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HomeMy WebLinkAboutChristianson - 700, 8/9/18 Economic Interest - Election DateSTATEMENT OF ECONOMIC COVER PAGE Please type or print in ink. Initial Filino Received AUG 0 9 2018 NAME OF FILER (LAST) (FIRST) Immi Christianson Carlyn Rae 1. Office, Agency, or Court Agency Name (Do not use acronyms) City of San Luis Obispo Division, Board, Department, District, if applicable City Council Your Position Council Member ► 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 lent one box) ❑ Annual: The period covered is January 1, 2017, through December 31, 2017. -or- The period covered is I I through December 31, 2017. ❑ Assuming Office: Date assumed —1 11/6/2018 ® Candidate: Date of Election Position: ❑ Judge or Court Commissioner (Statewide Jurisdiction) ❑ County of _ ❑ Other ❑ Leaving office: Date Left I I (Check one) O The period covered is January 1, 2017, through the date of -or- leaving office. O The period covered is through the date of leaving office. and office sought, if different than Part 1: 4. Schedule Summary (must complete) P. Total number of pages including this cover page: -3 Schedules attached ❑ Schedule A-1 - Investments — schedule attached ❑ Schedule A-2 - Investments — schedule attached © Schedule B - Real Property — schedule attached -or- E] None - No reportable interests on any schedule ® Schedule C - Income, Loans, & Business Positions — schedule attached ❑ Schedule D - Income — Gifts — schedule attached ❑ Schedule E - Income — Gifts — Travel Payments — schedule attached 5. Verification MAILING ADDRESS STREET CITY STATE ZIP CODE (Business or Agency Address Recommended - Public Document) San Luis Obispo CA 93401 DAYTIME TELEPHONE NUMBER E-MAILADDRESS ( 805 ) 550-9320 carlynpc@gmail.com 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 odgin* signed statement with your filing attittal.) FPPC Form 700 (2017/2018) 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 CITY San Luis Obispo 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 IF APPLICABLE, LIST DATE: --j---j-L7- /17 ACQUIRED DISPOSED ❑ Easement Mobile Home 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. ® None Name Christianson, Carlyn Rae ► ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS CITY FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 ❑ $10,001 - $100,000 17 ❑ $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. ❑ None * You are not required to report loans from commercial lending institutions made in the lender's regular course of business on terms available to members of the public without regard to your official status. Personal loans and loans received not in a lender's regular course of business must be disclosed as follows: NAME OF LENDER* ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, 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 Address Acceptable) BUSINESS ACTIVITY, IF ANY, 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 (2017/2018) Sch. B FPPC Advice Email: advice@fppc.ca.gov SCHEDULE C Income, Loans, & Business Positions (Other than Gifts and Travel Payments) NAME OF SOURCE OF INCOME Coastal Anesthesiology Medical Associates ADDRESS (Business Address Acceptable) P.O. Box 1185, San Luis Obispo, CA 93406 BUSINESS ACTIVITY, IF ANY, OF SOURCE Medical practice YOUR BUSINESS POSITION Practice Administrator GROSS INCOME RECEIVED ❑ 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 Christianson, Carlyn Rae 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) ❑ Other. — ❑ Other _ _— (Describe) (Describe) LOANSOR 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" Mary R. Kmetovic ADDRESS (Business Address Acceptable) 38 Country Club Gate, Pacific Grove, CA 93950 BUSINESS ACTIVITY, IF ANY, OF LENDER HIGHEST BALANCE DURING REPORTING PERIOD ❑ $500 - $1,000 ❑ $1,001 - $1o,000 ® $10,001 - $100,000 ❑ OVER $100,000 Comments: INTEREST RATE TERM (Months/Years) 6 ❑ None 15 years 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 FPPCToll-Free Helr�line-- 866/275-3777 v4ivw.franc,ca,Pnv