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HomeMy WebLinkAboutJan Marx - Form 700 - Amendment - 07-31-2012CALIFORNIA FORM 700 FAIR POLITICAL PRACTICES COMMISSION A PUBLIC DOCUMENT Please type or print in ink, NAME OF FILER (LAST) STATEMENT OF ECONOMIC INTERESTS I RF COVER PAGE I AUG 091012 MARX (FIRST) 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; Position: 2. Jurisdiction of Office (Check at least one box) ❑ State ❑ Multi- County _ City of San Luis Obispo I Type of Statement (Check at least one box) ❑ Judge or Court Commissioner (Statewide Jurisdiction) ❑ County of ❑ Other ❑ Annual: The period covered is January 1, 2011, through December 31, 2011. El Leaving Office: Date Left —J_I -or- (Check one) The period covered is �J through O The period covered is January 1, 2011, through the date of December 31, 2011. leaving office. ❑ Assuming Office: Date assumed ter O The period covered is — )— �1_ — .�Y.., through the date of leaving office. ❑X Candidate: Election Year 2012 Office sought, if different than Part 1- Mayor 4. Schedule Summary Check applicable schedules or "None. " ► Total number of pages including this cover page: ;K Schedule A -1 - Investments - schedule attached Schedule C - Income, Loans, & BUSi/le.SS Positions - schedule attached Schedule A -2 - Investments - schedule attached ❑ Schedule D - Income - Gifts - schedule attached Schedule B -Real Progeny - schedule attached ❑ Schedule E - Income - Gifts - Travel Payn7ents - schedule attached -or- ❑ None - No reportable interests on arty schedule 5. Verification - MAILlNO ADDRESS STREET � CITY (Business or Agency Address Recommended - Public DacumenrJ STATE 7,1P COQE 990 Palm Street San Luis Obispo CA OAYTIMF TELEPFi0t9E NumE ER 93401 E -MAIL, ADDRESS (OPTlONAt ) ( 805 ) 781 -7752 JanmarX@stanfordalumni.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 loregoin is true and correct. Date Signed ( arl Si nature q frawnrr� tkv veari 9 FPPC Form 700 (2011/2012) Toll -Free Helpline: 866 /275 -3772 wvw.fppc.ca.gov SCHEDULE A -1 Investments Stocks, Bonds, and Other Interests (Ownership Interest is Less Than 10 %) 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 - $1,000,000 ❑ 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: __8_/ 1_j_012 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: 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: ACQUIRED DISPOSED Comments: ► NAME Ur 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: 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: 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 FPPC Form 700 (2011/2012) Sch. A -1 FPPC Toll -Free Helpline: 866 /275 -3772 wvvw.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 dtd 1/30_/05 Name 265 Albert Drive San Luis Obispo CA 93405 Address (Business Address Acceptable) Check one ❑X Trust, go to 2 ❑ Business Entity, complete the box, then go to 2 GENERAL DESCRIPTION OF BUSINESS ACTIVITY i I FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $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 ❑ Sole Proprietorship ❑ Partnership ❑ Other .1YOUR BUSINESS POSITION 0$0-$499 ❑X $10,001 - $100,000 ❑ $500 - $1,000 ❑ OVER $100,000 ❑ $1,001 - $10,000 he Vanguard Grou Check one box: ❑ 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 FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 ❑ $10,00l - $100,000 ❑x $100,001 - $1,000,000 ACQUIRED DISPOSED ❑ Over $1,000,000 NATURE OF INTEREST ❑ Property Ownership /Deed of Trust ❑ Stock ❑ Partnership Law Offices of Jan Howell Marc 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 1+ GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $0 - $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 ❑X Sole Proprietorship ❑ Partnership ❑ Other f YOUR BUSINESS POSITION owner I $0 - $499 ❑ $10,001 - $100,000 IfI $500 - $1,000 ❑ OVER $100,000 ❑ $1,001 - $10,000 Check one box: ❑ INVESTMENT ❑ REAL PROPERTY 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 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 ❑ Property Ownership /Deed of Trust ❑ Stock ❑ Partnership ❑ Leasehold ❑ Other ❑ Leasehold ❑Other Yrs. remaining Yrs. remaining ❑ Check box if additional schedules reporting investments or real property ❑ Check box if additional schedules reporting investments or real property are attached are attached Comments: 14 % �hA ' 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 265 Albert Drive 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 ❑ $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. ► 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 - $100,000 ❑ $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 ❑ $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 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.ca.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 ❑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, list each source of $10.000 or more ❑ Other (Describe) NAME OF SOURCE OF INCOME Law Offices of Jan Howell Marx ADDRESS (Business Address Acceptable) 265 Albert Drive San Luis Obispo CA 93405 BUSINESS ACTIVITY, IF ANY, OF SOURCE law practice YOUR BUSINESS POSITION attorney GROSS INCOME RECEIVED ® $500 - $1,000 ❑ $1,001 - $10,00o ❑ $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 of $10,000 or more ❑ Other (Describe) LOANS OR OUTSTANDING DURING THE REPORTING •D * 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 (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 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 0 Salary ❑ Spouse's or registered domestic partner's income ❑ Loan repayment ❑ Partnership F-1 Sale of (Real property, car, boat, etc.) ❑ Commission or ❑ Rental Income, list each source of $90.000 or more ❑ 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 property, car, boat, etc.) ❑ Commission or ❑ Rental Income, list each source of $90,000 or more ❑ Other (Describe) 'Do- 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 (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 0 $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 F-1 snip of (Real property, car, boat, etc) ❑ Commission or ❑ Rental Income, list each source or $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 ❑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 F­1 Sale of (Real property, car, boat, etc.) ❑ Commission or ❑ Rental Income, list 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 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 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 p 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 ❑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 properly, car, boat, etc.) ❑ Commission or ❑ Rental Income, list each source of $10,000 or more ❑X 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' 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 A 'd city Of SAn OBI spo 990 Palm Street, San Luis Obisoo CA Augt Fai Tey- 47 k Form 700) filed aper6,2012 805) 781 -7102. 1 EThe City of San Luis Obispo is committed to include i - II of its services, programs and activities. �` Telecommunications Device for the Deaf (805) 781 -7410.