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RECEIVED

CALIFORNIA FORM 700


FAIR POLITICAL PRACTICES COMMISSION
STATEMENT OR ECONOMIC INTERESTS
r' ;\IR F'OLITICf.L
Dale Received
AP~'IU:'6'nI20 It

A PUBLIC DOCUMENT PRACT~OPAG~SION


LAKE COUNTY
REGISTRAR VOTEJltS
II APR I I PH 12: 22
Please type or print in ink.
NAME OF FILER (LAST) (FIRST) (MIDDLE)

BROWN ROBERT K.
1. Office, Agency, or Court
Agency Name
COUNTY OF LAKE
Division, Board, Department, District. if applicable Your Position
BOARD OF SUPERVISORS DISTRICT 5 SUPERVISOR
~ If filing for multiple positions. list below or on an attachment.

Agency: Position:

2. Jurisdiction of Office (Check at least one box)


o Slate o Judge (Statewide Jurisdiction)
o Multi·County _ _ _ _ _ _ _ _ _ _ _ _ __ ~ County of .:LA:...:.:.K=E'--_ _ _ _ _ _ _ _ _ __

o City of o Other
3, Type of Statement (Chock at loast one box)
~ Annuat: The period covered is January 1. 2010, through December 31, o Leaving Office: Date Left -----1-----1__
2010. -or.. (Check one)
The period covered is -----1-----1_ _ . through December 31, o The period covered is January 1. 2010. through the date of
2010. leaving office.

o Assuming Office: Date -----1-----1_ _ o The period covered is ~-----1_ _• through the date
of leaving office.
o Candidate: Election Vear _ _ _ _ __ Office sought, if different than Part 1: _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

4. Schedule SummarY
Check applicable s.chedules or "None." ~ Total number of pages including this cover _page:
.'
-6...-
o Schedule A·1 • Investmenm -·schedule attached o Schedule C • Income, Loans, & Business Posffions - schedule attached
0' Schedule A·2 • Investments - schedule attached .0 Schedule 0 • Income - Giffs - schedule attached
Ei2f Schedule B • Real Property - schedule attached o Schedule E • Income - Giffs. - Travel Payments - schedule attached
-or-
O None - No reportable interests on any schedule

‶″⁾※‡†
herein and in any attached schedules is true and complete. I acknowledge this is
I certify under penalty of :rj:~ under the laws of the'State of California tha ⁴⁨⁾⁥⁾⁵⁥⁡⁤†

Date Signed 4 b- 1 I
(moolh, day, year)
Signatur ⁾⁳† ⁾†
FPPC TolI·Free Helpline: 866/275-3772 www.fppc.ca.gov
SCHEDULE A-2 CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
Investments, Income, and Assets
Name
of Business Entities/Trusts
(Ownership Interest is 10% or Greater)

~ 1 BUSINESS ENTITY OR TRUST

Name Name
51'20 G{e 630 I &r-/:;M&{I\;
Address (Business Address Acceptable) Address (Business Address Acceptable)
Check one Check one
D Trust, go to 2 ~ Business Entity, complete the box, then go to 2 o Trust, go to 2 lj( Business Entity. compfete the box, then go to 2

GENERAL DESCRIPTION OF BUSINESS ACTIVITY GENERAL DESCRIPTION OF BUSINESS ACTIVITY

FAIR MARKET VALUE IF APPLICABLE, LIST DATE: FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
D $2,000 - $10,000 D $2,000 - $10,000
$10,001 - $100,000 --'--'-12... D $10,001 ~ $100,000 --'__L1!L ~--'-12...
·$100,001 - $1,000,000 ACQUIRED DISPOSED D $100,001 - $1,000,000 ACQUIRED DISPOSED
DOver $1,000,000 )2r Over $1,000,000
NATURE OF INVESTMENT NATURE OF INVESTMENT
Sole Proprietorship 0 Partnership 0 ___-;=:-___ Sole Proprietorship 0 Partnership 0 ------,cc-----
~ rnhN om"
YOUR BUSINESS POSITION b/'ULbe v: YOUR BUSINESS POSITION

~ 2 IDENTIFY THE GROSS INCOME RECEIVED (INCLUDE YOUR PRO RATA ~ 2 IDENTIFY THE GROSS INCOME RECEIVED (INCLUDE YOUR PRO RAjA
SHARE OF THE GROSS INCOME .!.Q THE ENTITYfTRUST) SHARE OF THE GROSS INCOME TO THE ENTlTYfTRUSTj

D SO - $499
D 5500 - $1,000
o $10,001 - $100,000
1ll OVER $100,000
D $0 - $499
D $500 - $1,000
D $10,001 - $100,000
J29 OVER $100,000
D $1,001 - $10,000 D $1,001 - $10,000
~ 3 LIST THE NAME OF EACH REPORTABLE SINGLE SOURCE OF ~ 3 LIST THE NAME OF EACH REPORTABLE SINGLE SOURCE OF
INCOME OF $10.000 OR MORE IAttoch ~ .cp,,~tc ShC"! d neee.,,,.,.! INCOME OF 510000 OR MORE IA!t;l(;h ~ "p~'J!~ ~he~! ,I ne(c.s,ry)

~ 4 INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD BY THE ~ 4 INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD BY THE
BUSINESS ENTITY OR TRUST BUSINESS ENTITY OR TRUST
Check one box: Check one box:
D INVESTMENT D REAL PROPERTY D INVESTMENT m REAL PROPERTY

b '30 ( Ber kMP-'/ . ~,


Name of Business Entity Q[ Name of Business Entity Q[
Street Address or Assessor's Parcel Number of Real Property Street Address or Assessor's Parcel Number of Real Property

Description of Business Activity Q[ Description of Business Activity QT/


City or Other Precise Location of Real Property City or Other Precise Location of Real Property

FAIR MARKET VALUE IF APPLICABLE, LIST DATE: FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
o $2,000 - $10,000
--,--,.JQ.--,--,,jrL
D $2,000 - $10,000
D 510,001 - $100,000 D $10,001 - $100,000
0$100,001 - $1,000,000 ACQUIRED DISPOSED D $100,001 - $1,000,000 ACQUIRED DISPOSED
Dover $1,000,000 ~ Over $1,000,000

NATURE OF INTEREST NATURE OF INTEREST


o Property Ownership/Deed of Trust D Stock o Parmershlp ~ Property OwnershipJDeed of Trust D Stock D Partnership

o Leasehold
Yrs. remaining
0 Other _ _ _ _ _ _ _ _ _ __
o Leasehold .,,--_-,..,.-
D Othor _ _ _ _ _ _ _ _ __
Yr5. remaining
o Check box if additional schedules reporting investments or real property
are attached
o Check box if additional schedules reporting investments or real property
are attached .
Commenm::___________________________________________ FPPC Form 700 (2010/2011) Seh. A-2
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ea.gov
"

CALIFORNIA FORM 700


SCHEDULE B FAIR POLITICAL PRACTICES COMMISSION

Name
Interests in Real Property
(Including Rental Income)

... STREET ADDRESS OR PRECISE LOCATION ... STREET ADDRESS OR PRECISE LOCATION

Gut:
CITY , ( CITY

4&'lrv:1 f ,. KeI<;'r?(v:ll.e {~
FAIR MARK T VALUE IF APPLICABLE, LIST DATE: FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
o $2,000 - $10,000 o $2,000 - $10,000
0$10,001 - $100,000 -----'-----'...1!L -----'-----'...1!L o $10,001 - $100,000 -----'-----'...1!L -----'-----'...1!L
.EJ$100,001 - $1,000,000 ACQUIRED DISPOSED I2S
$100,001 - $1,000,000 ACQUIRED DISPOSED
DOver $1,000,000 DOver $1,000,000

NATURE OF INTEREST NATURE OF INTEREST


~ Ownership/Deed of Trust D Easement o OwnershiplDeed of Trust o Easement
o Leasehold - , - - - , - - -
VB. remaining
0 ---."..,..----
Other
o Leasehold ---:-:---,-,---
Yrs. remaining
0----:-:----
QIh"

IF RENTAL PROPERTY, GROSS INCOME RECEIVED IF RENTAL PROPERTY, GROSS INCOME RECEIVED

o $0 - $499 0 $500 - $1,000, 0 $1,001 - $10,000 0$0 - $499 0 $500 - $1,000 0 $1,001 - $10,000

o $10,001 - $100,000 DOVER $100,000 0$10,001 - $100,000 DOVER $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" NAME OF LENDER"

&fY'lAL
ADDRESS (Business Address Acceptable)
¥a.". . "'~~ hw'1.~'"
ADDRESS (Business ddress Acceptable)

Cv:s<",- C -hi , ld J
BUSINESS ACTIVITY, IF ANY, bF lENDER
BUSINESS ACTIVITY, IF ANY, OF LENDER

~
• ". e.2<T'CJ. r
INTEREST RATE TERM (MonthsNears) INTEREST RATE TERM (MonthsNears)

_ _ _---'% 0 None ~ % o None 10


HIGHEST BALANCE DURING REPORTING PERIQD HIGHEST BALANCE DURING REPORTING PERIOD
0$500 - $1,000 0 $1,001 - $10,000 o $500 - $1,000 0 $1,001 - $10,000
0$10,001 -$100,000 ~OVER $100,000 0$10,001 - $100,000 ~ OVER $100,000

o Guarantor, if applicable o Guarantor, if applicable

Comments: ____________--------------~--------------------------------__--------------~----
FPPC Form 700 (2010/2011) Sch, B
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
CALIFORNIA FORM 700
SCHEDULE B FAIR POLITICAL PRACTICES COMMISSION

Name
Interests in Real Property
(Including Rentarl,:,In_c,::om=e::)~===~~$;'~~1m;:'=<>:f:tn====
... STREET ADDRESS OR PRECISE LOCATION ... STREET ADDRESS OR PRECISE LOCATION

55t o -, 'bpiile /2s:>d:- RJ CZSI{I{ ~ 'J>.-I±\~ ~~

&E~VAti; l/~ ,c,


CITY

FAIR MARKET VALUE IF APPLICABLE, UST DATE:


FAIR IF APPLICABLE, LIST DATE:
D $2,000 - $10,000 D $2,000 - $10,000
0$10,001 - $100,000 ---1---1~ ---1---1~ D $10,001 - $100,000 ---1---1~ ---1---1~
119. $100,001 - $1,000,000 ACQUlRED DISPOSED DiI $100,001 - $1,000,000 ACQUIRED DISPOSED

DOver $1,000,000 DOver $1,000,000

NATURE OF INTEREST NATURE OF INTEREST


.gOwnershipfDeed of Trust o Easement KI Ownership/Deed of Trust o Easement

o leasehold -:::::-===-
Yrs. remainIng
D--=:-:---
00"
D Leaseh~'d - : : - - , - , - - - D - - - : : : - - - - -
Yrs. remaining Other

IF RENTAL PROPERTY, GROSS INCOME RECEIVED IF RENTAL PROPERTY, GROSS INCOME RECEIVED

D So -$499 D $500 - $1,000 D $1,001 - SlO,ooO D $0 - $499 D $500 - $1,000 D $1,001 - $10,000
o $10,001 - $100,000 DOVER $100,000 D $10,001 - $100,000 DOVER $100,000
SOURCES OF RENTAL INCOME: If you own a 10% or greater SOURCES OF RENTAL INCOME: If you own a 101l/0 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* NAME OF LENDER*

E~1\ot ADDRESS (Business Address Acceptable)

BUSINESS ACTIVITY, IF ANY, OF LENDER

INTEREST RATE TERM (Months/Years) INTEREST RATE TERM (MonthslYears)

--,-R',--_% D None ----,% o None

HIGHEST BALANCE DURING REPORTING PERIOD HIGHEST BALANCE DURING REPORTING PERIOD
D $500 - $1,000 D $1,001 - $10,OOQ D $500 - $1,000 D $1,001 - $10,000
'gj $10,001 - $100,000 DOVER $100,000 D $10,001 - $100,000 DOVER $100,000
o Guarantor, if applicable D Guarantor, if applicable

Commenm: _______~-----------------------------------------------------------------------
FPPC Form 700 (2010/2011) Sch, B
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
CALIFORNIA FORM 700
SCHEDULE B FAIR POLITICAL PRACTICES COMMISSION

Name
Interests in Real Property
(Including Rental Income) <E, '6ro./'
.. STREET ADDRESS OR PRECISE LOCATION .. STREET ADDRESS OR PRECISE LOCATION

~b0L ~--tt(e, ~~ 'j2d{


CITY
-r20 f I #- s:t
c
IF APPLICABLE, LIST DATE:
l.9-.te ?tn-r
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
o $2,000 - $10,000 o $2,000 - $10,000
D $10,001 - $100,000 D $10,001 - $100,000 -----.l-----.l~ -----.l-----.l~
;0 $100,001 - $1,000,000 ACQUIRED DISPOSED )<l' $100,001
- $1,000,000 ACQUIRED DISPOSED
DOver $1,000,000 DOver $1,000,000

NATURE OF INTEREST NATURE OF INTEREST


/2kOWnershiplDeed of Trust o Easement ~ OwnershipfDeed of Trust D Easement

D Leasehold - : : - - - , - , - - -
Yrs. remaining
0-----::-:----
Other
o Leasehold - - - - - -
Yrs. remaining
0 - -Other
----

IF RENTAL PROPERTY, GROSS INCOME RECEIVED IF RENTAL PROPERTY, GROSS INCOME RECEIVED

0$0 - $499 0 $500 - $1,000 0 $1,001 - $10,000 [2J $0 - $499 0 $500 - $1,000 0 $1,001 - $10,000

D $10,001 - $100,000 DOVER $100,000 o $10,001 - $100,000 DOVER $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" NAME OF LENDER"

GMflC
ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable)

BUSINESS ACTIVITY, IF ANY, OF LENDER BUSINESS ACTIVITY, IF ANY, OF LENDER

INTEREST RATE TERM (MonthsNears) INTEREST RATE TERM (Months/Years)

----,% 0 None 3 % D None /0


HIGHEST BALANCE DURING REPORTING PERIOD HIGHEST BALANCE DURING REPORTING PERIOD
0$500 - $1,000 0 $1,001 - $10,000 0$500 - $1,000 0 $1,001 - $10,000
o $10,001 - $100,000 DOVER $100,000 D $10,001 • $100,000 ~OVER $100,000
D Guarantor, if applicable D Guarantor, if applicable

Comments: ____________________________________________________________________________
FPPC Form 7QO (201012011) Sch, B
FPPC Toll-Free Helpline: 8661275-3772 www.fppc.ca.gov
. , '

CALIFORNIA FORM 700


SCHEDULE B FAIR POLITICAL PRAC1"ICES COMMISSION

Interests in Real Property


(Including Rental Income)

~ STREET ADDRESS OR PRECISE LOCATION ... STREET ADDRESS OR PRECISE LOCATION

516' S- ric,) '" S5T /;Se>/ ':&r-k~

FAIR MARKET VAL E IF APPLICABLE, LIST DATE: FAIR MARKET VALUE /' IF APPLICABLE, LIST DATE:
o $2,000 - $10,000 o $2,000 - $10,000
0$10,001 - $100,000 ---1--.l 10 ---1---1.JQ. D $10,001 - $100,000 ---1---1.JQ. ---1--.l 10
~ $100,001 - $1,000,000 ACQUIRED DISPOSED 0$100,001 - $1,000,000 ACQUIRED DISPOSED

DOver $1,000,000 DOver $1.000,000

NATURE OF INTEREST NATURE OF INTEREST


iQ,QwnershipJDeed of Trust o Easement o Ownership/Deed of Trust o Easement

o Leasehold - - - - - - 0 ---- ---- o Leasehold _ _ _ _ __


0 - -Other
----
Yrs. remaining Other Yrs. remaining

IF RENTAL PROPERTY, GROSS INCOME RECEIVED IF RENTAL PROPERTY, GROSS INCOME RECEIVED

0$0 - $499 0 $500 - $1,000 0 $1,001 - $10,000 0$0 - $499 0 $500 - 51,000 0 $1,001 - $10,000

0$10,001 - $100,000 DOVER $100,000 o $10,001 - $100,000 0 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'" NAME OF LENDER'"

ADDRESS (Business Address Acceptable)


Ckse
ADDRESS (Business Address Acceptable)

BUSINESS ACTIVITY, IF ANY, OF LENDER


~
BUSINESS ACTIVITY, IF ANY. OF LENDER
r:s
~<
INTEREST RATE TERM (MonthsNears) INTEREST RATE TERM (MonthsNears)

_ _ _ _% DNone -eb,,---'% D None ?O


HIGHEST BAlANCE DURING REPORTING PERIOD HIGHEST BALANCE DURING REPORTING PERIOD

0$500 - $1,000 0 $1,001 - $10,000 0$500 - $1,000 0 $1,001 - $10,000


0$10,001 - $100,000 DOVER $100,000 0$10,001 - $100,000 BaVER $100,000

o Guarantor, if applicable o Guarantor, If applicable

Comments: ____________~----------------------------------------~------
. FPPC Form 700 (201012011) Sch, B
FPPC Toll-Free Helpline: 8661275-3772 www.fppc.ca.gov

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