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.