (Describe) of $0 - $499 of $500 or More (Report on Schedule C) IF APPLICABLE, L T DATE_ 'I —lam 11 ACQUIRED DISPOSED NAME OF BUSINESS ENTITY GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE ❑ $2,000 - $10,000 ❑ $100,001 - $1,000,000 NATURE OF INVESTMENT ❑ Stock ❑ Other - (Describe) ❑ Partnership Q 1 e Received of $0 - $499 nettle Received of $500 or More (Repoli on Schedule C) IF Af'PLICAB , LIST DATE: ACQUIRED DISPOSED ❑01 - $100,000 ver $1,000,000 Comments: I. NAME OF BUSINESS ENTITY GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE ❑ $2,000 - $10,000 ❑ $10 i - $100,000 ❑ $100,001 - $1,000,000 er $1,000,009 NATURE OF INVESTMENT ❑ Stock ❑ (Describe) ❑ Partnership ncome Received of $0 - $499 Income Received of $500 or More (Report on Schedule C) IF APPLI BLE, LIST DATE: ACQUIRED DISPOSED NAME OF BUSINESS ENTITY GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE ❑ $2,000 - $10,000 ❑ ,001 - $100,000 ❑ $100,001 - $1,000,000 Over $1,000,000 NATURE OF INVESTMENT ❑ Stock ❑ Oth (Describe) ❑ Partnership Q come Received of $0 - $499 Income Received of $500 or More (RepoA on Schedule C) IF APPLICABLE, LIST DATE: ACQUIRED DISPOSED NAME OF BUSINESS ENTITY GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE ❑ $2,000 - $10,000 ❑ $100,001 - $1,000,000 NATURE OF INVESTMEN ❑ Stock ❑ O r ❑ S�oo1 - $100,000 ❑+'Over 51,000,000 (Describe) ❑ Partnership nccme Received of $0 - $499 Income Received of $500 or More (Report on Schedule C) IF APPLICABLE, LIST DATE: ACQUIRED DISPOSED FPPC Form 700 (2011 /2012) Sch. A -1 FPPC Toll -Free Help)ine: 866 /275 -3772 wvvw.fppc.ca.gov SCHEDULE A -2 GALIFORNIAFORM 1,111-91 Investments, Income, and Assets ' of Business Entities /Trusts Name (Ownership Interest is 10% or Greater) -IWA/ 14+0 -)< 110 1. BUSINESS ENTITY-OR TRUST Steven and Jan Howell Marx Living Trust dtd 1130/05 Name 265, Albert Drive San Luis Obispo CA 93405 Address (Business Address Acceptable) Check one ® Trust, go to 2 ❑ Business Entity, complete the box, then go to 2 GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE IF APPLICABLE, LIST DATE_ ❑ $0 - $1,999 10$2000 - $10,000 El $10,001 - $100,01)0 ACQUIRED DISPOSED [j $100,001 - $1,000,000 Q Over $1,000,00o NATURE OF INVESTMENT Q Sole Proprietorship ❑ Partnership ❑ Other YOUR BUSINESS POSITION Q $0 - $499 © $10,001 - $100,000 ❑ $500 - $1,000 ❑ OVER $100,000 ❑ $1,001 - $10,000 The Van uard Group Check one box: ® INVESTMENT [] REAL PROPERTY Investment Firm f V(.cv�q �,f r,f,( Name of Business Entity, if Investment, or Assessor's Parcel Number or Street Addre f Real Property Description of Business Activity or City or Other Precise Location of Real Property FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 ❑ $10,001 - $100,000 -- j 11 ❑}C $100,001 - $1,000,000 ACQUIRED DISPOSED ❑ Over $1,000,000 NATURE OF INTEREST ❑ Property Ownership /Deed of Trust ❑ Stock ❑ Partnership ❑ Leasehold ❑ Other Yrs. remaining ❑ Check box if additional schedules reporting investments or real property are attached comments: Law Offices of Jan Howell Marx Name PO Box 1445 San Luis Obispo CA 93406 Address (Business Address Acceptable) Check one ❑ Trust, go to 2 Q Business En6fy, complete the box, then go to 2 GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ s0 - $1,999 ❑ $2,000 - $10,000 Q $10,001 - $100,000 ACQUIRED DISPOSED ❑ $100,001 - $1,000,000 [] Over $1,000,000 i NATURE OF INVESTMENT X Sole Proprietorship Q Partnership Q I Other YOUR BUSINESS POSITION Owner I DiT$O - $499 Q $10,001 - $100,000 $500 - $1,000 OVER $100,000 ❑ $1,001 - $10,000 Check one box: Q INVESTMENT ❑ REAL PROPERTY Name of Business Entity, if Investment, or Assessor's Parcel Number or Street Address of Real Property Description of Business Activity 2[ City or Other Precise Location of Real FAIR /$1,000,000 VALUE F APPLICABLE, LIST DATE: ❑ $210,000 ❑ $1$101),000 ❑ $1 $1,000,000 ACQUIRED DISPOSED Ov0,000 NATUNTE ST ❑ Prw rshiplDeed of Trust ❑ Stock ❑ Partnership Le❑ Other Yrs. remaining h if additional schedules reporting investments or real property are attached FPPC Form 700 (2011/2012) Sch. A-2 FPPC Toil -Free Helpline: 866 /275 -3772 www.fppc.ca.gov SCHEDULE B Interests in Real Property (Including Rental Income) ► ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS 265 Albert Drlve CITY San Luis Obispo FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 ❑ $10,001 - $100,000 ❑X $100,001 - $1,000,000 ACQUIRED DISPOSED ❑ Over $1,000,000 NATURE OF INTEREST ❑X Ownership /Deed of Trust ❑ Easement ❑ Leasehold ❑ Yrs. remaining Other IF RENTAL PROPERTY, GROSS INCOME RECEIVED ❑ $0 - $499 Q $500 - $1,D00 ❑ $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. Name 74V eAA-P-X- Y ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS 1515 Warm Springs Road #17 CITY Ketchum, Idaho 83340 FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 ❑ $10,001 - $100,00o ❑X $100,001 - $1,000,000 ACQUIRED DISPOSED ❑ Over $1,000,000 NATURE OF INTEREST ❑X Ownership /Deed of Trust ❑ Easement ❑ Leasehold ❑ Yrs. remaining Other IF RENTAL PROPERTY, GROSS INCOME RECEIVED 0$0-$499 ❑ $500 - $1,000 ❑X $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 LEN INTEREST RATE / TERM (Months/Years) % ❑ HIGHE/BA',,L-AN DURING REPORTING PERIOD ❑ $50 ❑ $1,001 - $10,000 1000 ❑ OVER $100,000 Ci Gulicable Comments: NAME OF LENDER" ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF LENDER INTEREST RATE { TERM (Wriths/Yews) ❑ HIGHEST BALAN DURING REPORTING PERIOD ❑ $500 - $1. $1,001 - $10,000 ❑ 510, . - $100,000 ❑ OVER $100,000 if applicable FPPC Form 700 (201112012) Sch, B FPPC Toll -Free Helpline: 866 /275 -3772 www.fppc.ca,gov SCHEDULE C CALIFORNIA FORM 1 1 Income, Loans, & Business FAIR POLITICAL PRACTLCES COMirAISSION Positions Name (Other than Gifts and Travel Payments) --JRw 1-14VV _ NAME OF SOURCE OF INCOME City of San Luis Obispo ADDRESS (Business Address Acceptable) 990 Palm Street San Luis Obispo CA 93401 13USINESSACWATY, IF ANY, OF SOURCE municipal government YOUR BUSINESS POSITION Mayor GROSS INCOME RECEIVED ❑ $soo - $1,000 ❑ $1,001 - $10,000 ❑X $10,001 - $400,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED Q Salary ❑ Spouse's or registered domestic partner's income ❑ Loan repayment ❑ Partnership ❑ Sale of (Real pmperty, car, boat, efc.) ❑ Commission or ❑ Rental Income, fist each source cr510,000 or more R Other {Describe) NAME OF SOURCE OF INCOME SLO Council of Governments ADDRESS (Business Address Acceptable) 1114 Marsh Street, San Luis Obispo BUSINESS ACTIVITY, IF ANY, OF SOURCE metropolitan planning organization YOUR BUSINESS POSITION Board Member GROSS INCOME RECEIVED ® $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary ❑ Spouse's or registered domestic partner's income ❑ Loan repayment ❑ Partnership ❑ Sale of (Real pmpally, car, boat, atc.) ❑ Commission or ❑ Rental Income, list each source of $10,000 ormore 4 �. Other 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` INTEREST RATE TERM (MonthsNears) ❑ None ADDRESS (Business Address Acceptable) SECURITY FOR LOAN BUSINESS ACTIVITY, IF ANY, OF LENDER ❑ None ❑ Personal residence [] Real Property S1 eda HIGHEST BALANCE DURING REPORTIN ERIi70 ❑ $500 - $1,Oo0 City ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑Guarantor ❑ OVER $100,000 ❑ Other. (Describe) CDn1ments: FPPC Form 700 (2 0 1 1120 1 2) Sch. C FPPC Toll -Free Helpline: 8661275 -3772 www.fppc.ca.gov SCHEDULE C Income, Loans, & Business Positions (Other than Gifts and Travel Payments) NAME OF SOURCE OF INCOME ADDRESS (Busin s Address Acceptable) _I� errsf BUSINESS ACTIVITY. IF ANY, OF SOURCE �h Lis 6 C4 YOUR BUSINESS POSITION GROSS INCOME RECEIVED e$500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary [-] Spouse's or registered domestic partner's income ❑ Loan repayment ❑ Partnership ❑ Sale of _ (Real property, car, boat, etc.) ❑ Commission or ❑ Rental Income, list each source of $10,000 or mole Other . S*% l2 " - (Describe) Name SAA) �44#0�X/ NAME OF SOURCE OF INCOME ADDRESS (Business Address Acceptable) 3-V�- BUSINESS ACTIVITY, IF ANY, OF SOURCE YOUR BUSINESS POSITION GROSS INCOME RECEIVED K $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100.000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary [] Spouse's or registered domestic partner's income ❑ Loan repayment ❑ Partnership n Sale of (Real property, car, boat, etc) ❑ Commission or ❑ Rental Income, list each source of $10,000 or more KOther__,J T -�—e W__ (17escrfbe} LOANS 2. 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 LENDER' tpJ -'_r: ST RATE TERM (Months/Years) % ❑ None ADDRESS (Business Address Acceptable) SECURITY FOR LOAN BUSINESS ACTIVITY, IF ANY, OF LENDER ❑ None ❑ Personal resid Real Property Street address HIGHEST BALANCE ❑ $500 - $1,000 City ZREPORTING $1,001 - $10,000 Guarantor $10,001 - $100,00❑ OVER $100,000 ❑ Other (Describe) Gomm FPPC Form 700 (2013/2014) Sch. C FPPC Advice Email: advice @fppc.ca.gov FPPC Toll-Free Heipline: 866/275 -3772 www.fppc.ca.gov SCHEDULE C Income, Loans, & Business Positions (Other than Gifts and Travel Payments) NAME OF SOURCE OF INCOME Air Pollution Control District ADDRESS (Business Address Acceptable) 3433 Roberto Court San Luis Obispo BUSINESS ACTIVITY, IF ANY, OF SOURCE addressing air pollution YOUR BUSINESS POSITION Board Member GROSS INCOME RECEIVED ® $500 - $9,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED * Salary ❑ Spouse's or registered domestic partner's Income ❑ Loan repayment ❑ Partnership ❑ Sale of (Real proper[}; car, boat, etc.) ❑ Commission or ❑ Rental Income, list each source of $10,000 or more KOther 5,� 7"` (Oesaibe) NAME OF SOURCE OF INCOME Cal Pers ADDRESS (Business Address Acceptable) PO Box 942716 Sacramento CA 942716 BUSINESS ACTIVITY, IF ANY, OF SOURCE retirement fund YOUR BUSINESS POSITION spouse is receiving pension GROSS INCOME RECEIVED ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑X $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ salary ❑X Spouse's or registered domestic partner's income Loan repayment ❑ Partnership n .sarP „f (Real property, car, boat, etc) Commission or ❑ Rental Income, IM each source or $10,000 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` ADDRESS (BUSrness Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF LENDER HIGHEST BALANCE DURING REPORTI PERIOD ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 Comments: INTEREST RATE TERM (Months/Years) % ❑ None SECURITY FOR LOAN ❑ None ❑ Personal resider Real Property Street address R Guarantor ❑ Other City (Describe) FPPC Form 700 (201112012) Sch. C FPPC Toll -Free Helpline: 8661275 -3772 wwwfppc.ca.gov v„ SCHEDULE C CALIFORNIA FORM 11111 Income, Loans, & Business ' Positions Name (Other than Gifts and Travel Payments) J-(4N MA4- NAME OF SOURCE OF INCOME Social Security Administration (Western Center) ADDRESS (Business Address Acceptable) PO Box 2000, Richmond CA 94802 -1791 BUSINESS ACTIVITY, IF ANY, OF SOURCE government retirement fund YOUR BUSINESS POSITION retiree GROSS INCOME RECEIVED ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑ X $10,001-$100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED 171 Salary ❑ Spouses or registered domestic partner's Income ❑ Loan repayment ❑ Partnership ❑ Sale of (Real propertj car, boat, etc.) ❑ Commission or ❑ Rental Income, list each source of S10,000 or more FX other retirement benefits ( Descrbe) NAME OF SOURCE OF INCOME Social Security Administration (Northeastern Center) ADDRESS (Business Address Acceptable) PO Box 310120 Jamaica NY 1143 -0120 BUSINESS ACTIVITY, IF ANY, OF SOURCE government retirement fund YOUR BUSINESS POSITION spouse is retiree GROSS INCOME RECEIVED [] $5oo - $1,000 ❑ $1,001 - $10,0oo X❑ $10,001 - $1D0,D00 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ salary ❑X Spouse's or registered domestic partners income Loan repayment ❑ Partnership Sale of (Real property, car, boat, elc.) ❑ Commission or ❑ Rental Income, list each source of S10,000 or more ❑Other spouse is retiree (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 discloses follows: NAME OF LENDER` ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF HIGHEST BAL/GURING PORTING PERIOD ❑ $500 - $1,❑ $1,001 - $❑ $10,001 - ❑OVER $10 Comments, INTEREST RATE TERM (Months/Years) ❑ None _ SECURITY FOR LOAN ❑ None ❑ Personal ❑ Real Property ❑ Guarantor ❑ Other freer address City (Describe) FPPC Form 700 (201112012) Sch, C FPPC Toll -Free Helpline: 866/275 -3772 www.fppo.ce.gov SCHEDULE A -2 Investments, Income, and Assets of Business Entities/Trusts (Ownership Interest is 10% or Greater) 5*6 LA,, �[ ��.- ✓r' i s Name fable) Check one Y'05 y Trust, go to 2 ❑ Business Entity, complete the box, then go to 2 GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE IF APPLICABLE, LIST DATE: $0 - $1,999 ❑ $2,000 - $10,00o ❑ $10,001 - $100,000 ACQUIRED DISPOSED ❑ $100,001 - $1,000,000 ® Over $1,000,000 NATURE OF INVESTMENT ❑ Sole Proprietorship ❑ Partnership Other YOUR BUSINESS POSITION 0$0-$499 ,R $10,001 - $100,000 ❑ $500 - $1,000 ❑ OVER $100,000 ❑ $1,001 - $10,000 ❑ None AMENDMENT Check one box: %INVESTMENT REAL PROPERTY MAY 0 7 2013 Name of Busines ntity, if Investment, or f / City or Other Precise Location of Real Property FAIR MARKET VALUE ❑ $2,000 - $10,000 ❑ $10,001 - $100,000 $1001001 - $1,000,000 ❑ Over $1,000,000 �N,A(TURE OF INTEREST Ix Property Ownership /Deed of Trust IF APPLICABLE, LIST DATE: —J —/ 12 —J_ i 12 ACQUIRED DISPOSED ❑ Stock ❑ Partnership ❑ Leasehold )� Yrs. Other remaining ❑ Check box if additional schedules reporting investments or real property are attached Comm Print Name Tel;., 4 91 AOef t� Office, Agency or Court Statement Type 2012/2013 Annual Annual1. ❑ Assuming ❑ Leaving QTCandidate 7) 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 certify under penalty of perjuryy under the laws of the State of California 2013) FPPC Advice Email: advice @fppc.ca.gov FPPC Toll -Free Helpline: 866/275 -3772 www.fppc,ca.gov SCHEDULE A -2 CALIFORNIA FORM Investments, Income, and Assets FAIR POLITICAL PRACTICES C4 of Business Entities /Trusts Name (Ownership Interest is 10% or Greater) 4P -V-m &VP't Name Address (Business Address Acceptable) Check one ❑ Trust, go to 2 ❑ Business Entity, complete the box, then go to 2 GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $0 -$1,999 ❑ $2,000 - $10,000 �__j 11 [] $10,001 - $1o0,000 ACQUIRED DISPOSED ❑ $100,001 - $1,000,000 ❑ Over $1,000,000 NATURE OFINVESTMENT Sole Proprietorship ❑ Partnership ❑ Other. YOUR BUSINESS POSITION ❑ $0 - $499 ❑ $10,001 - $100,000 ❑ $500 - $1,000 ❑ OVER $100,000 ❑ $1,001 - $10,000 Check one box: INVESTMENT ❑ REAL PROPERTY Name of Business Entity, if Investment, 2 Assessor's Parcel Number or Street Address of Real Property Description of Business Activity or City or Other Precise Location of Raul Property 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 OFINTEREST 0 Property Ownership /Deed of Trust ❑ Stock Partnership ❑ Leasehold s ❑ Other Yr remairwng ❑ Check box if additional schedules reporting investments or real property are attached _zAg±z y t� l u /fix FPPC TOIL -Free Help9ne: 866 /275 -3772 www.fppc.ca.gov /Vfir.ti.�,, : j csf ! /�� �r-X,, a✓ ' rJ- (.cam, -,7- C4 c% s ,'1� r� c I _ a a I a a I rti't'* -sue- , 1r <L✓" t�Gt rC t -�C tie /G+/ / � ' % `� ]`k.-r S T�` +�rr°r � � ]�+fiaJ �%% Achy 7 f CiA � � • - • - 1 I STATEMENT OF ECONOMIC INTERESTS "R41`14gt13 COVER PAGE Please type or print in ink NAME OF FILER (LAST) (FIRST) (MIDDLE) MARX JAN HOWELL 1. Office, Agency, or Court Agency Name City of San Luis Obispo Division, Board, Department, District, if applicable Your Position Mayor ► If filing for multiple positions, list below or on an attachment. Agency: Air Pollution Control District of San Luis Obispo Co Position: Board Member 2. Jurisdiction of Office (Check at least one box) ❑ State ❑ Judge or Court Commissioner (Statewide Jurisdiction) ❑ Multi- County _ ® County of _San Luis Obispo © City of San Luis Obispo ❑ Other 3. Type of Statement (Check at least one box) [L� Annual: The period covered is January 1, 2012, through ❑ Leaving Office: Date Left December 31, 2012. (Check one) -or- 0 The period covered is January 1, 2012, through the date of The period covered is �J ,through P Y 9 December 31, 2012. leaving office. 12 03 2012 0 The period covered is J_�..r_— through © Assuming Office: Date assumed �_� P g the date of leaving office. ❑ Candidate: Election year 4. Schedule Summary Check applicable schedules or "None." © Schedule A -1 - Investments - schedule attached ✓❑ Schedule A -2 - Investments - schedule attached © Schedule B - Real Property- schedule attached and office sought, if different than Part 1: ► Total number of pages including this cover page: a © Schedule C - Income, Loans, & Business Positions - schedule attached ❑ Schedule D - Income - Gifts - schedule attached ❑ Schedule E - Income - Gifts - Travel Payments - schedule attached .or- F1 None - No reportable interests on any schedule 5. Verification MAILING ADDRESS STREET CITY STATE ZIP CODE (Business or Agency Address Recommended - Public Doalrnenf) 990 Palm Street San Luis Obispo CA 93401 DAYTIME TELEPHONE NUMBER E-MAIL AUUKESS (UF1IUNAL) ( 805 ) 781 -7120 jmarx @slocity.org 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 (2012/2013) FPPC Advice Email: advice @fppc.ca.gov FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov SCHEDULE A -'I CALIFORNIA FORm j Investments FAIR POLYTICAL PRACTICES COWUSSION, Stocks, Bonds, and Other Interests Name (Ownership Interest is Less Than 10%) .7A i" /W-R Do not attach brokerage or financial statements, ► NAME OF BUSINESS ENTITY Palo Alto Networks GENERAL DESCRIPTION OF BUSINESS ACTIVITY computer firewall programs FAIR MARKET VALUE X❑ $2,000 - $10,000 ❑ $10,001 - $100,000 ❑ $100,001 - $1,00o,000 ❑ Over $1,000,000 NATURE OF INVESTMENT ❑X Stock ❑ Other _ (Describe) ❑ Partnership O Income Received of $0 - $499 O Income Received of $500 or More (Report on Schedule C) IF APPLICABLE, LIST DATE: 8 t t—J-JU2 1__j 11 ACQUIRED DISPOSED ► NAME OF BUSINESS ENTITY GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE ❑ $2,000 - $10,000 ❑ $10,001 - $100,000 ❑ $100,001 - $1,000,000 ❑ Over $1,000,000 NATURE OF INVESTMENT ❑ Stock ❑ Other (Describe) ❑ Partnership O Income Received of $0 - $499 O Income Received of $500 or More (Report on Schedule C) IF APPLICABLE, LIST DATE: I —J-11 __ J_1 11 ACQUIRED DISPOSED ► NAME OF BUSINESS ENTITY GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE ❑ $2,000 - $10,000 ❑ $10,001 - $100,000 ❑ $100,001 - $1,000,000 ❑ Over $1,000,000 NATURE OF INVESTMENT ❑ Stock ❑ Other (Describe) ❑ Partnership O Income Received of $0 - $499 O Income Received of $500 or More (Repoli on Schedule C) IF APPLICABLE, LIST DATE: ACQUIRED DISPOSED Comments-, ► NAME OF BUSINESS ENTITY GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE ❑ $2,000 - $10,000 ❑ $10,001 - $100,000 ❑ $100,001 - $1,000,000 ❑ Over $1,000,01)0 NATURE OF INVESTMENT ❑ Stock ❑ Other (Describe) ❑ Partnership O Income Received of $0 - $499 O Income Received of $500 or More (Report on Schedule C) IF APPLICABLE, LIST DATE: ACQUIRED DISPOSED ► NAME OF BUSINESS ENTITY GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE ❑ $2,000 - $10,000 ❑ $10,001 - $100.000 ❑ $100,001 - $1,000,000 ❑ Over $1,000,000 NATURE OF INVESTMENT ❑ Stock ❑ Other. (Describe) ❑ Partnership O Income Received of $0 - $499 Q Income Received of $500 or More (Report on Schedule C) IF APPLICABLE, LIST DATE: ----- JAI_ ACQUIRED DISPOSED j ► NAME OF BUSINESS ENTITY I GENERAL DESCRIPTION OF BUSINESS ACTIVITY I w FAIR MARKET VALUE I ❑ $2,000 - $10,000 ❑ $10,001 - $100,000 ; ❑ $100001 - $1,000,000 ❑ Over $1,000,000 NATURE OF INVESTMENT ❑ Stack ❑ Other (Describe) ❑ Partnership O Income Received of $0 - $499 O Income Received of $500 or More (Report on Schedule C) IF APPLICABLE, LIST DATE: ACQUIRED DISPOSED FPPC Form 700 (201112012) Sch. A -1 FPPC Toll -Free Helpline: 8661275 -3772 www,fppc.ca.gov SCHEDULE A -2 ffim7e Investments, Income, and Assets of Business Entities /Trusts Na(Ownership Interest is 10% or Greater) R� rM2X Steven and Jan Howell Marx Living Trust dtd 1/30/05 Name Address (Business Address Acceptable) Check one ® Trust, go to 2 ❑ Business Entity, complete the box, then go to 2 GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE IF APPLICABLE, LIST DATE: $0 -$1.999 $2,000 - $10,000 r--r $10,001 • $100,000 ACQUIRED DISPOSED [t $100,001 - $1,000,000 [] Over $1,000,000 NATURE OF INVESTMENT ❑ Sole Proprietorship ❑ Partnership YOUR BUSINESS POSITION IN E1$0-$499 © $10,001 - $100,000 ❑ $500 - $1,000 ❑ OVER $100,000 ❑ S1,001 - $10,000 The Vanguard Qrpu p Check one box: ❑X INVESTMENT ❑ REAL PROPERTY Investment Firm Name of Business Entity, if Investment, or Assessor's Parcel Number or Street Address of Real Property Description of Business Activity or City or Other Precise Location of Real Property Other FAIR MARKET VALUE IF APPLICABLE, LIST DATE: $2,000 - $110,000 $10,001 - $100,000 X $100,001 - $1,000,000 ACQUIRED DISPOSED ❑ Over $1,000,000 NATURE OF INTEREST ❑ Property Ownership /Deed of Trust ❑ Stock ❑ Partnership ❑ Leasehold ❑ Other Yrs. remaining ❑ Check box if additional schedules reporting investments or real property are attached Comments: Law Offices of Jan Howell Marx Name PO Box 1445 San Luis Obispo CA 93406 Address (Business Address Acceptable) Check one ❑ Trust, go to 2 ❑x Business Entity, complete the box, then go to 2 R GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $o - $1,999 ❑ $2.000 - $10,000 ❑X $10,001 - $100,000 ACQUIRED DISPOSED ❑ $100,001 - $1,000,000 ❑ Over $1,000,000 NATURE OF INVESTMENT ® Sole Proprietorship ❑ Partnership ❑ Other YOUR BUSINESS POSITION owner M$0 - $499 0 $10,001 - $100,000 $500 .$1,000 ❑ OVER $iD0,000 ❑ $1,001 - $10,000 Check one box: ❑ INVESTMENT ❑ REAL PROPERTY Name of Business Entity, if Investment, o Assessor's Parcel Number or Street Address of Real Property Description of Business Activity 2C City or Other Precise Location of Real Property FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 ❑ $10,001 - $100,00o ❑ $100,001 - $1,000,000 ACQUIRED DISPOSED ❑ Over $1,000,000 NATURE OF INTEREST ❑ Property Ownership /Deed of Trust [1 Stock ❑ Partnership ❑ Leasehold ❑ Other Yrs. remaining ❑ Check box if additional schedules reporting investments or real property are attached FPPC Form 700 (2011/2012) Soh. A -2 FPPC Toll -Free Helpline: 8661275 -3772 www.fppe- ce.gov SCHEDULE B Interests in Real Property (Including Rental Income) ► ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS CITY San Luis Obispo FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 ❑ $1o,001 - $100,000 0 $100,001 - $1,000,000 ACQUIRED DISPOSED ❑ Over $1,000,000 NATURE OF INTEREST Q Ownership /Deed of Trust ❑ Easement ❑ Leasehold ❑ - -- Yrs. remaining 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, Name 74 A) 1,AAf1-X 1 AJJtJJVKJ YAKQtL NUM13hK UK SIKttl AUUKt2iJ CITY Ketchum, Idaho 83340 FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 ❑ $10,001 - $100,000 ❑X $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 © $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" NAME OF LENDER" ADDRESS (Business Address Acceptable) `T ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF LENDER _ BUSINESS ACTIVITY, IF ANY, OF LENDER INTEREST RATE TERM (MonthslYears) INTEREST RATE TERM (MonlhsNears) off, ❑ None HIGHEST BALANCE DURING REPORTING PERIOD ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 ❑ Guarantor, if applicable Comments: ly ❑ None 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.ce.gov SCHEDULE C Income, Loans, & Business Positions (Other than Gifts and Travel Payments) NAME OF SOURCE OF INCOME Cal Poly State University ADDRESS (Business Address Acceptable) 1 Grand Ave, San Luis Obispo CA 93407 BUSINESS ACTIVITY, IF ANY, OF SOURCE Higher Education YOUR BUSINESS POSITION spouse is partly retired faculty member GROSS INCOME RECEIVED ❑ $500 - $1,000 ❑ $1,001 - $10,000 Q $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ salary ® Spouse's or registered domestic partner's income ❑ Loan repayment ❑ Partnership ❑ Sale of (Real proper/ car, boat, e(c.) ❑ Commission or ❑ Rental Income, IW each source or $10,000 or more ❑ Other (Describe) CALIFORNIA FORM 700 FAIR POLITICAL PRACTICES COMMISSION NAME OF SOURCE OF INCOME Law Offices of Jan Howell Marx ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF SOURCE law practice YOUR BUSINESS POSITION attorney GROSS INCOME RECEIVED ® $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED X❑ Salary ❑ Spouse's or registered domestic partner's income ❑ Loan repayment ❑ Partnership ❑ Sale of (Real property, car, boat, etc.) ❑ Commission or ❑ Rental Income, list each source or $10,000 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" ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF LENDER HIGHEST BALANCE DURING REPORTING PERIOD ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 Comments: INTEREST RATE TERM (MonthsNears) ❑ None SECURITY FOR LOAN ❑ None ❑ Personal residence ❑ Real Property Street address ❑ Guarantor ❑ Other City (Describel FPPC Form 700 (201112012) Sch. C FPPC Toll -Free Helpline: 8661275 -3772 www.fppc.ca.gov SCHEDULE C Income, Loans, & Business Positions (Other than Gifts and Travel Payments) NAME OF SOURCE OF INCOME City of San Luis Obispo ADDRESS (Business Address Acceptable) 990 Palm Street San Luis Obispo CA 93401 BUSINESS ACTIVITY, IF ANY, OF SOURCE municipal government YOUR BUSINESS POSITION Mayor GROSS INCOME RECEIVED ❑ $500 - $1,000 ❑ $1,001 - $10,000 0 $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED © Salary [] Spouse's or registered domestic partner's income ❑ Loan repayment ❑ Partnership ❑ sale of (Real properly, car, boat, e(F) ❑ commission or ❑ Rental Income, list each source of $10,000 or m0/e ❑ Other (Describe) CALIFORNIA FORM 700 FAIR POLITICAL PRACTICFS COWAISSION NAME OF SOURCE OF INCOME SLO Council of Governments ADDRESS (Business Address Acceptable) 1114 Marsh Street, San Luis Obispo BUSINESS ACTIVITY, IF ANY, OF SOURCE metropolitan planning organization YOUR BUSINESS POSITION Board Member GROSS INCOME RECEIVED ® $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary ❑ Spouse's or registered domestic partner's income ❑ Loan repayment ❑ Partnership ❑ Sale of ._ __.._ (Rea! propeny, car, boat, efc.) ❑ Commission or ❑ Rental Income, list each source of S1o,000 ormore ❑ Other - (Describe) ( Descdbe) 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" ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF LENDER HIGHEST BALANCE DURING REPORTING PERIOD ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 • $100,000 ❑ OVER $100,000 Comments: INTEREST RATE TERM (Monthsl'Years) ❑ Nona _..._- i r SECURITY FOR LOAN 1 ❑ None ❑ Personal residence ❑ Real Properly Street address City ❑ Guarantor ❑ Other (Oescnbe) FPPC Form 700 (2011/2012) Sch. C FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov SCHEDULE C Income, Loans, & Business Positions (Other than Gifts and Travel Payments) NAME OF SOURCE OF INCOME Air Pollution Control District ADDRESS (Business Address Acceptable) 3433 Roberto Court San Luis Obispo BUSINESS ACTIVITY, IF ANY, OF SOURCE �^ addressing air pollution YOUR BUSINESS POSITION Board Member GROSS INCOME RECEIVED © $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ® Salary ❑ Spouse's or reglstered domestic partner's Income ❑ Loan repayment ❑ Partnership ❑ Sale of ._ (Real property, car, boat, etc.) ❑ Commission or ❑ Rental Income, list each source of $10,000 or more ❑ Other (Describe) NAME OF SOURCE OF INCOME Cal Pers ADDRESS (Business Address Acceptable) PO Box 942716 Sacramento CA 942716 BUSINESS ACTIVITY, IF ANY, OF SOURCE retirement fund _ YOUR BUSINESS POSITION spouse is receiving pension GROSS INCOME RECEIVED ❑ $500 - $1,000 ❑ $1,001 - $10,000 Q $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary ❑X Spouse's or reglstered domestic partner's Income ❑ Loan repayment ❑ Partnership ❑ Sale of (Real property, car, boat, etc.) ❑ Commission or ❑ Rental Income, 11st each source of $10,000 or more ❑ Other (Describo) * 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' INTEREST RATE TERM (Months/Years) ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF LENDER HIGHEST BALANCE DURING REPORTING PERIOD ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 Comments: % E] None SECURITY FOR LOAN ❑ None ❑ Personal residence ❑ Real Property ❑ Guarantor ❑ Other Street address City (Describe) FPPC Form 700 (2011/2012) Sch. C FPPC Toll -Free Helpline: 866 /275 -3772 www.fppc.ca.gov v SCHEDULE C CALIFORNIAFOR lllf Income, Loans, & Business FAIR POLITICAL PRACTICES COMMISSION Positions Name (Other than Gifts and Travel Payments) J4 /U Mg-� NAME OF SOURCE OF INCOME Social Security Administration (Western Center) ADDRESS (Business Address Acceptable) PO Box 2000, Richmond CA 94802 -1791 BUSINESS ACTIVITY, IF ANY, OF SOURCE government retirement fund YOUR BUSINESS POSITION retiree GROSS INCOME RECEIVED ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑X $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary ❑ Spouse's or registered domestic partner's Income ❑ Loan repayment ❑ Partnership ❑ Sale of (Real property car, boat, etc.) ❑ Commission or ❑ Rental Income, list each sauce of $10.000 or more ❑x Other retirement benefits (Describe) NAME OF SOURCE OF INCOME Social Security Administration (Northeastern Center) ADDRESS (Business Address Acceptable) PO Box 310120 Jamaica NY 1143 -0120 BUSINESS ACTIVITY, IF ANY, OF SOURCE government retirement fund YOUR BUSINESS POSITION spouse is retiree GROSS INCOME RECEIVED ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑X $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary ❑X Spouse's or registered domestic partner's income [] Loan repayment ❑ Partnership ❑ Sale of (Real property, car, boat, etc.) ❑ Commission or ❑ Rental Income, llsl each source or $10,000 or more FX Other Spouse is retiree _ (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' INTEREST RATE TERM (MonthsfYears) ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF LENDER HIGHEST BALANCE DURING REPORTING PERIOD $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 Comments: % ❑ None SECURITY FOR LOAN ❑ None ❑ Personal residence ❑ Real Property Street address ❑ Guarantor ❑ Other city (Describe) FPPC Form 700 (201 112 01 2) Sch, C FPPC Toll -Free Helpllne: 866)275 -3772 www.fppo.ca.gov I i STATEMENT OF ECONOMIC INTERESTS I R COVER PAGE I FEB 10 2012 Please type or print in ink. - - Spa CITY C, NAME OF FILER (LAST) (FIRST) - MID. C. MARX JAN HOWELL 1. Office, Agency, or Court Agency Name CITY OF SAN LUIS OBISPO MAYOR Division, Board, Department, District, if applicable ► If filing for multiple positions, list below or on an attachment. Agency: Your Position Position: 2. Jurisdiction of Office (Check at least one box) State ❑ Judge or Court Commissioner (Statewide Jurisdiction) ❑ Multi- County ❑ County of ❑x City of San Luis Obispo _ ❑ Other 3. Type of Statement (Check at least one box) ❑ Annual: The period covered is January 1, 2011, through ❑ Leaving Office: Date Left JJ -or- December 31, 2011. (Check one) The period covered is through O The period covered is January 1, 2011, through the date of December 31, 2011. leaving office. X❑ Assuming Office: Date assumed 12 1 1 1 2011 O The period covered is _�_� through the date of leaving office. ❑ Candidate: Election Year Office sought, if different than Part 1: 4. Schedule Summary Check applicable schedules or 'None," ► Total number of pages including this cover page: 5 ❑ Schedule A -1 - Investments - schedule attached X❑ Schedule C - Income, Loans, & Business Positions - schedule attached ❑X Schedule A -2 - Investments - schedule attached ❑ Schedule D - Income - Gifts - schedule attached ❑X 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) E-MAIL ADDRESS (OPTIONAL) ( jmarx @slocity.org 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. Date Signed February 10, 2012 (, (month, day, year) $I 9 nature // Pe the aViwgslgmtrsr�[cwnwuwith FPPC Form 700 (2011/2012) FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov SCHEDULE A -2 Investments, Income, and Assets of Business Entities/Trusts (Ownership Interest is 10% or Greater) 0- 1. BUSINESS ENTITY OR TRUST Name :�?_ t� r Dr'j vc- Ste.- Lly "/° n (� Address (Business Address Accept ble) f 3 V a3 Chgpk on Trust, go to 2 ❑ Business Entity, complete the box, then go to 2 GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ED $0 - $1,999 ❑ $2,000 - $10,000 �] $10,001 - $100,000 ACQUIRED DISPOSED $100,001 - $1,000,000 Over $1,000,000 NATURE OF INVESTMENT El Sole Proprietorship 0 Partnership Other YOUR BUSINESS POSITION ❑ $0 - $499 52r$10,001 - $100,000 ❑ $500 - $1,000 OVER $100,000 ❑ $1,001 - $10,000 Check one box. XINVESTMENT REAL PROPERTY 7A, Va rt [r Name of Business E ty, if Investment, Q Assessor's Parcel Number or Street Address of Real Property S` ,Yx-a wT R(- n-, Description of Business Activity Q City or Other Precise Location of Real Property FAIR MARKET VALUE IF APPLICABLE, LIST DATE: E] $2,000 - $10,000 [] $10,001 - $1oo,000 ff$100,001 - $1,000,000 ACQUIRED DISPOSED Over $1,000,000 NATURE OF INTEREST F] Property Ownership /Deed of Trust Ej Stock, - pE] Partnership F1 Leasehold _ _ Other M Yrs remaining ❑ Check box if additional schedules reporting investments or real property are attached Comme Name 01 1. BUSINESS ENTITY OR TRUST Name Address (Business Address Acceptable) Check one ❑ Trust, go to 2 ❑ Business Entity, complete the box, then go to 2 GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE IF APPLICABLE, LIST DATE- El $0 - $1,999 ] $2,000 - $10,000 _/_/ 11 $10,001 - $100,000 ACQUIRED DISPOSED $100,001 - $1,000,000 fl L) Over $1,000,000 NATURE OF INVESTMENT Sole Proprietorship Q Partnership -.. Other YOUR BUSINESS POSITION • $0 - $499 EJ $10,001 - $100,000 ❑ $500 - $1,000 OVER $100,000 n $1,001 - $10,000 Check one box: INVESTMENT jXREAL PROPERTY 15 (5 idrrh : lj�ll.J' 1 %fZ�u�n1 Lt� 4 �7 Name of Business Entity,'if Investment, o[ F- Assessor's Parcel Number or Street Address of Real Property Description of Business Activity or City or Other Precise Location of Real Property FAIR MARKET VALUE F] $2,000 - $10,000 $10,001 - $100,000 $100,001 - $1,000,000 ❑ Over $1,000,000 NATURE OFINTEREST Property Ownership /Deed of Trust IF APPLICABLE, LIST DATE: ACQUIRED DISPOSED ❑ Stock 0 Partnership E] Leasehold Ej Other Yrs. remaining Check box if additional schedules reporting investments or real property are attached FPPC Form 700 (2011/2012) Sch. A -2 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 ADDRESS :16'-<- +1- o f Dri v, CITY n FAIR MARKET VALUE ❑ $2,000 - $10,000 ❑ $10,001 - $100,000 .$100,001 - $1,000,000 ❑ Over $1,000,000 NATURE OFINTEREST Ownership /Deed of Trust ❑ Leasehold _ Yrs remaining IF APPLICABLE, LIST DATE: ACQUIRED DISPOSED ❑ Easement El Other Name A' ► ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS 12ss- Orc111- IPi # QI >l� CITY sue.. (,,.-.7 0611 FAIR MARKET VALUE ❑ $2,000 - $10,000 `..$10,001 - $100,000 ❑ $100,001 - $1,000,000 ❑ Over $1,000,000 NATURE OFINTEREST KOwnership/Deed of Trust ❑ Leasehold Yrs remaining C,- f3Yo I IF APPLICABLE, LIST DATE: ACQUIRED DISPOSED ❑ Easement E) Other IF RENTAL PROPERTY, GROSS INCOME RECEIVED IF RENTAL PROPERTY, GROSS INCOME RECEIVED ❑ $0 - $499 ❑ $500 - $1,000 ❑ $1,001 -$10,000 ❑ $0 - $499 ❑ $500 - $1,000 V$1.001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 /$10,001 - $100,000 ❑ OVER $100,000 SOURCES OF RENTAL INCOME: If you own a 10% or greater SOURCES OF RENTAL INCOME: If you own a 10% or greater interest, list the name of each tenant that is a single source of interest, list the name of each tenant that is a single source of income Of $10,000 or more. 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 % ❑ 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 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 (2011/2012) Sch. B FPPC Toll -Free Helpline: 866 /275 -3772 www.fppc.Ga.gov SCHEDULE C Income, Loans, & Business Positions (Other than Gifts and Travel Payments) NAME OF SOURCE OF INCOME G r W f ADDRE ( sinessAddressAcceptable) ft o A 611 It Jam, bw 6 (214 BUSINESS ACTIVITY, IF ANY, OF SOURCE 93 yo Se p ►rt¢_ $I,, + r x.-'i r YOUR BUSINESS POSITION peul o GROSS INCOME RECEIVED ❑ $500 - $1,000 ❑ $1,001 - $10,000 010,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED Salary ❑ Spouse's or registered domestic partner's income ❑ Loan repayment ❑ Partnership ❑ Sale of (Real property car, boat, etc.) ❑ Commission or ❑ Rental Income, list each source of $10,000 or more ❑ Other _ (Describe) Name s1 �4 lrx NAME OFD SOURCE OF INCOME I ADDRESS (Business Arfdte4Acceptable) PD do �< -1-o o o l2t L4Au,, ( C4 1'S o7- - BUSINESS ACTIVITY, IF ANY, OF SOURCE (7q YOUR BUSINESS POSITION re6'rCd GROSS INCOME RECEIVED ❑ $500 - $1,000 ❑ $1,001 - $10,000 9$10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary ❑ Spouse's or registered domestic partner's income ❑ Loan repayment ❑ Partnership ❑ Sale of . (Real property, car, boat, etc.) ❑ Commission or ❑ Rental Income, list each source of $10,000 or more Other ° z e,, � , _5 (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` ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF LENDER HIGHEST BALANCE DURING REPORTING PERIOD ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 Comments: INTEREST RATE TERM (Months/Years) % ❑ None SECURITY FOR LOAN ❑ None ❑ Personal residence ❑ Real Property ❑ Guarantor ❑ Other Street address city (Describe) FPPC Form 700 (2011/2012) Sch. C FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov . SCHEDULE C Income, Loans, & Business Positions (Other than Gifts and Travel Payments) NAME OF SOURCE OF INCOME Cal Poly State University ADDRESS San Luis'Obispo CA 93467 BUSINESS ACTIVITY. IF ANY, OF SOURCE Higher Education YOUR BUSINESS POSITION Spouse is partly retired faculty member GROSS INCOME RECEIVED. El $500 - $1,000 ❑ si.col - $10,000 ® $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ salary ® Spouse's or registered domestic partner's income ❑ Loan repayment ❑ Sale of (Property, car, boa4 etc.) ❑ Commission or ❑ Rental Income, list each source of $10,000 or more ❑ Other ( Desuibe) !CALI,FQRNIA_FORM .,.� 00_ , ff R ,PC LITICAL :PRACTICES COMMISSION Name Jan Howell Marx ,NAME OF SOURCE OF INCOME Cal Pers Pension ADDRESS P.O. Box 942716 Sacramento CA 94229 -2716 BUSINESS ACTIVITY, IF ANY, OF SOURCE YOUR BUSINESS POSITION Spouse is pensioner GROSS INCOME RECEIVED ❑ $500 - $1,000 ❑ $1,001 - $10,000 X❑ $10,001 - $100,000 ❑ OVER 3100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary ® Spouse's or registered domestic partner's Income ❑ Loan repayment ❑ Sale of (Properly. car, boaL etc.) ❑ Commission or ❑ Rental Income, fist each source of 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` INTEREST RATE TERM (Months(Years) ADDRESS BUSINESS ACTIVITY, IF ANY, OF LENDER HIGHEST BALANCE DURING REPORTING PERIOD E] $500 - $1,000 ❑ $1,001 - $10,1)00 ❑ 510,001 - $100,000 �] OVER $100,000 Comments: __ % ❑ None SECURITY FOR LOAN ❑ None ❑ Personal residence 171 Real Property ❑ Guarantor ❑ Other Street address cify - _ (Describe) FPPC Form 700 (200812009) Sch. C FPPC Toll -Free Helpline: 866/ASK-FPPC www.fppc.ca.gov STATEMENT OF ECONOMIC INTERESTS QfIzecK� MAF "c!aTsV1'f" COVER PAGE SLO CITY CLERK Please type or print in ink NAME OF FILER (LAST) [rtR$T) (MIDDLE) MARX JAN HOWELL 1. Office, Agency, or Court Agency Name CITY OF SAN LUIS OBISPO Division, Board, Department, District, if applicable Your Position MAYOR as of December 1, 2010 ► If filing for multiple positions, list below or on an attachment. Agency: City of San Luis Obisp Position: Council Member 2008 -2010 2. Jurisdiction Of Office (Check at least one box) ❑ State ❑ Judge (Statewide Jurisdiction) ❑ Multi- County ❑ County of ❑X City of San Luis Obispo ❑ Other I Type of Statement (Check at least one box) ❑X Annual: The period covered is January 1, 2010, through December 31, ❑ Leaving Office: Date Left —J_J 2010. -or- (Check one) The period covered is 1 through December 31, O The period covered is January 1, 2010, through the date of 2010, leaving office. ❑X Assuming Office: Date 12 J 1 i 10 O The period covered is I —J , through the date of leaving office. ❑ Candidate: Election Year Office sought, if different than Part 1: 4. Schedule Summary Check applicable schedules or "None." ► Total number of pages including this cover page: 7 ❑ Schedule A -1 - Investments – schedule attached X Schedule C - Income, Loans, & Business Positions – schedule attached ❑X 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- F1 None - No reportable interests on any schedule 5. Verification MAILING ADDRESS STREET CITY (Business or Agency Address Recommended - Public Document) San Luis ( ZIP CODE CA 93401 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 FPPC Form 700 (2010/2011) Toll -Free Helpline: 866 /275 -3772 www.fppe.ca.gov SCHEDULE A -2 CALIFORNIA FORM Investments, Income, and Assets of Business Entities/Trusts Name (Ownership Interest is 10% or Greater) Jan Howell Marx Steven and Jan Howell Marx Living Trust dtd 1/30/05 Name 265 Albert Drive San Luis Obispo CA 93405 Address Check one ® Trust, go to 2 Q Business Entity, complete the box, then go to 2 GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE IF APPLICABLE, LIST DATE: $2,000 - $10,000 $10,001 - $100,000 —/ d8 /`1 08 ❑ $100,001 - $1,000,000 ACQUIRED DISPOSED [] Over $1,000,000 NATURE OF INVESTMENT ❑ Sole Proprietorship ❑ Partnership ❑ Other YOUR BUSINESS POSITION ❑ $0 - $499 Q $10,001 -.$100,000 ❑ $Soo - $t,oao ❑ OVER $100,000 ❑ $1,001 - $10,000 The Vanguard Group Mutual Funds Check one box: ® INVESTMENT ❑ REAL PROPERTY The Vanguard Group Name of Business Entity or Street Address or Assessor's Parcel Number of Real Property Investment Firm Description of Business Activity 4t City or Other Precise Location of Real Property FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 ❑ $1o,001 - $1o0,000 ® $100,001 - $1,000,000 ACQUIRED DISPOSED ❑ Over $1,000,000 NATURE OF INTEREST ❑ Property ownership /Deed of Trust ❑ Stock ❑ Partnership ❑ Leasehold ® Other mutual funds Yrs. remaining ❑ Check box if additional schedules reporting Investments or real property are attached Law Offices of Jan Howell Manx Name 265 Albert Drive San Luis Obispo CA 93405 Address Check one 0 Trust, go to 2 x Business Entity, complete the box, than go to 2 GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE IF APPLICABLE, LIST DATE: �A1� $2,000 - $10,000 tg43 v� � Q, $10,001 - $100,000 2J� _ i /J—fis $100,001 - $1,000,000 ACQUIRED DISPOSED Over $1,000,000 NATURE OF INVESTMENT 19 Sole Proprietorship ❑ Partnership ❑ /Owner Other e YOUR BUSINESS POSITION Attorn y p $0 - $499] $10,001 - $100,000 ❑ $500 - $1,000 ❑ OVER $100,000 ❑ $1,001 - $10,000 None. Check one box: ❑ INVESTMENT ® REAL PROPERTY 1515 Warm Springs Road, Ketchum Idaho 83340 Name of Business Entity 91 Street Address or Assessor's Parcel Number of Real Property rental condo. Description of Business Activity gL City or Other Precise Location of Real Property FAIR MARKET VALUE $2,000 - $10.000 $10,001 - $100,000 © $1001001 - $1,000,000 ❑ Over $1,000,000 NATURE OF INTEREST ® Property Ownership /Deed of Trust IF APPLICABLE, LIST DATE: ACQUIRED DISPOSED ❑ Stock ❑ Partnershlp ❑ Leasehold �. -- C] Other Yrs. remaining ® Check box if additional schedules reporting investments or real property are attached Comments- FPPC Form 700 (2.0(18/2009) Sch. A -2 FPPC Toll -Free Helpline: 8661ASK -FPPC www.fppc.ca.gov SCHEDULE B Interests in Real Property (Including Rental Income) ► STREET ADDRESS OR PRECISE LOCATION 265 Albert Drive CITY San Luis Obispo CA 834 -05 FAIR MARKET VALUE IF APPLICABLE, LI T DATE: ❑ $2,000 - $10,000 6 / t & ❑ $io,0o1 - $100,000 _-..i_ f A� -i-J-0 © $100,001 - $1,000,000 ACQUIRED DISPOSED ❑ Over $1,000,000 NATURE OF INTEREST ® Ownership/Deed of Trust ❑ Easement ❑ Leasehold ❑ rr°. remaining 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. Law Office is 14,49% of my home (fmv $600,000) thus $86,940 is fmv of home office Name Jan Howell Marx ► STREET ADDRESS OR PRECISE LOCATION 1515 Warm Springs Rd #17 CITY Ketchum, Idaho 83340 FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 ❑ $10,001 - $100,OOD ❑X $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 E1$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 eacti tenant that Is a single source of Income of $10,000 or more. rental income is less than $10,000 - I I * 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 T BUSINESS ACTIVITY OF LENDER INTEREST RATE TERM (MonihwYears) _% ❑ None HIGHEST BALANCE DURING REPORTING PERIOD ❑ $500 - $1,000 ❑ $1.001 - $10,000 ❑ $10,001 - $1100,000 ❑ OVER $100,000 ❑ Guarantor, if applicable Comments: NAME OF LENDER' ADDRESS BUSINESS ACTIVITY 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 FPPC Form 700 (200812009) Sch. IS FPPC Toll -Free Helpline: 866 /ASK -FPPC wwwfppC.Ca.gov SCHEDULE B Interests in Real Property (Including Rental Income) STREET ADDRESS OR PRECISE LOCATION 1255 Orcutt Road #816 CITY San Luis Obispo CA 93401 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 g Ownership/Deed of Trust ❑ Easement ❑ Leasehold D Yrs. remaining Other IF RENTAL PROPERTY, GROSS INCOME RECEIVED ❑ $0 - $499 ❑ $500 - $1,000 ❑ $1,001 - $10,000 O $10,001 . $100,000 ❑ OVER $100,000 interest, list the name of each tenant that is a single source of income of $10,000 or more. Rental Income is less than $10,000 CALIFORNIA FORM 700 FAIR POLITICAL PRACTICES COMMISSION Name Jan Howell Marx ► STREET ADDRESS OR PRECISE LOCATION CITY FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 ❑ $10,001 - $100,000 108 ❑ $100,001 - $1,000,000 ACQUIRED DISPOSED ❑ Over $1,000,00D NATURE OF INTEREST ❑ Ownership /Deed or Trust ❑ Easement ❑ Leasehold ❑ Yrs. remaining Older IF RENTAL PROPERTY, GROSS INCOME RECEIVED ❑ $0 - $499 ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 -v v. ­14 - IAN-vIC. it yvu VVVII 8 lV7a W 9lCL1ktN 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 ACTIVITY OF LENDER INTEREST RATE °k ❑ None TERM (Monihs/Years) 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 ACTIVITY 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 $11)0,000 [,] Guarantor, if applicable FPPC Farm 700 (200812009) Sch. B FPPC Toll -Free Helpline: 866 /ASK -FPPC WWW.fppe.Ca.gov SCHEDULE C CALIFORNIA FORM Income, Loans, & Business FAIR POLITICAL PRACTICES COM, Positions Name (Other than Gifts and Travel Payments) Jan Howell Marx NAME OF SOURCE OF INCOME City of San Luis Obispo ADDRESS 990 Palm St. San Luis Obispo CA 93401 BUSINESS ACTIVITY, IF ANY, OF SOURCE Service on City Council YOUR BUSINESS POSITION City Council Member GROSS INCOME RECEIVED ❑ $500 - $1,000 ❑ $1,001 - $10,000 ® $10,001 - $100,000 El OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ® Salary ❑ Spouse's or registered domestic partner's income ❑ Loan repayment ❑ Sale of (Property, car, boar, etc.) ❑ Commission or ❑ Rental Income, bit each source of $10.000 or more ❑ Other (Describe) NAME OF SOURCE OF INCOME Law Offices of Jan Howell Marx ADDRESS P.O. Box 1445 San Luis Obispo 93406 BUSINESS ACTIVITY, IF ANY, OF SOURCE law practice YOUR BUSINESS POSITION attorney /owner GROSS INCOME RECEIVED ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑X $10,001 - $100,000 [:1 OVER $$100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary ❑ Spouse's or registered domestic partner's income ❑ Loan repayment ❑Sale of _. (Prop —Y, car, boat etc.) ❑ Commission or ❑ Rental Income, Est each source of $10,000 or more ❑x other attorney's fees (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' ADDRESS BUSINESS ACTIVITY, IF ANY, OF LENDER HIGHEST BALANCE DURING REPORTING PERIOD ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,Oo1 - $100,000 ❑ OVER $100,000 Comments: INTEREST RATE TERM (Months/Years) ❑ None SECURITY FOR LOAN [] None ❑ Personal residence [❑ Real Property ❑ Guarantor — ❑ Other Street oordrass Clry (Describe) FPPC Form 700 (200812009) Sch. C FPPC Toll -Free Helpline: 866 /ASK -FPPC www.rppc.ca.gov SCHEDULE C Income, Loans, & Business Positions (Other than Gifts and Travel Payments) NAME OF SOURCE OF INCOME ADDRESS BUSINESS ACTIVITY, IF ANY, OF SOURCE YOUR BUSINESS POSITION GROSS INCOME RECEIVED ❑ $500 - $1,000 ❑ $1, 1 - $10,000 ❑ $10,001 - $100,000 ❑ ER $100,000 CONSIDERATION FOR Will INCOME WAS RECEIVED ❑ salary ❑ Spouse- registered domestic partner's income ❑ Loan repayment 1 ] Sale of (Property, car, heat, etc.) ❑ ColwnIS57 r ❑ Rental Income, list each source of $10,000 or more ❑ plhe`q (Describe) CALIFORNIA FORM 700 FAIR POL111CAL PRACTICES CUMNIISSIUN Name Jan Howell Marx NAME OF SOURCE OF INCOME Social Security Administration ADDRESS P.O. Box 2000 Richmond, CA 94802 -1791 BUSINESS ACTIVITY, IF ANY, OF SOURCE retirement benefits YOUR BUSINESS POSITION retired as of July 1, 2010 GROSS INCOME RECEIVED ❑ $500 - $1,000 ® $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary [] Spouse's or registered domestic partner's Income [] Loan repayment ❑ Sale of (Property, car, boat erc.) [] Commission or [] Rental Income, list each source or sio,000 or more ❑R Other retirement benefits (Aesenbe) 10- 2, LOANS RECEIVED OR OUTSTANDING DURING THE REPORTWIG 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 LENDER' ADDRESS BUSINESS ACTIVITY, IF ANY, OF LENDER HIGHEST BALANCE DURING REPORTING PERIOD ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 Comments: INTEREST RATE TERM (Months/Years) % ❑ None SECURITY FOR LOAN [] None [] Personal. residence [] Real Property ❑ Guarantor ❑ Other Stmet address city (Describe) FPPC Form 700 (200812009) Sch. C FPPC Toll -Free Helpline: 866/ASK-FPPC www.fppc.ca.gov SCHEDULE C C ALIFORNIA • Income, Loans, & Business FAIR POLIFICAL PRACTICES COM, Positions Name (Other than Gifts and Travel Payments) Jan Howell Marx NAME OF SOURCE OF INCOME Cal Poly State University ADDRESS San Luis Obispo CA 93407 BUSINESS ACTIVITY, IF ANY, OF SOURCE Higher Education YOUR BUSINESS POSITION Spouse is partly retired faculty member GROSS INCOME RECEIVED ❑ $500 - $1,000 ❑ $1,001 - $10,000 ® $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary 0 Spouse's or registered domestic partner's income ❑ Loan repayment :❑ Safe of (Properly, car, boat, e1c.) ❑ Commission or O Rental Income, 1lsi each source or 510,000 or more ❑ Other (Describe) NAME OF SOURCE OF INCOME Cal Pers Pension ADDRESS P.O. Box 942716 Sacramento CA 94229 -2716 BUSINESS ACTIVITY, IF ANY, OF SOURCE pension YOUR BUSINESS POSITION Spouse is pensioner GROSS INCOME RECEIVED ❑ $500 - $1,000 ❑ $1,001 - $10,000 Q $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary ® Spouse's or registered domestic partner's income ❑ Loan repayment ❑ Sale Of (Property, car, boat etc.) ❑ Commission or ❑ Rental Income, N'sr each source of S10,000 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' ADDRESS BUSINESS ACTIVITY, IF ANY, OF LENDER HIGHEST BALANCE DURING REPORTING PERIOD ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 Comments: INTEREST RATE TERM (Months(Years) % ❑ None SECURITY FOR LOAN ❑ None ❑ Personal residence ❑ Real Property ❑ Guarantor ❑ Other Sweet address city (Describe) FPPC Form 700 (2006/2009) Sch. C FPPC Toll -Free Helpline. 866 1ASK -FPPC www.fppc.ca.gov Marx, Jan Howell = 707.04 Statements of Economic Interes Legislative & Legal D 11 Date Rece'Ived ALIFORNIA FORM700 STATEMENT OF ECONOMIC INTERESTS FEQ 4,, DOCUMENTIR POLIIICAL PRACTICES COMMISSION A PUBLIC COVER PAGE Please type or print in ink. NAME OF FILER (LAST) (FIRST) (MIDDLE) Marx Jan Howell 1. Office, Agency, or Court Agency Name (Do not use acronyms) City of San Luis Obispo Division, Board, Department, District, if applicable Your Position Mayor P. If filing for multiple positions, list below or on an attachment. (Do not use acronyms) Agency: Air Pollution Control District 2. Jurisdiction of Office (Check at least one box) ❑ State ❑ Multi -County — © City of San Luis Obispo Position: Board Member ❑ Judge or Court Commissioner (Statewide Jurisdiction) © County of San Luis Obispo ❑ Other 3. Type of Statement (Check at least one box) © Annual: The period covered is January 1, 2013, through ❑ Leaving Office: Date Left I J. December 31, 2013. (Check one) .or - The period covered is I I through December 31, 2013. ❑ Assuming Office: Date assumed © Candidate: Election year 2014 O The period covered is January 1, 2013, through the date of leaving office. O The period covered is — the date of leaving office. and office sought, if different than Part 1: 4. Schedule Summary Check applicable schedules or "None." ► Total number of pages including this cover page: through © 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- None - No reportable interests on any schedule 5. Verification MAILING ADDRESS STREET CITY STATE ZIP CODE (Business or Agency Address Recommended - Public Document) 990 Palm Street San Luis Obispo CA 93401 DAYTIME TELEPHONE NUMBER tML ADDRESS (OPTIONAL) ( 805 ) 781-7120 1 jmarx@slocity.org 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 FPPC Advice Email: advice@fppc.ca.gov FPPC Toll -Free Helpline: 866/275-3772 wwwJppc.ca.gov California Form 700 Attachment to Cover Page 1. Agency San Luis Obispo Council of Governments San Luis Obispo Regional Transportation Agency LOSSAN Rail Corridor Agency Jan Marx Board Member Board Member Alternate Board Member SCHEDULE A-1 CALIFORNIA Investments FAIR POLITICAL PRACTJCES CO(viNlISSIO Stocks, Bonds, and Other Interests Name (Ownership Interest is Less Than 10%) —1 AtJ AA Do not attach brokerage or financial statements. ► NAME OF BUSINESS ENTITY ► NAME OF BUSINESS ENTITY Palo Alto Networks GENERAL DESCRIPTION OF BUSINESS ACTIVITY computer firewall programs FAIR MARKET VALUE X❑ $2,000 - $10,000 ❑ $10,D01 - $10o,o0o ❑ $100,001 - $1,000,000 ❑ over $1,000,00o NATURE OF INVESTMENT ❑X Stock ❑ Other (Describe) ❑ Partnership O Income Received of $0 - $499 O Income Received of $500 or More fkeport on Schedule C) IF APPLICABLE, LIST DATE: g 11—J-0 12 —1:� 9 9 ACQUIRED DISPOSED ► NAME OF BUSINESS ENTITY GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE ❑ $2.000 - $10,000 ❑ $100,001 - $1,000,0D0 NATURE OF INVESTMENT ❑ Stock ❑ Other _ ❑ Partnership O Income O lnconyr IF APPLICABLE, LJKT DATE: ❑ $10,001 - ❑ Over (Describe) of $0 - $499 of $500 or More (Report on Schedule C) _J_J 11 DISPOSED ► NAME OF BUSINESS ENTITY GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE ❑ $2,000 - $10,000 ❑ $100,001 - $$1.000,000 NATURE OF INVESTMENT ❑ Stock ❑ (>ber- (Describe) ❑ Partnership O 1 me Received of $0 - $499 ncome Received of $500 or More (Report on Schedule C) IF APPLICAB , LIST DATE: �J-----J 11 — I—J 11 ACQUIRED DISPOSED Comments: 01 - $100,000 $1.000,000 GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE ❑ $2,000 - $10,D00 ❑ $1oo,00l - $i,000,000 NATURE OF INVESTMEN' ❑ Stock 0 Ot ❑ $1D 1 - $100,000 ver $1,000,000 (Describe) ❑ Partnership ncnme Received of $0 - $499 Income Received of $500 or More (Report on schedule C) IFAPPL ABLE, LIST DATE: ACQUIRED DISPOSED NAME OF BUSINESS ENTITY GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE ❑ $2,000 - $10,000 ❑ $100.001 - $1,000,000 NATURE OF 1NVESTMEN ❑ Stock ❑ OlirOl El Partnership O mr ❑ Pf Doi • $100,000 Over $1,000,000 - (Describe) Received of $0 - $499 Received of $500 or More (Report on schedule C) IF APPLICABLE, LIST DATE: ACQUIRED DISPOSED r NAME OF BUSINESS ENTITY GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE ❑ $2,000 - $10,000 ❑ S ,001 - $100,000 ❑ $100,001 . $1,000,000 Over $1,000,000 NATURE OFINVEST0 ❑ Stock ❑ 0 r (Dmailbe) ❑ Partnership ncome Received of $D - $499 Income Received of $500 or More (Report on Schedule C) IF APPLICABLE, LIST DATE: —J—,J 11 —1.. —1 11 ACQUIRED DISPOSED FPPC Form 700 (2011/2012) Sch, A-1 FPPC Toll -Free Helplfne: 866/275-3772 vvww.fppc ca.gov SCHEDULE A-2 Investments, Income, and Assets of Business Entities/Trusts (Ownership Interest is 10% or Greater) 1101. SWINESS ENTITY OR TRUST Steven and Jan Howell Marx Living Trust dtd 1/30/05 Name Address (Business Address Acceptable) Check one Trust, go to 2 ❑ Business Entity, complete the box, then go to 2 GENERAL DESCRIPTION OF BUSINESS AELICAB FAIR MARKET VALUE IF APE, LIST DATE: ❑ $0 - $1,999 $2,000 - $10,000 1 J� 11 $10.001 • $100,000 ACQUIRED DISPOSED $100.001 - $1,000,000 ❑ Over $1,000,000 NATURE OF INVESTMENT ❑ Sole Proprietorship 0 Partnership ❑ Other YOUR BUSINESS POSITION ❑ $0 - $499 Xn $10,001 - $100,000 ❑ $500 - $1,000 ❑ OVER $100,000 ❑ $1,001 - $10,000 Th V n uar oup Check one box: nXX INVESTMENT C] REAL PROPERTY Investment Firm Name of Business Entity, if Investment, or Assessor's Parcel Number or SlreelAttdr f Real Property Description of Business Activity or City or Other Precise Location of Real Property FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 ❑ $10,001 - $100.000 ❑X $100,001 - $1,000,000 ACQUIRED DISPOSED ❑ Over $1,000,000 NATURE OF INTEREST ❑ Property Ownership/Deed of Trust ❑ Stock ❑ Partnership ❑ Leasehold ❑ Other Yrs• rernakliny ❑ Check box if additional schedules reporting investments or real property are attached Comments: M- Law Offices of Jan Howell Marx Name _PO Box 1445 San Luis Obispo CA 93406 Address (Business Address Acceptable) Check one ❑ Trust, go to 2 ❑x Business Entity, complete the box, then go to 2 FRAESIPTION OF BUSINESS ACTIVITY UE IF APPLICABLE, LIST DATE: 0 �_ _/ 91 —._/_i11 I] $10,001 - $100,001) ACQUIRED DISPOSED ❑ $1oo,001 - $1,000,000 [j Over $1.000,000 NATURE OF INVESTMENT �[]X Sole Proprietorship ❑ Partnership ❑ Other YOUR BUSINESS POSITION Owner $0 - $499 Q $10,001 - $100,000 $500 - $1,000 OVER $iD0,000 ❑ $1,001 - $10,000 Check one box; ❑ INVESTMENT ❑ REAL PROPERTY Name of Business Entity, if Investment, 1 Assessor's Parcel Number or Street Address of Real Description of Business Activity !u City or Other Precise Location of Real FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $1D,000 El$1o,00l - $1oo,000 1 ❑ $100,0ol - $1,000,000 ACQUIRED DISPOSED ❑ Over $1,000,000 NATURE OF INT E ST ❑ Property Ow rshipMeed of Trust ❑ Stock C] Partnership Lesseh ❑ Other Y.. remW.IrIg ❑ Ch box if additional schedules reporting investments or real property are attached FPPC Farm 700 (2011)2012) Soh, A-2 FPPC Toll -Free Helpline: 8661275-3772 www.ippc.ca.gov SCHEDULE B Interests in Real Property (Including Rental Income) ► ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS CITY San Luis Obispo FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 ❑ $1o,001 - $100,000 ❑X $100,001 - $1,o00,000 ACQUIRED DISPOSED ❑ Over $1,000,000 NATURE OF INTEREST ❑X Ownership/Deed of Trust ❑ Easement ❑ Leasehold ❑ Yrs, remaining Other IF RENTAL PROPERTY, GROSS INCOME RECEIVED ❑ $0 - $499 ❑ $500 - $1,D00 ❑ $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. Name 741' AAAAx ► ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS CITY Ketchum, Idaho 83340 FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2.000 - $10,000 ❑ $10,D01- $100,000 ^J __1, 0 $100,001 - $1,000,000 ACQUIRED DISPOSED ❑ Over $1,000,000 NATURE OF INTEREST Q Ownership/Deed of Trust ❑ Easement ❑ Leasehold ❑ Yrs. remaining Other IF RENTAL PROPERTY, GROSS INCOME RECEIVED ❑ $0 - $499 ❑ $500 - $1,000 ❑X $1,001 - $10,000 ❑ $10-001 - $100-000 ❑ OVER $100,000 SOURCES OF RENTAL INCOME: 1f 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 INTEREST RATE ❑ TERM (Months/Years) HIGHE/BALAA1N1,PDURING REPORTING PERIOD $50 ❑ $1,001 - $10,000 ❑ $1000 ❑ OVER $100,000 Guslicable Comments: NAME OF LENDER" ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF LENDER INTEREST RATE HIGZBALANDURI ❑0 cable TERM (Months/Years) i REPORTING PERIOD ❑ $1,001 - sw,D00 ❑ OVER $100,000 FPPC Form 700 (2011/2012) Sch, B FPPC Toll -Free Helpline: 866/275-3772 www.fppe.ce.gov SCHEDULE C Income, Loans, & Business Positions (Other than Gifts and Travel Payments) NAME OF SOURCE OF INCOME City of San Luis Obispo ADDRESS (Business Address Acceptable) 990 Palm Street San Luis Obispo CA 93401 BUSINESS ACTIVITY, IF ANY, OF SOURCE municipal government YOUR BUSINESS POSITION Mayor GROSS INCOME RECEIVED ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑X $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED Q Salary ❑ Spouse's or registered domestic partner's Income ❑ Loan repayment ❑ Partnership r I Sale of (Real property, car, boat, etc.) ❑ Commission or ❑ Rental Income, list each source of $10,000 or more ❑ other (Describe) CALIFORNIA FORM 700 FAIR POLITICAL PRACTICES COMMISSION NAME OF SOURCE OF INCOME SLO Council of Governments ADDRESS (Business Address Acceptable) 1114 Marsh Street, San Luis Obispo BUSINESS ACTIVITY, IF ANY, OF SOURCE metropolitan planning organization YOUR BUSINESS POSITION Board Member GROSS INCOME RECEIVED ® $500 - $1,000 O $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED [] Salary ❑ Spouse's or registered domestic partner's income ❑ Loan repayment ❑ Partnership ❑ Sale of (Real property, car, boar, etc.) ❑ Commission or ❑ Rental Income, fist each source of $10,000 ormore Other --gig 0!24 (08-be) v■ ■- v ■ -v- a . 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, ADDRESS (Busbtess Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF LENDER HIGHEST BALANCE DURING ❑ $500 - $1,000 ❑ $1,0ol - $1o,000 ❑ $10,007 - $100,000 ❑ OVER $100,100 Comments: INTEREST RATE TERM (MDnths(Years) % ❑ None SECURITY FOR LOAN [] None ❑ Personal residence ❑ Real Property ❑ Guarantor ❑ Other City (Describe) FPPC Form 700 (201112012) Soh. C FPPC Toll -Free Helpline: 666/276-3772 wvvw.fppc.ca.gov 1 SCHEDULE C Income, Loans, & Business Positions (Other than Gifts and Travel Payments) NAME OF SOURCE OF INCOME 51-0 rQ o/"10" ADDRESS (Suv s Address Acceptable) BUSINESS ACTIVITY, IF ANY. OF SOURCE d�-h "I- 061i?2o C4 YOUR BUSINESS POSITION V ,(-D" /tL�-� GROSS INCOME RECEIVED �$500 - $1,000 ❑ $1,001 - $10.000 ❑ $10,001 - $100.000 u OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary ❑ Spouse's or registered domestic partner's income ❑ Loan repayment ❑ Partnership ❑ Sale of (Real property, car, boat, eta) Commission or ❑ Rental Income, list each source of $10,000 or more YL Other._ (Describe) Name Q sAA) /44/ Y NAME OF SOURCE F INCOME .� J ADDRESS (Business Add ss Acceptable) BUSINESS ACTIVITY, IF ANY, OF SOURCE 9::-1, � 68)so _0 �-�y01 YOUR BUSINESS POSITION or 120a,'-d I,-W tz, � e,-r GROSS INCOME RECEIVED e,$500 - $1,000 ❑ $1,001 - $1o,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary ❑ Spouse's or registered domestic partner's income ❑ Loan repayment ❑ Partnership n Sale of (Real property, car, boat, etc) Commission or LJ Rental Income, list each source of $10,000 or more Other _.._._ r��r * 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" ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF LENDER HIGHEST BALANCE DURING REPORTING PE $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10.0ol - $100,000 ❑ OVER $100,000 T RATE TERM (MonthsNears) —% ❑ None a,00, SECURITY FOR LOAN ❑ None ❑ Personal ❑ Real Property Sheet address ❑ Guarantor ❑ Other City (Describe) FPPC Form 700 (2013/2014) Sch. C FPPC Advice Email: advice@fppc.ca.gov FPPC Toll -Free Helpline:866/275-3772 www.fppc.ca.gov i SCHEDULE C Income, Loans, & Business Positions (Other than Gifts and Travel Payments) NAME OF SOURCE OF INCOME Air Pollution Control District ADDRESS (Business Address Acceptable) 3433 Roberto Court San Luis Obispo BUSINESS ACTIVITY, IF ANY, OF SOURCE addressing air pollution YOUR BUSINESS POSITION Board Member GROSS INCOME RECEIVED © $50o - $1,aoo ❑ $1.001 - $10.000 ❑ $10,001 -.$100,000 ❑ OVER $100.000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED Salary t] Spouse's or registered domestic partner's Income ❑ Loan repayment ❑ Partnership n GAtA of (Real property, car, boat, etc.) ❑ commission or ❑ Rental Income, list each source of $10,000 or more Other !2kaz (Desrribe) NAME OF SOURCE OF INCOME Cal Pers ADDRESS (Business Address Acceptable) PO Box 942716 Sacramento CA 942716 BUSINESS ACTIVITY, IF ANY, OF SOURCE retirement fund YOUR BUSINESS POSITION spouse is receiving pension GROSS INCOME RECEIVED ❑ $500 - $1.000 ❑ $1,001 - $10,000 Q $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary ❑X Spouse's or registered domestic partner's income ❑ Loan repayment ❑ Partnership ❑ Safe of (Real property, car, boat, etc.) ❑ Commission or ❑ Rental Income, list each source or sio,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' . INTEREST RATE TERM (Months/Years) ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF LENDER HIGHEST BALANCE DURING REPORTI PERIOD ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑ $1o,001 - $100,000 ❑ OVER $100,000 Comments: SECURITY F( ❑ None ❑ Real Prop ❑ Guarantor ❑ Other (Describe) FPPC Form 700 (2011/2012) Sch. C FPPC Toll -Free Helpline: 866l275-3772 www.fppc,ca.gov SCHEDULE C CALIFORNIA FORM1 Income, Loans, & Business FAIR POLITICAL PRACTICES COMMISSION Positions Name (Other than Gifts and Travel Payments) JA f J M NAME OF SOURCE OF INCOME Social Security Administration (Western Center) ADDRESS (Business Address Acceptable) PO Box 2000, Richmond CA 94802-1791 BUSINESS ACTIVITY, IF ANY, OF SOURCE Ww government retirement fund YOUR BUSINESS POSITION retiree GROSS INCOME RECEIVED ❑ $500 - $1,000 ❑ $1,001 - $10,000 0 $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED Q Salary ❑ Spouse's or registered domestic partner's Income ❑ Loan repayment ❑ Partnership ❑ Sale of (Real property car, boat, etc) ❑ Commission or ❑ Rental Income, list each source or $to,000 or more ❑x other retirement benefits (Descdbe) NAME OF SOURCE OF INCOME Social Security Administration (Northeastern Center) ADDRESS (Business Address Acceptable) PO Box 310120 Jamaica NY 1143-0120 BUSINESS ACTIVITY, IF ANY, OF SOURCE government retirement fund YOUR BUSINESS POSITION spouse is retiree GROSS INCOME RECEIVED ❑ $500 - $1,000 ❑ $1,0o1 - $10,D00 ❑X $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary ❑X Spouse's or registered domestic partner's income ❑ Loan repayment ❑ Partnership n Sale of (Real property, car, boat, etc.) ❑ Commission or ❑ Rental Income, list each source of $10,o0o or more ❑X Other Spouse is retiree (describe) -LOANS■ OR OUTSTANDING; - •O- •D You are not required to report loans from commercial lending institutions, or any indebtedness created as part: of a j 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 i regular course of business must be disclose S follows: NAME OF LENDER` INTEREST RATE TERM (Months/Years) _ ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, 1F ANY, OF HIGHEST BA/[)URINIG3PORTING PERIOD ❑ $500 - $1,❑ $1,001 - $❑ $10,00, -❑ OVER vc Comments: None SECURITY FOR LOAN ❑ None ❑ Personal ❑ Real Property ❑ Guarantor ❑ Other sheet ddOWS Cily (Describe) FPPC Form 700 (201112012) Sch, C FPPC Toll -Free Helpline: 866/275-3772 www.fppo.ca.gov rKIIEURNIA FORMICAL PRACTICES"COMPAISSION Please type or print in ink. STATEMENT OF ECONOMIC COVER PAGE A Public Document bgrEST R E . ed FFR 2. � K`10 SLO CITY CLERK NAME (LAST) (FIRST) (MIDDLE) DAYTIME TELEPHONE NUMBER MARX JAN HOWELL ( 805 ) 541-2716 MAILING ADDRESS STREET (Business Address Acceptable) CITY STATEZIP CODE OPTIONAL: E-MAIL ADDRESS 990 Palm Street San Luis Obispo CA 93401 1. Office, Agency, or Court Name of Office, Agency, or Court: San Luis Obispo City Council Division, Board, District, if applicable: Your Position: City Council Member P. If filing for multiple positions, list additional agency(ies)/ position(s): (Attach a separate sheet if necessary.) Agency: Position: 2. Jurisdiction Of Office (Check at least one box) ❑ State ❑ County of ® City of San Luis Obispo ❑ Multi -County ❑ Other 1. Type of Statement (Check at least one box) ❑ Assuming Office/Initial Date: ® Annual: The period covered is January 1, 2009, through December 31, 2009. -or- 0 The period covered is —�—Jthrough December 31, 2b09. ❑ Leaving Office Date Left: (Check one) O The period covered is January 1, 2009, through the date of leaving office. -or- 0 The period covered is — the date of leaving office. ❑ Candidate Election Year: _ through 4. Schedule Summary ► Total number of pages 6 including this cover page: ► Check applicable schedules or "No reportable interests." I have disclosed interests on one or more of the attached schedules: Schedule A-1 ❑ Yes - schedule attached Investments (Less than 70% Ownership) Schedule A-2 ❑X Yes - schedule attached Investments (70% or Greater Ownership) Schedule B © Yes - schedule attached Real Property Schedule C © Yes - schedule attached Income, Loans, & Business Positions (Income other than Gifts and Travel Payments) Schedule D ❑ Yes - schedule attached Income - Gifts Schedule E ❑ Yes - schedule attached Income - Gifts - Travel Payments -or- No reportable interests on any schedule 5. Verification 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 certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date Signed ) FPPC Form 700 (2009/2010) FPPC Toll -Free Helpline: 866/ASK-FPPC www.fppc.ca.gov SCHEDULE A-2 Investments, Income; and Assets of Business Entities/Trusts (Ownership Interest Is 10% or Greater) Steven and Jan Howell -Marx Living Trust dtdl/30/05 Name Chec e Trust, go to 2 ❑ Business Entity, complete the box then go to 2 GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE IF APPLICABLE, UST DATE: ] $2,000 • $10,000 ] $10,001 • $100,000 _/_/ 0, J_ j �_ ] $100,001 • $1,000,000 ACQUIRED DISPOSED' ] Over Si.000,000 NATURE OF. INVESTMENT ❑ Sole Proprietorship ❑ Partnership ❑ Other YOUR BUSINESS POSITION of Jan Howell. Marx []x Business Entity, complete the box, then go to 2 DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑;z,000 - $10,000 $10,001 • $100,000 $100,001 - $1,000,000 ACQUIRED DISPOSED [� Over 31,000,000 NATURE OF INVESTMENT ❑X Sole Proprietorship . ❑ Partnership ❑ YOUR BUSINESS POSITION Attorney/Owner Oar 0$0-$499 0 $10,001 - $100,000 ❑ $500 • $1,000 $1 ❑ $1,001 ❑ OVER.$100,000 $0-$499 $500, ❑X $10,001 - $100,000 .� . E] OVER $100,000 - $10,000 $1,001 - $10,000 The Vanguard Group Mutual Funds Check one box: ❑X INVESTMENT ❑ REAL PROPERTY The Vanguard Group Name of Business Entity of Street Address of Assessor's Parcel Number of Real Property none:' Cheek one box.- INVESTMENT ox:INVESTMENT ❑ REAL PROPERTY ,v " "91"900 wary ,Qj Street Address or Assessor's Parcel Number of Real Property v-U>Lfv�erl.P' ,�r rn-1 Il6i.•[ qua r�r �or� Description of 8usmess Activity y0 DeseriPUon of Busine City ar Olher Predse LacaUan of Real Propedy City or Other Precise FAIR MARKET -VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 ❑ $10,001- $100,000 Q $100,001 - $1,000,000 ACQUIRED DISPOSED ❑ Over s1;000,000 NATURE OF INTEREST ❑ Property OwnGmhlpfDead of Trust Stock .❑ Partnership Leasehold Q Other mutual funds' Yrs renainlnp p Check box it additional schedules reporting Investments or real. properly are attached FAIR MARKET VALUE ] $2,000 - $10,000 ] $10,001- $100,000 ] $100,001 - $1,000,00D ] over $1,000,000 NATURE OF INTEREST ML of Real Property IF APPLICABLE, LIST DATE: 0 ACQUIRED DISPOSED ❑ Property Ownershlp/Deed of Trust ❑ Stock ❑ Partnership ] Leasehold' ❑ Other Yrs. remaining' ] Check box If additional schedules reporting Investments or real property are attached SCHEDULE B Interests in Real Property (Including 'Rental Income) > Crr, San Luis Obispo, CA 93405 FAIR MARKET VALUE IF APPLICABLE, LIST DATE ❑ $2,000 -.S10.000 ❑ $10,001- $100,000 f $100,001 - $1.000.000., ACQUIRED DISPOSED ❑ Over $1,000,000 NATURE OFINTEREST ❑X Ownership/Deed of Trust ❑ Easement ❑ Leasehold ❑ Yrs. remaining Other IF RENTAL PROPERTY, GROSS INCOME RECEIVED ❑ so , sags ❑ $coo - $1,000 ❑ $1,001- $10,000 ❑ $10.0ol - $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 income4f $10,000 or more. Office is 14.49% of home (est fmv $600,000), thus . $86,940 is fmv of home office. Name Jan Howell Marx > STREETADDRESS OR PRECISE LOW CITY Ketchum, Idaho 83340 FAIR MARKED VALUE IFAPPUCABLE/ UST DATE: ❑ $2,00D - $10,000 1 9 0 $%ool - $100,000 __j_JArL __j—J © $100,007 - $1,000,000 ACQUIRED DISPOSED' ❑ Over $1,000,000 NATURE OF INTEREST ❑X Owneiship/Deed of Trust ❑ Easement ❑ Leasehold ❑ Yrs. remaining Other IF RENTAL PROPERTY, GROSS INCOME RECEIVED ❑ so - $ase ❑ $soo - $1,000 ❑x $1,001- $10,000 ❑ $10,001- $100,000 ❑ OVER $100,000 SOURCES OF RENTAL INCOME: It you own a 10% or greater interest, list the name of each tenant that is a single source or Income of $10,000 or more. nla * You are not required'to report -loans frb* m commercial lending Institutions, or. any indebtedness created as part of a -retail Installment or credit card transactipn, 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 fotiows: NAME OF LENDER' ADDRESS .BUSINESS ACTIVITY OF LENDER INTEREST RATE 'TERM (Months/yeafs) % ❑ None HIGHEST BALANCE DURING REPORTING PERIOD ❑ $500 - $1,000 ❑ $1,001. $10,000 ❑ $10,001- $10D,000 ❑ OVER $100,000 ❑ Guarantor, It applicable M Comments: NAME OF LENDER' ADDRESS BUSINESS ACTIVITY OF LENDER INTEREST RATE TERM (Montha/Years) % ❑ None HIGHEST BALANCE DURING REPORTING PERIOD ❑ $600 - $1,000 ❑ $1,001 .$10.000 ❑ $10,001 - $100,000' E] -OVER $100.000 ❑ Guarantor, If applicable n ` SCHEDULE B' Interests in Real Property (Including Rental Income) > STREET ADDRESS OR PRECISE LOCATION CITY San Luis Obispo, CA 93401 FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 410.000 ❑x slo,00l- $100,000 09 r 15 f �� —J—� U7 ❑ $100,001 - $1,000,000 ACQUIRED DISPOSED ❑ Over $1,000,000 NATURE OF INTEREST ❑ OwnershfplDeed of Trust ❑ Leasehold Yrs remelning ❑ Easement mobile home Other IF RENTAL PROPERTY, GROSS INCOME RECEIVED ❑ $0 -$499 ❑ $500 - $1,000X❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 SOURCES OF RENTAL INCOME: If you own a 1.0% or greater interest, list the name of each tenant that is a single source of Incom`e6vF$10,000 or more. mobile home'rented'at cost -to family member. > STREETADDRESS OR PRECISE LOCATION CITY _ Sa"� (air J rJbIS�'� Of 93 V, FAIR MARKET VALUE IF APPLICABLE, UST DATE: •❑ sz000 - $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 ;2n06/��' �tGy1^c- YM rereaWng - Other IF RENTAL PROPERTY •GROSS INCOME RECEIVED ❑ $0 - $409 ❑ $500 - $1,000 ❑X $1,001 - S10,000 sto,00l . $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 institution's, 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.-.officlal 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 ACTIVITY- OF LENDER INTEREST RATE TERM (Months/Years) Y0 ❑None HIGHEST BALANCE DURING REPORTING PERIOD. ❑ $500 -;1.000 ❑ $1,001- sto,000 ❑ $10,001- $100,000 ❑ OVER $100,000 ❑ Guarantor, if appQcabie NAME OF LENDER' ADDRESS BUSINESS ACTIVITY OF LENDER INTEREST RATE ❑ None TERM (Months/Years) HIGHEST MLANCE DURING REPORTING PERIOD ❑ $600 - $1,000 ❑ $1,001 • $10,000 ❑ $10,001 - $100,000 - ❑'OVER $100,000 ❑ Guarantor, If applicable SCHEDULE C r Income, Loans,. & Business . Positions (Other than Gifts *and Travel Payments) NAME OF SOURCE OF INCOME Cal Poly State Unlorsity ADDRESS San Luis Obispo CA 93407 BUSINESS ACTMTI; IF ANY, OF SOURCE Higher Education YOUR BUSINESS POSITION. Spouse Is partly retired faculty member GROSS INCOME RECEIVED - ❑ $500 - $1,0o0 ,00 ❑ $11 - $10,000 ® $10,001 - $100,000 Q OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary ® Spouse's or registered domestic partner's Income ❑ Loan repayment Q sale of (PrcWerty, car, boa; eta) Q Cammisslon or Q Rental Income, Est e,msawW �r$i0000arm" Q Other • (DescnDe). Jan Howell Marx NAME OF SOURCE OF INCOME Law Offices of Jan Howell Marx ADDRESS BUSINESS ACTIVITY IF ANY, OF SOURCE . law pr6oiice YOUR BUSINESS PO01110N attorney GROSS INCOME RECEIVED p ss0o.: $1,000 Q $1,001- $io.000 ® $10,001,- $i00,000 Q OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED Salary Q Spouse's or registered domestic partner's Income ❑ Loan repayment Q Sale of (Property, car, Doat etc) Q Commission or . Q Rental Income, Est each 30U/W a 510,000 or mom ® Omer Attorney's fees, _ (DescrfDe) * You are not required. to report loans from' Commercial lending'institlitions, or any'indebtedness created Of a reiaii Installment or credit, card tr nsaction,. made in the lender's regular course of business on terms as part available to members of the public wit6oilt're.ga�d.:to your'officiat 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 ACTIVITY, 4F ANY, OF LENDER HIGHEST BALANCE DURING REPORTING PERIOD Q $500 • $1,000 Q $1,001 • $10,00D Q $10,001 • $100,000 Q OVER $100,000 Comments; INTEREST RATE TERM, (Months/Years) ❑ None SECURITY FOR LOAN Q None . Q Personal residence Q Real Property !e0 rass Q Guarantor ❑ Other ' - (Dascdbe) SCHEDULE Income, Loans,. & Business . Positions . (Other than Gifts and Travel Payments) NAME OF SOURCE•OF INCOME Jonah Manx ADDRESS PO Box 2659 Ketchum, Idaho BUSINESS ACTIVITY, IF ANY, OF SOURCE construction YOUR BUSINESS POSITION n/a GROSS INCOME RECEIVED ❑ $500 - $1,000 ®$1,001 $10,000 • ❑ $10,001. $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary ❑ Spouse's or registered domestic partner's Income ® Loan repayment ❑ Sale or (Property, cq boat, piq ❑ Commisslon or ❑ Rental Income, Oat each source of $fQ000 or more ❑ Other .(Describe) Jan Howell Marx NAME OF SOURCE OF INCOME Drs ky11,,.Xj ozlltf, 1 AD RESS BUSINESS ACTIVITY, IF ANY, OF SOURCE 4� C+ 27/� BUSINESS POSITION GROSS INCOME RECEIVED ❑ $000 - $1,000 ❑ $1,001- sto,000 VA $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ SalAry ❑ Spouse's or registered domestic partner's income ❑ Loan repayment ❑ Sale of fProper0; car, boat, efe) •❑ Cemmisglon or []Rental Income, qst each source of =,,00d or more Other 6 f_1LCI r a,,, %/ �) ' o caaet You are not required to.report.loans:from commercial.lending, institutions, or. any. indebtedness created as part of a retail installment. or credit'car'd transaction, madI6 in:.the'lenders regular course of business on terms evailable'to.members. of'the•public withouf 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' INTEREST RATE TERM (MonthsNears) ADDRESS % ❑ None BUSINESS ACTNITY, IF ANY, OF LENDER HIGHEST BALANCE DURING REPORTING PERIOD ❑ $500 - $1,000 ❑ $1,001- $10,000 ❑ $10,001- $100,000 ❑ OVER $100,000 Cotnments: SECURITY FOR LOAN ❑ None p Personal residence ❑ Real Property e a ass ❑ Guarantor._ ❑ other fDascdbe) FORM700 COMINIISSIGN "�ITICAL PRACTICES Please type or print in ink. NAME (LAST) MARX MAILING ADDRESS STREET (May use business address) Date Received ofATEMENT OF ECONOMIC INTERi:-jECEIV ED COVER PAGE' A Public Document (FIRST) JAN San Luis Obispo 1. Office, Agency, or Court Name of Office, Agency, or Court: San Luis Obispo City Council Division, Board, District, if applicable: Your Position: Council Member If filing for multiple positions, list additional agency(ies)1 position(s): (Attach a separate sheet if necessary.) Agency: — Position: 2. Jurisdiction of Office (Check at least one box) ❑ State ❑ County of 0 City of San Luis Obispo ❑ Multi -County ❑ Other 3. Type of Statement (Check of least one �box�),�/ %Assuming OfficeMifial Date: f 2 1 1 ❑ Annual: The period covered is January 1, 2007, through December 31, 2007. -or- .O The period covered is _I -J_, through December 31, 2007. ❑ Leaving Office Date Left: (Check one) O The period covered is January 1, 2007, through the date of -leaving office. -or- 0 The period covered is _J_/through the date of leaving office. ® Candidate OIC HOWELL CA 93405 4. Schedule Summary Total number of pages Including this cover page: DEC 12 2008 DAYTIME TELEPHONE • Check applicable schedules or "No reportable Interests." I have disclosed interests on one or more of the attached schedules: OK-J'WA Schedule A-1 Ig Yes -.schedule attached Investments (cess than ro% ownership) Schedule A-2 O'Yes - schedule attached Investments (io% or greater ownersNp) Schedule B 0 Yes- schedule attached Real Property Schedule C 0 Yes - schedule attached Income, Loans, &. Business Positions (Income other than Gifts and Travel Payments) Schedule D ❑ Yes - schedule attached Income - Gifts Schedule E ❑ Yes - schedule attached Income - Travel Payments. -or- F-1 No reportable interests on any schedule 5. Verification 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 certify under penalty of perjuryunderthe laws of the State of California that the foregoing is true and correct. Date Signe t. -26/ili�Pit� /_2 1400f, FPPC Form 700 (2007120081 SCHEDULE A-2 .. Investments, Income, and Assets of Business Entities/TrustsNene (Ownership Interest is 10% or Greater) Jan Howell Marx I> 1.. BUSINESS ENTRY OR TRUST _> 1. BUSINESS ENTITY ORT RUST Steven and Jan Howell Marx Living Trust dtdl/30/05 Name Chec rte Trust, go to 2 ❑ Business Entity, complete the box, Ihen go to 2 GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 - D $10,001 - $100,000 _/J 07 ❑ $100,001 - $1,000,000 ACQUIRED DISPOSED Over $1,000,000 NATURE OF INVESTMENT D Sole Proprietorship [] Partnership D Other YOUR BUSINESS POSITION • ••Meng. D $0.$499 rx-1 $10,0011 $100,000 ❑ $500 - $1,000 D OVER. $100,000 ❑ $1,001 - $10,000 • • r rrr •• o• The Vanguard Group Mutual Funds > 4 ;INVESTMENTS AND INTERESTS. IN ;REAL PROPERTY.HELD RV THE .BUSINESS ENTITY. ORTRUST - - Check one box: © INVESTMENT F1 REAL PROPERTY The Vanguard Group Name of Business Entity gt Street Address or Assessor's Parcel Number of Real Property Description of Business Activity gt City or Other Precise Location of Real Property FAIR MARKET VALUE ❑ $2,000 - $10,000 ❑ $10,001- $100,000 ❑X $100,001 -$1,000,000 Over $1,000,000 NATURE OF INTEREST ❑ Property Ownership/Deed of Trust IF APPLICABLE, LIST DATE: _/J 07 _jJ 07 ACQUIRED DISPOSED ❑ Stock .Q Partnership D Leasehold QX Other mutual funds Yrs. mnalnbv QX Check box It additional schedules reporting imrestmerts or real property . are attached ik Law Offices of Jan Howell Marx Name Address Check one ❑ Trust, go to 2 ❑x Business Entity, complete the box, then go to 1 GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 DX $10,001 - $100,000 ❑ $100,001 - $1,000,000 ACQUIRED DISPOSED Over $1,000,000 NATURE OF INVESTMENT QX Sole Proprietorship D Partnership D YOUR BUSINESS POSITION Attome - Y /Owner other • •• • ❑ $0-$499 DX $10,001 - $100,000 ❑ $500 - $1,000 D OVER $100,000 ❑ $1,001 -$10,000 - •- practice =none:@'stateplanning Check one box: INVESTMENT D REAL PROPERTY Name of Business Entity g Street Address or Assessor's Parcel Number of Real Property Description of Business Activity gt City or Other Precise Location of Real Property FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 ❑ $10,001 - $100,000 _/_,/ 07 JJ 07 $100,001 - $1,000,000 ACQUIRED DISPOSED ❑ Over $1,000,000 NATURE OF INTEREST Property Ownership/Deed of Trust Stock ParMershtp D Leasehold Other - Yrs. remalrift Chea box If additional schedules reporting Investments or real property . are attached Comments: FPPC Forth 700'(2007/2006) Sch. A-2 FPPC Tol6Free Helpline: 866/ASK-FPPC SCHEDULE B Interests in Real Property (Including Rental Income) > STREET ADDRESS OR PRECISE LOCATION San Luis Obispo, CA 93405 FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 ❑ $10,001 -$100,000 ❑X $100,001 - $1,000,000 ACQUIRED DISPOSED ❑ Over $1,000,000 NATURE OFINTEREST ❑X Ownership/Deed of Trust ❑ Easement ❑ Leasehold ❑ Yrs. remaining 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. Office is 14.49% of home (est fmv $600,000), thus $86,940 is fmv of home office. Name Jan Howell Marx > STREET ADDRESS OR PRECISE LOCATION CITY Ketchum, Idaho 83340 FAIR MARKET VALUE ❑ $2,000- $10,000 ❑ $10,001 - $100,000 ❑X $100,001 - $1,0D0,000 Over $1,000,000 NATURE OF INTEREST ❑X Ownership/Deed of Trust IF APPLICABLE, LIST DATE: ___/_/ 07 ___/_/ 07 ACQUIRED DISPOSED . ❑ Easement ❑ Leasehold ❑ Yrs. remaining Other IF RENTAL PROPERTY, GROSS INCOME RECEIVED ❑ $o .$499 ❑ $500 - $1,000 ❑x $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. n/a * 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 ADDRESS BUSINESS ACTMTY 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 ACTIVITY OF LENDER INTEREST RATE TERM (Months/Years) % ❑ None HIGHEST BALANCE DURING REPORTING PERIOD ❑ $500 -,$1,000 ❑ $1,001 - $10,000 ❑ $top01 - $100,000 OVER $100,000 ❑ Guarantor, if applicable FPPC Form 700 (2007/2008) Sch. B FPPC T08 -Free Heinline: 888IASK.FPPC ` SCHEDULE B Interests in Real Property (Including Rental Income) > STREET ADDRESS OR PRECISE LOCATION CIT`/ San Luis Obispo, CA 93401 FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2.000 -'$10,000 Q $10,001 - $10o,000 Olt, 15 /07 ❑ $100,001 - $1,000,000 ACQUIRED DISPOSED ❑ Over $1,000,000 NATURE OF INTEREST ❑ Ownership/Deed of Trust ❑ Easement ❑ Leasehold mobile home . YM remaining Other IF RENTAL PROPERTY, GROSS INCOME RECEIVED ❑ $0 - $499 ❑ $500.$1.000 ❑x $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. mobile home rented -at Cost to family member. STREET ADDRESS OR PRECISE LOCATION CITY Lund, British Columbia V8A 4Z3 FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 ❑ $10,001- $100.000 —J__/_g7 JJ 07 ❑X $100,001 - $1,000,000 ACQUIRED DISPOSED ❑ Over $1,000,000 NATURE OF INTEREST ❑X Ownership/Deed of Trust ❑ Easement ❑ Leasehold ❑ Yrs. rermmnB�g Other IF RENTAL PROPERTY„GROSS INCOME RECEIVED ❑ $0 - $499 ❑ $500 -$1,000 ❑X $1,001- $1o,000 ❑ $10,001 - $100,000, ❑ OVER $100,000 SOURCES OF RENTAL INCOME: If you own a 10% or greater interest, fist 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, 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: OF LENDER* BUSINESS ACTIVITY OF LENDER INTEREST RATE TERM (Months/Years) % ❑ None HIGHEST BALANCE DURING REPORTING PERIOD ❑ $600 - $1.000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 ❑ Guarantor. if applicable NAME OF LENDER* ADDRESS BUSINESS ACTIVITY OF LENDER INTEREST RATE TERM (MonthslYears) % ❑ None HIGHEST BALANCE DURING REPORTING PERIOD ❑ $e00 - $1,000 ❑ $1.001 - $10,000 ❑ $10,001- $100,000 p OVER $100,000 ❑ Guarantor, if applicable Comments: - FPPC Form 700 (2007/2008).Sclt: B FI PC Toll -Free Heloline: 866/ASK-FPP6 SCHEDULE C Income, Loans, & Business Positions (Other than Gifts and Travel Payments) NAME OF SOURCE OF Cal Poly State University ADDRESS San Luis Obispo CA 93407 BUSINESS ACTIVITY, IF ANY, OF SOURCE Higher Education YOUR BUSINESS POSITION Spouse is partly retired faculty member. GROSS INCOME RECEIVED ❑ $500 - $1,000 ❑ $1,001 - $10,000 ® $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary ® Spouse's or registered domestic partner's income ❑ Loan repayment ❑ Sale of (Propedy, car, boe4 etc) ❑ Commission or ❑ Rental Income, Est each source of $10,000 or more ❑ Other (Descdbe) NAME OF SOURCE OF INCOME Law Offices of Jan Howell Marx ADDRESS _ BUSINESS ACTIVITY, IF ANY, OF SOURCE law practice YOUR BUSINESS POSITION attorney GROSS INCOME RECEIVED ❑ $500. - $1,000 ❑ $1,001 - $10,00ll ® $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑'Salary ❑ Spouse's or registered domestic partner's Income ❑ Loan repayment ❑ Sale of (Pmperfy, car, boat, ere.) ❑ Commission or ❑Rental Income, list each source of sfg000 or mora ® other Attorney's fees. (Describe) R.AW4M lug * 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* ADDRESS BUSINESS ACTIVITY, IF ANY, OF LENDER HIGHEST BALANCE DURING REPORTING PERIOD ❑ $500 - $1,000 . ❑ $1,001- $10,000 ❑ $10,001- $100,000 ❑ OVER $100,000 Comments: INTEREST RATE TERM (MonthslYears) °%o ❑ None SECURITY FOR LOAN ❑ None ❑ Personal residence ❑ Real Property a cess ❑ Guarantor ❑ Other (Desalts) FPPC Form 700 (2 0 0712 0 0 8) Sch. C FPPC1011-Free Helpline: 866/ASK-FPPC SCHEDULE C Income, Loans,. & Business . Positions (Other than Gifts and Travel Payments) NAME OF SOURCE OF INCOME Jonah Marx ADDRESS BUSINESS ACTIVITY, IF ANY, OF SOURCE construction YOUR BUSINESS POSITION n/a GROSS INCOME RECEIVED ❑ $500 - $1,000 % $1,001 $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,060 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary ❑ Spouse's or registered domestic partner's Income © Loan repayment ❑ Sale of (Property, car, boat etc.) ❑ Commission or ❑ Rental Income, fist each source of $10.000 or more ❑ Other .(Describe) .. NAME OF SOURCE OF ADDRESS BUSINESS ACTIVITY, IF ANY, OF SOURCE YOUR BUSINESS POSITION GROSS INCOME RECEIVED ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,00i - $100,000 ❑ OVER $100.000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary ❑ Spouse's or registered domestic partner's Income ❑ Loan repayment ❑ Sale of (Property; ear, boat etc) ❑ Commission or ❑ Rental Income, fist each source or fr0000 or more ❑ Other (Desalbe) 2. LOAN a * 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 jyour 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 ACTIVITY, IF ANY OF LENDER HIGHEST BALANCE DURING REPORTING PERIOD ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 Comments: INTEREST RATE TERM (Months/Years) % ❑ None SECURITY FOR LOAN ❑ None ❑ Personal residence ❑ Real Property ❑ Guarantor ❑ Other (Dasafbel FPPC Form 700 (2007I2008) Sch. C FPPC Toll -Free Helpline: 866/ASK-FPPC CALIFORNIA FORM 700 FAIR POLITICAL PRACTICES COnr�siss,ora Please tvoe or print in ink. Date Received orATEMENT OF ECONOMIC INTtj.E,6 RECEIVED COVER PAGE DEC 12 2008 A Public Document 1, Office, Agency, or Court Name of Office, Agency, or Court: San Luis Obispo City Council Division, Board, District, if applicable: Your Position:" i,� Council Member " If filing for multiple positions, list additional agency(les)/ position(s): (Attach a separate sheet if necessary.) Agency: Position: 2. Jurisdiction of Office (Check at /east one box) ❑ State ❑ County of ❑R City of San Luis Obispo ❑ Multi -County 0 Other j 3. Type of Statement (Check at least one box) %Assuming Office/Initial Date: % � lSL ❑ Annual: The period covered is January 1, 2007, through December 31, 2007. .or - 0 The period covered is —J_/ through December 31, 2007. ❑ Leaving Office Date Left: (Check one) O The period covered is January 1, 2007, through the date ofJeaving office. -or- 0 The period covered is _J_Jthrough the date of leaving office. . ® Candidate Ok Schedule Summary m*Total number of pages including this cover page: Check applicable schedules or "No reportable Interests." I have disclosed interests on one or more of the attached schedules:. Schedule A-1 [ill Yes -.schedule attached Investments (Less than 10% Ownership) Schedule A-2 ❑X'Yes - schedule attached Investments (70% er greater ownership) Schedule B Yes - schedule attached Real Property Schedule C Q Yes - schedule attached Income, Loans, &. Business Positions (income other than Girta and Trdvel.Payments) Schedule D ❑ Yes -schedule attached Income - Gilts Schedule E ❑ Yes - schedule attached Income - Travel Payments. -or- F-1 No reportable interests on any schedule S. Verification I have used all reasonable diligerice,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 certify under penalty of perjuryunderthe laws of the State of California that the foregoing is true and correct. Date Signet, -)2� �"Z !J6 Signature FPPC Form'700 (20071200al SCHEDULE A-2 1 Investments, Income, and Assets of Business Entities/Trusts (Ownership Interest is 10% or Greater) > 1. BUSINESS ENTITY OR TRUST Steven and Jan Howell Marx Living Trust dtdl/30/05 Name Address ChecLpne Trust, go to 2 ❑ Business Entity, complete the box, then go to 2 GENERAL. DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE IF APPLICABLE; LIST DATE: ❑ $2,000 - $10,000 ❑ $10,001 - $100,000 _/_J 07 ❑ $100,001 - $1,000,000 ACQUIRED DISPOSED ❑ Over $1,000,000 NATURE OF INVESTMENT ❑ Sole Proprietorship ❑ Partnership ❑ Other YOUR BUSINESS POSITION 0$0-S499 $10,001 $100,000 ❑ $500 - $1,000 ❑ OVER. $100,000 ❑ $1,001 - $10,000 The Vanguard Group Mutual Funds Check one box. ❑X INVESTMENT ❑ REAL PROPERTY The Vanguard Group Name of Business Entity gr Street Address of Assessor'sParcel Number Number of Real Property` -"Y1 V'if� Y (�i✓�ya ri qUa n r COM Description of Business Activity gr City or Other Precise Location of Real Property FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ] $2,000 - $10,000 ] $10,001- $100,000 1 107 _IJ 07 $100,001 - $1,000,000 ACQUIRED DISPOSED ] Over $1,000,000 NATURE OF INTEREST Property Ownership/Deed of Trust ❑ Stock ❑ Partnership ] Leasehold ❑x Omer mutual funds_ Yrs. remamv Check box It additional schedules reporting Investments or real property are attached Jan Howell Marx > 1. BUSINESS ENTITY OR TRUST Law Offices of Jan Howell Marx Name Address Check one ❑ Trust, go to 2 ❑x Business Entity, complete the box, then go to 2 GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 ❑x $10,001 - $100,000 --J--j_27 --/--/_L7 ❑ $100,001 - $1,000,000 ACQUIRED, DISPOSED I] Over $1,000,000 NATURE OF INVESTMENT ❑X Sole Proprietorship ❑ Partnership ❑ YOUR BUSINESS POSITION Attorney/Owner Oar ❑ $0-$499 ❑X $10,001 - $100,000 ❑ $500 - $1,000 ❑ OVER $100,000 ❑ $1,001 - $10,000 none: estate planning practice Check one box: ❑ INVESTMENT ❑ REAL PROPERTY Name of Business Entity 4r Street Address or Assessor's Parcel Number of Real Property Description of Business Activity g! City or Other Precise Location of Real Property FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 ❑ $10,001 - $100,000 _/_J 07 _/__j 07 ❑ $100,001 - $1,000,000 ACQUIRED DISPOSED ❑ Over $1,000,000 NATURE OFINTEREST ❑ Property OwnershlpMeed of Trust ❑ Stock C] Partnership ❑ Leasehold ❑ Omer Yrs. remalrtinp' ❑ Check box If additional schedules reporting Investments or real property . are attached Comments, FPPC Form 70D (200712008) Sch A-2 FPPC Toll -Free Hemline: a861A-gK-rvw: ' SCHEDULE B Interests in Real Property (Including Rental Income) > CITY San Luis Obispo, CA 93405 FAIR MARKET VALUE- IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 ❑ $10,001 - $100,000 ❑X $100,001 - $1,000,000 ACQUIRED DISPOSED ❑ Over $1,000,000 NATURE OF INTEREST ❑X Ownership/Deed of Trust ❑ Easement ❑ Leasehold ❑ Yre. remaMing Other IF RENTAL PROPERTY, GROSS INCOME RECEIVED ❑ $0 - sass ❑ $500 - $t,00o ❑ $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. Office is 14.496/o of home (est fmv $600,000), thus $86,940 is fmv of home office > STREETADDRESS OR PRECISE LOCATION Ketchum, Idaho 83340 FAIR MARKET VALUE ❑ $2,000 - $10,000 ❑ $10,001 - $100,000 ❑X $100,001 - $1,000,000 ❑ Over $1,000,000 NATURE OF INTEREST ❑X Ownership/Deed of Trust IF APPLICABLE, LIST DATE: __J_J07 07 -J_J 07 ACQUIRED DISPOSED . ❑ Easement ❑ Leasehold ❑ Ym, remaining Other IF RENTAL PROPERTY, GROSS INCOME RECEIVED ❑ $0-S499 ❑ $50o - s1,0oo ❑x $1,00l - $10,000 ❑ $10,001 - $100,0o0 ❑ OVER $100,000 SOURCES OF RENTAL INCOME: It 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. n/a * 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. Per loans and loans received not in a lender's regular course of business must be disclosed as follows: NAME OF LENDER' ADDRESS .BUSINESS ACTIVITY 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 Comments: NAME OF LENDER' ADDRESS BUSINESS ACTIVITY OF LENDER INTEREST RATE TERM (Months/Years) % ❑ None HIGHEST BALANCE DURING REPORTING PERIOD ❑ $e00 - $1,000 ❑ $1.001- $10,00o ❑ $10,001- $100,000 ❑ OVER $100,000 ❑ Guarantor, if appricable FPPC Form 700 (200712008) Sch. B FPPC Too -Free Helpline: 6661ASK-FPPC m I SCHEDULE B Interests in. Real Property (Including Rental Income) > STREET ADDRESS OR PRECISE LO CITY San Luis Obispo, CA 93401 FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 -'$10,000 ❑x $10,001 -$100,000 01 / 15 / 07 -JJ O7 ❑ $100,001 - $1,000,000 ACQUIRED DISPOSED ❑ Over $1,000,000 NATURE OFINTEREST ❑ Ownership/Deed of Trust ❑ Easement ❑ Leasehold. mobile home . Yrs. remaining - Other IF RENTAL PROPERTY, GROSS INCOME RECEIVED ❑ $0 - $499 ❑ $500 - $1,000 ❑x $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. mobile home rented at cost to family member. > STREET ADDRESS OR PRECISE LOCATION CITY Lund, British Columbia V8A 4Z3 FAIR MARKET VALUE ❑ $2,000 - $10,000 ❑ $10,0ol - $100,000 ❑X $100,001 - $1,000,000 ❑ Over $1,000,000 NATURE OF INTEREST ❑X Ownership/Deed of Trust IF APPLICABLE, LIST DATE: --J_-J-.07 _J_ J O7 . ACQUIRED DISPOSED ❑ Easement ❑ Leasehold ❑ Yra. remaining Other IF RENTAL PROPERTY,.GROSS INCOME RECEIVED ❑ $0 - $499 ❑ $500 - $1.000 os 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, 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' ADDRESS BUSINESS ACTIVITY OF LENDER INTEREST RATE TERM (Months/Years) % ❑ None HIGHEST BALANCE DURING REPORTING. PERIOD ❑ $600 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001- $100,000 ❑ OVER $100,000 ❑ Guarantor, 'd applicable Comments: NAME OF LENDER' ADDRESS BUSINESS ACTIVITY OF LENDER INTEREST RATE TERM (Months/Years)' % ❑ None HIGHEST BALANCE DURING REPORTING PERIOD ❑ $600 - $1,000 ❑ $1,001- $10,000 ❑ $10,001- $100,000 p OVER $100,000 ❑ Guarantor, if appiiwbte FPPC Form 700 (200712008).SCh+ B COUP T it2..... U.. - . w.. 1 NAME OF SOURCE OF INCOME SCHEDULE C Income, Loans, & Business Positions (Other than Gifts and Travel Payments) Cal Poly State University ADDRESS San Luis Obispo CA 93407 BUSINESS ACTIVITY, IF ANY, OF SOURCE Higher Education YOUR BUSINESS POSITION Spouse is partly retired faculty member GROSS INCOME RECEIVED ❑ $500 - $t,0oo ❑ $1,001 - $10,000 0 $10,001 - $100,000 OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED Salary ® Spouse's or registered domestic partner's income Loan repayment Sale of (Property, car boat. etc.) Commission or C] Rental Income, 6sr each source or $10,060 w mom ❑ Other (Describe). OF SOURCE OF INCOME Jan Howell Marx Law Offices of Jan Howell Marx ADDRESS law practice YOUR BUSINESS POSITION attorney GROSS INCOME RECEIVED ❑ $500, - $1,000 $1,001 - $10,000 ® $10,001 - $100,000 OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary [I Spouse's or registered domestic partners income ❑ Loan repayment Sale of (Property, car, boat, etc) Commission or O.Rental Income, fist each sat=e w$10,000 wmom ® other Attorney's fees. . (DesalbeJ . * 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' INTEREST RATE TERM. (Monthslyears) ADDRESS BUSINESS ACTIVRY IF ANY, OF LENDER HIGHEST BALANCE DURING REPORTING PERIOD ❑ $5o0 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 OVER $100,000 Comments: ^/o ❑ Notre SECURITY FOR LOAN ❑ None . E] Personal residence Real Property a s ❑ Guarantor Other IDesa)be) FPPC Foran 700 (2007/2008) Sch. C FPPC Toff -Free Helpfine: 888/ASK-FPPC SCHEDULE C Income, Loans,. & Business Positions (Other than Gifts and Travel Payments) NAME OF SOURCE OF INCOME Jonah Marx ADDRESS BUSINESS ACTIVITY, IF ANY, OF SOURCE construction YOUR BUSINESS POSITION n/a GROSS INCOME RECEIVED - ❑ $500 - $1,000 ® $1,001 $10,000 ❑ $10,001 - $100,000 . ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary ❑ Spouse's or registered domestic partner's Income © Loan repayment ❑ Sale of (Prope(ty, car, boat, etc.) ❑ Commission or ❑ Rental Income, Fist each source or $10,000 or more ❑ Other .(Dasalbe) .. .T ADDRESS OF INCOME BUSINESS ACTIVITY, IF ANY, OF SOURCE YOUR BUSINESS POSITION GROSS INCOME RECEIVED p $500 - $1,0oo ❑ $1,001- $10,000 ❑ $10,00i - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary. ❑ Spouse's or registered domestic partner's Income ❑ Loan repayment ❑ Sale of (Property car, boat, eta) ❑ Commission or ❑ Rental Income, Fist each source of $10,000 or more ❑ Other (Describe) * You are not required to report -loans from commercial lending Institutions, or any. indebtedness created as part of a retailinstallment.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* INTEREST RATE TERM (Months/Years) ADDRESS BUSINESS ACTIVITY IF ANY, OF LENDER HIGHEST BALANCE DURING REPORTING PERIOD ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 Comments: % ❑ None SECURITY FOR LOAN ❑ None ❑ Personal residence ❑ Real Property aver aWress IE -1 ❑ Older (pasoibe) FPPC Form 700 (200712006) Sch. C FPPC Toll -Free Helpline: SWASK-FPPC