HomeMy WebLinkAboutHarmon - 700 - 08-08-2018 - Election Date 11/6/18STATEMENT OF ECONOMIC INTERESTS
COVER PAGE
Please type or print in ink.
Date 15HR '�i�ngF ceW ived
Official Use only
AUG 0 8 2018
SL[7_CI iY C�LFK.
NAME OF. F!L (LAST) (FIRST) (MIDDLE)
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
f- Sam Lal 06'�'f:)o
Division, Boa , Department, District, if applicable Your Position
C UL VA C_ s Gk ►�`
► 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 _
l City of �
3. Type of Statement (Check at least one box)
❑ Annual: The period covered is January 1, 2017, through
December 31, 2017.
.or -
The period covered is through
December 31, 2017.
❑ Assuming Office: Date assumed I
Position:
❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ County of
❑ Other
❑ Leaving Office: Date Left ---J—/-
(Check
_—J/_(Check one)
O The period covered is January 1, 2017, through the date of
leaving office.
.or -
0 The period covered is ..1. . through
the date of leaving office,
4 Candidate: Date of Election N0 \1 � -d0 Mand office sought, if different than Pao 1:
4. Schedule Summary (must complete) ► Total number of pages including this cover page:
Schedules attached
❑ Schedule A-1 - Investments – schedule attached
❑ Schedule A-2 - Investments – schedule attached
❑ Schedule B - Real Property – schedule attached
.or -
El None - No reportable interests on any schedule
5. veritication
M Schedule C - Income, Loans, & Business Positions – schedule attached
Schedule D - Income – Gifts – schedule attached
❑ Schedule E - Income – Gifts – Travel Payments – schedule attached
MAILING ADDRESS STREETCITY STATE ZIP CODE
(
'.&V 1d_X iS Q i p a- CA.
L4C)
DAYTIME TELEPHONE NUMBER E-MAIL DRESS `
I have used all reasonable diligence in preparing this statement. I have reviewed this statement and to the best of my c
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 Form 700(2017/2018)
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
LM BG
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOUR BUSINESS POSITION
GROSS INCOME RECEIVED F -]No Income - Business Position Only
❑ $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)
Name
4e_ mi k a- rirn im
NAME OF SOURCE OF INCOME
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOUR BUSINESS POSITION
GROSS INCOME RECEIVED ❑ No Income - Business Position Only
❑ $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)
❑ OtherI I
F -]Other
(Describe) (Describe)
1� 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 (Months/Years)
% ❑ None
SECURITY FOR LOAN
❑ None ❑ Personal residence
❑ Real Property
❑ Guarantor
❑ Other
Street address
city
(Describe)
FPPC Form 700 (2017/2018) Sch. C
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov
SCHEDULE D
Income — Gifts
► NAME OF SOURCE (Not an Acronym)
ca -k 5k6Lie On'►JerSi
ADDRESS (Business Address Acceptable) Ct 3L4 O
C,rc�v7 .i Save LLiiS `Dh; C
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mmlddlyy) VALUE DESCRIPTION OF GIFT(S)
0�ar- iv,c� 1 A55
► NAME OF SOURCE (Not an Acronym)
e a( -e Epm
ADDRESS (Business Address Acceptable)
PD P �10 x H S t'0 5'v e- -a�C ,Z
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
o • oo c�kei5� ectc,"
► NAME OF SOURCE (Not an Acronym)
C � H oZ -i c
ADDRESS[ (Business Address Acceptable) �y ( C, j}R
! `�
i�' V
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/dd/yy) VALUE
slav
Comments:
DESCRIPTION OF GIFT(S)
Jh Lxn_•+ S
Name
14e t [-�) 1 44:x- t W10
► NAME OF SOURCE (Not an Acronym)
G iyi' L � �.t I e✓-� -I-
/..juRESS (Business Ad css Acceptable) S`� �l l S
'3q 2--t M Ue,1 � _�O CD(, r+ C r+ Gt r{u t
BUSINESS ACTIVITY- IF ANY, OF SOURCE
DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
17- 1 joj l T $ (0 (p 4-i c!_ re. f 5 -j) tVccIcvO
► NAME OF SOURCE (Not an Acronym)
C pin ,,- 4�,)r-\
�-Gti b p r M c- vx ct! e wiz4-4
C o wlvv, [ e
ADDRESS (Business Address Acceptable)
�
1 -M- � ao
G�1�trG� ab3
BUSINESS ACTIVITY, IF ANY, OF kURCE
b i Irl ne \(-
DATE (mm/dd/yy) VALUE DESCRIPTION
OF GIFT(S)
H 1, 1% $ 312 g D3 vn ane ,r -Ev e.
► NAME OF SOURCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
I__ r s
__J__j_ $
FPPC Form 700 (2017/2018) Sch. D
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov