1994-03Conflict of Interest RESOLUTION NO. 94-03
OF THE HOUSING AUTHORITY OF THE CITY OF ENCINITAS
ADOPTING A CONFLICT OF INTEREST CODE
PURSUANT TO GOVERNMENT CODE 8700 AND OTHER
LAWS PERTAINING TO CONFLICTS OF INTEREST
WHEREAS, the Housing Authority must, pursuant to Health and
Safety Code S 34278 and S 34281, as well as Government Code
87300 et seq., adopt a Conflict of Interest Code; and
WHEREAS, the Fair Political Practices Commission has
promulgated a standard conflict of interest code which can by
regulation be incorporated by reference.
NOW, THEREFORE, be it resolved that:
SECTION 1. The Conflict of Interest Code which has been
submitted by staff be and hereby is approved as amended in open
session this date.
SECTION 2. That said Conflict of Interest Code be effective
on the 27th day of April, 1994.
SECTION 3. That said Conflict of Interest Code be
incorporated into the Personnel Rules and Regulations of the
Housing Authority in accordance with Health and Safety Code
34278.
Dated: April 27, 1994
AYES: Bond, DAvis, Duvivier, Hano, Wiegand
APPROVED: April 27, 1994 NOES: None
ATTEST: HOUSING AUTHORITY OF THE CITY
OF ENCINITAS
By: ~ By:
LB/EM/crolO-970 w~p51 (04-14-94)
Boo~ # / --,'~,Ee F ~
CONIC!CT OF INTEREST CODE
OF THE
HOUSING AUTHORITY OF THE CITY OF ENCINITAS
SECTION 1. PURPOSe. Pursuant to the provisions of Government Code §§ 87300, et seq,,
the Housina Authority of the City of Encinitas hereby adopts the following Conflict of Interest Code
(Co~lflicts Cods). This Conflict of Interest Code shaJl be incorporated into the Personnel Rules and
Regulations of the Housing Authority pursuant to Health and Safety Code § 34278. It is intended that
the provisions of this code conform to the greatest extent possible with the provisions of the City's
Conflict of Interest Code and that compliance by any city employee with the more restrictive of the two
codes shall suffice as compliance with this.Conflict of Interest Code, Duplicate ~ings shall not be
r~quired.
Nothing contained herein is intended to modify or abridge the provisions of the Political
Reform Act of 1974 (Government Code § 81000 st seq. 'the Act"). The provolone of this Conflicts
Code are to effect compliance with Government Code {.~ 87100 - 87500; Health & Safety Code ~
34281, 34328.2 and other laws pertaining to conflicts of interest including the Hatch Act, 18 U,S,C,
{595. Except as otherwise indicated, the definitions of said Act and regulations adopted pursuant
thereto are incorporated herein and this Conflicts Code shall be interpreted in a manner consistent
therewith.
SECTION 2. AMENDMENT AND REVIEW.
(a) Amendment
(1) Chan<3ed Circumstances. Changed circumstances include, but are not limited
to the creation of new positions which must be designated for the operation of the
Authority and relevant changes in the duties assigned to existing positions.
(2) Amendment Due To Chanqed Circumstanceg. Within ninety days after the
changed circumstances necessitating the amendment to this Conflicts Cede become
apparent, the Executive Director shall submit a proposed amendment to the C~,/
Council. Amendments shall be approved only at regular City Council meetings.
(b) Biennial Review.
(1) NO later than July 1 of each even-numbered year, the Board of Commissioners
of the Authority shall review this Conflicts Code,
(2) if a change in this Conflicts Code is necessitated by changed circumstances, it
shall be amended pursuant to subsection (a) of this section.
(3) If no change in this Conflicts Code Is required, the Executive Director shall
submit a written statement to that effect to the City Council no later than October I of
the sarce year.
SECTION 3. DEFINITIONS INCORPORATED. Unless otherwise indicated, the definitions of
the Act, regulations and amendments thereto and binding judicial opinions thereon are incorporated
herein, and this Chapter shall be interpreted in a rcanner consistent with such definitions.
SECTION 4. STANDARD CODE.
(a) By this reference, the Standard Conflict of Interest Code, 2 Cal. Cede of Reg. § 18730,
is incorporated herein. Each amendrcent thereto duly adopted by the Fair Political Practices
Commiaslon shall be reviewed by the Board of Commissioners to determine whether it shell
constitute an arcendment to this Conflists Code to be effested pursuant to Section {a) sucre.
(b) The Executive Director shall maintain three copies of the Standard Conflict of Interest
Cede for the public review.
SECTION 5. DESIGNATED POSITIONS. The positions listed on Exhibit 'A' are designated
positions. Officers and employees holding those positions are designated employees and are deemed
~o make, or participate in the making of, decisions which may foreseeably have a material effect on a
financial interest from which they may derive some benefit.
SECTION 6. QISCLOSL)RE STATEMENTS. Designated positions shall be assigned to one
or more of the disclosure categories set forth on Exhibit "B'. Each designated employee and
w222-6
consultant shall file an annual statement disclosing that employee's interest in investments, real
property, and income, designated as reportable under the category to which the employee's position
is assigned on Exhibit
SECTION 7, PLACE AND TIME OF FILING.
(a) NI designated employees required to submit a statement of financial interests shall file
the original with the F. xecutive Director of the Housing Authority.
(b) As allowed by Section 87500(j) of the Government Code, the Executive Director of the
Authority shall receive and fommrd the original to the City Council retaining no copy at the
Authority,
(c) A designated employee required to submit a statement of financial interest shall submit
an initial statement within 30 days after the effective date of this Conflicts Code, Statements
already on file for a designated employee with regard to his/her job with the City shall suffice
for this initial filing.
(d) Merit system employees appointed, promoted er transferred to designated positions
shall file initial statements within 30 days a/ter date of such personnel action.
(e) All other employees appointed, promoted or transferred to designated positions shall
file initial statements not less than 10 days before assuming office (or if subject to confirma-
tion, 10 days before being confirmed) unless an earlier assumption of office is required by
emergency circumstances, in which case the statement shall be filed within 30 days thereafter.
(f) Annual statements sha~l be filed by all designated employees during the month of
February disclosing reportable investments in business entities, interests in real property, and
income held or received in the period between the closing date of the emplcyea's previously
filed statement and January 31.
(g) Each person who leaves a designated position for a position not specified in Exhibit
· A' shall file a leaving office statement within thirty days after leaving.
(h) A designated employee required to ~le a statement of financial interest with any other
agency, which has the same territorial jurisdiction, may comply with the provisions of this
3 W222.
Conflicts Code by filing a duplicate copy of the statement filed with the other agency, in lieu of
an entirely separate document.
SECTION 8, CONTENTS OF DISCLOSURE STATEMENTS,
(al Disclosure statements shall be mede on the appropriate attached forms, end shall
contain the following information;
(1) Contents of Investment and Real Property Reports:
When an investment, or an interest in real propen'y, is required to be reported, the
statement shell contain:
(Al A statement of the nature of the investment or interest;
(B) The neme of the business entity in whloh each Investment is held, and
a general description of the business ectivity in which the business entity is
engaged;
(C) The address or c~her precise location et the real property;
(D) A statement whether the fair market value of the investment, or interest
in real property, exceeds ten thousand dollars {$10,000), and whether it
exceeds one hundred thousand dollare, ($100,000). ~This information need not
be orovided with-resoe~ to..a.n, interest in real property which Is used pdnci-
oallv as the residence of the filer.
(2) Contents of PersenaJ Inoorne Reports:
When personal income is required to be reported, the statement shall contain:
(A) The name and address of each source of income aggregating two
hundred and ~ty dollars ($250) or more in value, or twenty-five dollars ($25) or
more in value if the income was a gift, and a general description of the
business activity, if eny, of each source;
(B) A ~tetement whether the aggregate value of inceme from each source
was greater than one thousand dollars ($1,000), and whether it was greater
than ten thousand dollars ($10,000);
(C) A description of the consideration, if any, for which the Income was
received;
(D) In the case of a gift, the amount and the date on which the gift was
received.
(3) Contents of Business Entity Income Reports:
When income of a business entity, including income of a sole proprietorship, is
required to be reported, lhe statement shall contain:
(A) The name, address, and a general description of the business activity
of the business, entity;
(B) In the ease of a business entity which provides legal or brokerage
services, the name of every parson who paid fees to the business entity if the
· er's pro rela share of fees from such person was equal to or greater than
one thousand dollars ($1,000);
(C) In the _,~___~e of a business entity not covered by'paragraph (2), the
name of eve~/person from whom the business entity received payments if the
lilts pro rata share of gross receipts from such person was equal to or
greater than ten thousand dollars ($10,000) during a calendar year.
(b) Contents of Initial Statement'.
The initial statement filed by an employee appointed to a designated position shall
disclose any reportable investments and interests in real property.
(c) Contents of Annual Statements:
The annual statement filed by a designated employee shall disclose any reportable
investments, interests in real property, and income held or received during the period after the
closing date of the previous statement filed pursuant to this Conflicts Cede.
(d) Contents of Leaving Office Statements:
The leaving office statement filed by designated employees shall disclose reportable
investments, interests in real property, and income during the period held or received between
5 ~22 - 6
the closing date of the last statement ~ecl pursuant to this Conflicts Code and the date the
designated employee left office.
(e) Acquisition or Disposal During Reporting Period:
In the case of a statement filed under Section 70) above, state whether the investment,
or interest in real property, was partially or whctly acquired or disposed of during the pedod
covered by the statement, the date of acquisition or disposal.
SECTION 9. REPORTABI~ INTERESTS.
Interests which shall be reported are:
(a) Any business entity in which the public official has a direct or indirect investment worth
one thousand dollars ($1,000) or more.
(b) Any real property in which the public official has a direct or indirect interest worth one
thousand dollars ($1,000) or more.
(c) Any source of income, other tt~n gms and ofher loans by a commercial lending
institution in a regular course of business on terms available to the public without regard to
. official statue, aggregating two hundred fifty dollars (II~50) or more in v&lue provided to,
received by or promised to the public official within 12 months prior to the time when the
decision is made.
(d) Any business entity in whic~ the public ofliclal is a director, officer, partner, trustee,
employee, or holds any position of management,
(e) Any donor of, or any intermediary or agent for a donor of, a gift or gifts aggregating
two hundred fifty dollars ($250) or more in value provided to, received by, or promised to the
public official within 12 months prior to the time when the decision is made.
For purposes of this section, indirect investment or interest means any investment or interest
owned by the spouse or dependent child of a public official, by an agent on behalf of a public official,
or by a business entity or trust In which the official, the official's agents, spouse, and dependent
children ova~ directly, indirectly, or beneficially a 10% interest or greater.
SECTION 10. DISQUALIFICATION. A designated employee must disqualify himself or herseff
from making or participating in the making of any decisions which will foreseeably have a material
6 ~222'6
/ /3
financial effect, distinguishable from its effect on the public generally, on the official or a member of
his/liar immediate family or on any reportabJe interest as described in Section g.
The acquisition of any direct or indirect interest in any real property included or planned to be
included in any project a~er taking office shall disqualify the designated employee or official from
participation in any decision as aforesaid. The existence of any direct or indirect interest in any
contract ar proposed contract for materials or services to be furnished or used in connection with any
housing project shall disqualify any designated employee or official from participating in any decision
as aforesaid.
No designated employee shall be prevented from making or participating in the making of any
decision to the extent his or her participation is legally required for the decision to be made.
Participation is not legally reql~ired if its effeot is to break a tie.
SECTION 11. EFFECTIVE DATI~. The effective date of this Conflict of Interest Code shall be
April 27, 1994,
7 [~222-&
Boo~
EXHIBIT
DESIGNATED POSITIONS
Designated Positions Disclosure Cateqow
Member, Beard of Commissioners I 2 3 4 5 6
Executive Director, I 2 3 4 5 6
i,e. City Manager
Assistant Executive Director, 1 2 3 4
Comptroller, Director of Finance I 2 3 4
Director of Operations, I 3 4
Maintenance Supen/isor I 2 3
Director of Administration 1 2 3
Except for the Executive Director, ail employees who serve the Housing Authority are te be
furnished by the City of Encinitas under contract. The City is therefore a ~ontractor within the meaning
of Discteaure categories. The employees wflo do the Housing Authority's work must not be otherwise
employed by the City so as to affect their Independent judgment to act in the best interest of the
Housing Authority.
A- 1 ~J222 - 6
BooI~ # ,, /, ,--*'age #
EXHII~IT
DISCLOSURE CATEGORIES.
Cate.qon/1 - Business Position/Investment Interests, Disclose each Authority-related or HUD-
program-participating, business entity in which the employee/member holds a position or has a direct
or indirect business Investment worth more than $1,000.
Cateaorv 2 - R.e.a.I Prooerty Interests. Disclose each interest in real property located within the
jurisdiction of the Authority in which the ~mployee/member has a direct or indirect interest worth more
than $1,000.
Cate~3orv 3 - Income Interco. ts. Disclose all income of the employee/member from any
Authority-related or HUD-program-participating source aggregating $250.00 or more (or $25.00 or
more in the case of gilts) during the reporting period.
Cateaorv 4 - Less Inclusive Reportable Interest?. Disclose all investment and management
interests in buslner~ entities (as described in Categories I and 3) contracting with or selling to the City
or which fcreseeably could so contract or sell; and ail income from a source ( as described in
Category 2) which sells or contracts with the City or which foreseeably could so sell or contract.
Pursuant to the Housina Authority Law Individual Commissioners Must Add~!_~nally Report to th-
Board of Commissioners:
Cateaorv ,5 -Foreseeable ,Contrsct~. Investments in any business entity which, within the last
two years has, or in the future foreseeably may, contract with the Housing Authority of the City of
Encinitas to provide services or supplies, materials, machinery or equipment to the Housing Authority
of tile City of Enclnitas or any of Its sub-eentractors.
Cateaorv 6 - Foreseeab, Ie C.,ontracts, Income from any source which, within the last two years,
has contracted, or in the future foreeaeably may contract, with the Housing Authority of the City of
Encinitas to provide services, supplies, materials, machinery or equipment to the Housing Authority of
the Ci~ of Enclnitas or any of its sub-eentrautors,
INSTRUCTION MANUAL
FOR
STATEMENT OF ECONOMIC INTERESTS
FOR DESIGNATED EMPLOYEES~
FILING PURSUANT TO A CONFLICT OF INTEREST CODE
These instructions apply to any Housing Authority employee or official whose position has been
designated to be within the coverage ef the Conflict of Interest Code. Occupants of designated
positions will be required to disclose ce.r~in economic interests, The Authority's Conflict of Interest
Code was required to be adopted by the Political Reform Act of 1974, This is a complicated Act, and
so is the satisfaction of disclosure requirements of your Conflict of Interest Code. The inb'eductory
material and Statement of Economi~ Interests manual provisions which follow may not answer all
questions concerning disclosure requirements. Further questions in this regard, should be addressed
to the Executive Director of the authority. The staff of the Fair Political Pra~'doss Commission is
available to assist Designated Officials if your authority is unable to do so.
The Corlfiict of Interest Conflict of Interest Code requires Designated Employees or officials to file
statements disclosing osl'tain economic interests which may foreseaably be affected materially by any
decision mede or participated in by the Designated Official because of his or her official position.
The amount of disclosure required by every covered Commissioner or employee ("Designated
Employee') is based on his or her official duties, Each Designated Official will be required to disclose
only these types of financial interests, as set forth in the Conflict of Interest Code, which are relevant to
his or her duties. The Conflict of Interest Code must specifically inform each Designated Official of the
types of economic interests which must be disclosed.
This manuel and the Statement of Economi,~ Interests are designed to apply to all Designated Ofrmiais,
regardless of the disclosure categories. When completing Statement of Economic Interests, refer to
your Conflict of Interest Cede to determine the .applicable disclosure requirements, and complete only
the applicable schedules.
Each Desianated Employee must disclose all of his or her interests which are made reportable for hl~
or her 13osition es set forth In the Conflict of Interest Co~I,,:
INSTRUCTION MANUAL FOR STATEMENT OF ECONOMIC INTERESTR
These insa'uoflons are intended to assist Designated Officials to comply with the financial disclosure
requirements of Conflict of Interest Codes, when they must file:
- initial statements
- annuaJ statemellts
- leaving office statements
1 Throughout this manual the term Designated Employee and Designated Official are used
interchangeably to refer to persons who occupy positions designated within a Conflict of Interest Code.
Designated Employee or Designated Official are terms defined in Government Code Sections 82019 and
87200.
U222.6
WHAT I~ A STATEMENT OF ECONOMIC INTERESTS?
A Statements of Economic Interests Js a form which discloses certs, in economic interests of the official,
and which is available for inspection by the public,
WHO MUST FILE STATEMENTS?
Statements of Economic Interests must be filed by Authority employees and officials whose positions
are designated In the Cortfilct of interest Code.
WHEN MUST STATEMENTS BE FII~.ED?
Statements of Economic Interests are/ited annually during the period prescribed by the Conflict of
Interest Code. However, statements mu. st also be filed 10 days prior to assuming an appointed
designated position; within 30 days after a person is transferred to a different designated position; and
within $0 days after a person leaves a designated position.
WHAT PERIOD SHOULD THE STATEMENT COVER?
Initial s~.tements disclose reportable investments in business entities which do business within the
Authority's jurisdiction2 and interests in real property within the Authority's jurisdiction and manage-
ment positions in business entities held by the Designated Official on the effective date of the Conflict
of Interest Code. In addition, when a person is appointed to a designated position, the statement shall
disclose reportable investments in business entities which do business within the Authority's jurisdic-
tion and interests in real property within the Authority's jurisdiction and management positions in
business entities held by the Designated Official at the time of filing, Disclosure of income, including
gifts, shall not be re¢iuired by the Conflict of Interest Code on initial statements.
Annual statements will cover the period from one day following the =losing date of the last statement
flied by the Designated Offi=lal to the closing date specified in the code. Annual statements disclose
reportable investments in business entities which do business within the Authority's jurisdi=ion,
interests in real property within the Authority's jurisdiction, and income, including gifts and business
positions held or received at any time during the previous oslendar year or since the date the
Designated Employee took office i~ during the calendar year.
Leaving office statements will cover the period from one day following the closing date of the last
statement filed by the Designated Official to the date of leaving office. Leaving office statements
disclose reportable investments in business entities which do business within the Authorlty's jurisdic-
tion, interests in real property within the Authority's jurisdiction, and income, including gifts, and
management positions in business entities made reportable by the Con~ict of Interest Code.
WHERE MUST STATEMENTS BE FILED?
Statements are filed with the Authority Executive Director.
HOW TO COMPLETE A STATEMENT OF ECONOMIC INTERESTS
REPORTABLE INTERESTS
Designated Employees who mus~ complete Statements of Economic Interests are required to disclose
certain investments and/or interests in real property and/or income. Each Designated Employee
discloses pursuant to his or her disclosure category, as indicated in the Authority's Conflict of interest
Code. Your Conflict of Interest Cods, thus, determines your reportable interests. Rely on your code
to inform you of what is reportable.
2 "Jurisdiction" means the City of En=lnitas. Real property shall be deemed to be 'within the
jurisdiction' with respect to the Housing Authority if the property or any part of it is located within or not
more than two miles outside the boundaries of the City or within two miles of any land owned or used by
the Authority.
Boo~-/ _~age #., /~
INVESTMENTS
No asset shall be deemed an investment unless its fair market value exceeds $1,000.
NOTE: Check the disclosure requirements for your position to determine which investments in
business entities~ if any, you are required to dlsclose~
Any investments held by your spouse or dependent children must be reported as though held by you
personally. In addition, if you or your spouse own directly, indirectly, or beneticially a 10% or greater
interest in a business entity or trust, you must report your pro rata share of investments of that entity
or trust, if your share is worth over $1,ooo. For each reportable investment you must report the
following information:
Nature of the investment (e.g., common stock, partnership).
Name of the business entity and a general description of the business active.
Date you acquired or disposed of the investment if you did so dudng the period
covered by the statement. (Not applicable for initial statements,)
Value of your investment. For purposes of determining whether or not the value ct an
investment exceeds $1,ooo, $1o,oo0 or $100,000, you should consider the hiqhest
value of the asset during the period. (Highest value determination is not applicable
for initial statements.)
EXCEPTIONS: You are not required to disclose the following:
Time or demand deposit in a financial institution.
Shares in a credit union,
Any insurance policy,
Any bend or other debt instrument issued by any government or government agency
8AMPLE
(Assume that each of the investments below is made reportable by your ConVict of Interest Code.)
On February I you purchased $800 worth of stock in XYZ Corporation; a corporation doing
business in the Authodty's jurisdiction. On March I the stock had a market value of $1,200. On May
1, you sold the stock for $900. (You must list the stock because for part of the period covered by the
Statement your investment was worth more than $1,000.) In addition, you have a 10% partnership
interest worth $40.000 in your insurance firm which owns stock in General Utilities Company, your pro
rata share being $1,500, Both your insurance firm and General Utilities Company do business in the
Authority's jurisdiction. The investment schedule would be completed ss follows:
Check One
XYZ Co~ora~;ion [~ Value does not exceed $1o,ooo
(N.a~e of Company)
Coalmmmn Stock [ ] Value exceeds $10,000 but does not
(Nature of interests, e.g. Common Stcek, Partnemhip interest otc,) exceed $1oo,0o0
#anufect, ures widgets Date A¢~tuited [ ] Value exceeds $100,000
(GeneraJ Description of B~nese A~tivJty) Oa~e Oispoeed 5/1/93
Check One
Smith & slack [ ] Value does not exceed $10,000
(Nome of Company)
Pa~-tn~-~h~p [~[ Value exceeds $10,000 but does not
(Nature of interests, e.g, Common Sto~k, Partnership Interest, et~,) exceed $100,000
Insuran(;e Brokers Date Acquired [ ] Value exceeds $100,000
(Genor~ 0escHplJO~ Of Bueineee Activity) Date Disposed
Check One
General U~,ilttie~ [~ Value does not exceed $10,000
(Ne, rna of Company)
Commn Stack [ ] Value exceeds $10,000 but does not
(Nature of interests, e.g. Common $~k, Partcemh[p Interest. otc,) exceed $100,000
Serves electric pmeer Data A~qui~ed [ ! Value exceeds $100,000
(Genara~ Oeecription of ~lu~ine~s Ac~vi~y) Date Diapered
3 w222,6
/ /7
BOOK # ~age #
INTERESTS IN REAL~ PROPI~RTY
No interest in real property shall be reportable unless its fair marl<et value exceeds $1,0(30 unless it is
included or planned to be included in any Housing Project.
NOTE; Check your disclosure cateqory to determine which interests in real property, if any,
you are required to disclose.
Any interests in real property held by your spouse or dependent children must be reported as though
held by you personally, in addition, if you or your spouse owns, directly, indirectly, or beneficially a
10% or greater interest in any business entity or trust which holds real property in the Authority's
jurisdiction, you must report your pro rata share of the interest if your share is worth over $1,000. For
each reportable Interest in real property you must show the foUowing:
Street address or precise location. If there is no street address, you must state the lot
number and subdivision of the real property.
Nature of your interest (e.g., ownership, option).
Date you acquired or disposed of the real property if you did so during the period
covered by the Statement. (Not applicable for inltisl statements,)
Value of your interest. To determine the value of your interest, you should only
consider your equity interest. For example, if you own property worth $25,000 in
which you have an $8,000 equity, your reportable interest is $8,000.
SAMPLE
(Assume that each of the interests in real property below is made reportable by the Authority's Conflict
of Interest Code.)
You are purchasing a home in the Authority's jurisdiction and you also have an equity interest
worth $4,500 in a lot in the Authority'a jurisdiction. (The Conflict of Interest Code does not require the
disclosure of real property which serves only as the principal residence of the filer. However, where
the residence is &leo used for a commercial or business purpose or where the residence may
foreseeably be affected materially as a normal consequence of the official's action, disclosure of the
residence will be required by the code.) In addition, Smith and Jones, the business in which you have
a 20% interest recently purchased a commercial building in Mudville, having a fair market value of
$125,000. The interest in real property schedule would be completed as follows:
1345 Third Street, I~tdvllle Check One
[ ] Value does not exceed $10,000
($b-eet Addreu or Precise L~ea~en of Propeff/) [ ] Value exceeds $10,000 but does not
exceed $100,000
Equity Date Acquired [ ] Value exceeds $100,000
(Nature of lateral e.o. Equity. Option) Dam D~po~ ~[:~ Property is my principal residence
Checl( One
Lot 212, [dylwflde Subdfvision, Mudville tX] Value does not exceed $10,000
(Street Addre~ ~ Precise Lo,alien of Property)
[ ] Valueexcecds $10.000 but does not
Equity exceed $100.000
Date Acquired [ ] Value exceeds $100,000
(Nature of Interest, e.g. Equity, Op~en) Date Disposed
Check One
555 Main Street, /e~dvtlle [ ] Value does not exceed $10,0o0
(St:est Address o.~ Precise Location of Property)
[Xj Value exceeds $10.ooo but does not
exceed $100.000
Ec~utt;y Date A~:q~he~ 9/5/93 [ ] Value exceeds $10o,000
(Natuce of tnteCe~L e.g. Equity. Option) Date
4 U222-6
INVESTMENTS AND INTERESTS IN REAL PROPERTY
HELD BY BUSINESS ENTITLES YOU CONTROL
NOTE: Complete only those schedules which your disclosure cate.cleW requires.
If you, your spouse or dependent children hold an ownership interest et 50% or more in a business
entity listed on the Investment Schedule, you must report all investments, worth over $1,000 of that
entity in business entities which do business, plan to do business or have done business in the last
two years in the Authority's jurisdiction and all interests in real property worth over $1,OOO held by that
entity within the Authoriys judediction, A separate schedule must be completed for each business
entity, For each investment held by such a business entity you must disclose the name, the nature of
the investment, a general description of the business activity, the date the interest was acquired or
disposed of if it fails within the period covered by your report, and the value. For the real property
within the Authority's jurisdiction held by such a business entity, you must disclose the street address
or precise location, the nature of the interest held, the date of acquisition or disposal if it falls within
the period covered by the report and the value.
SAMPLE
(Assume that each of the investments and interests in real property below is ma. de reportable by your
Conflict of Interest Code.)
On September 6, 1993, Metro Properties, Inc., in which you own a 75% Ini:erest, purchased an
apartment complex, The Parkside, located in the Authority's iurisdiction and valued at $280,000. Metro
Properties also purchased at the same time the undeveloped lot worth $25,000 adjacent to the
complex. This schedule would be comoleted as follows:
Name of Business Entity Net~.o PropertieS, [nc.
INVESTMENTS HELD BY BUSINESS ENTITY
Che~k One
The Para,de [ ] Value does not exceed $10,000
(Nazne ~f
Ps~'tnemh~ p ]nterest. [ ] Value exceeds $10,000 but does not
(Nature of interests, e.g, C4;~mrno~ Stc~;k, P~ehip intefe,~, et~,) exceed $100,o00
Apsrtment..Coeslex 0a~eAcquked 9/6/93 iX] Valueexoeeds $100,000
(Oen~eJ De~criplfon of Busin~,s AMity) Da~e
INTERESTS JN REAL PROPERTY HELD BY BUSIN :SS ENTITY
Check One
Lot: 1014, Bria~mod Subd'ivis~en, ~ludvllie [ ] Value does not exceed $10,0oo
(6tzeet Addrea~ or Precise Location of
[~ Value exceeds $10,000 but does
exceed $100,000
Eouitv Date Acquired 9/6/93 [ ] Value exceeds $100,000
(Nature of Interest. e.g, Equity, Option) O~e Disposed
INCOME
Only income aggregating $250 or more trom a reportable source during the reporting period must be
reported, You must also report as income any community property interest you have in income from -~
reportable source received by your ~pouse. Otherwise, you are not required to report income of your
spouse or your children.
NOTE: Check your disclosure cateqory to determine what income, if any~ you are required tn
.disclose.
When income from a reportable source is reported, you must disclose the following:
Name of the source et income.
Address of the source of income.
Business activity of the source of income.
Description of the consideration, if any, for the income.
Amount or value received,
EXCEPTIONS: You are not required to disclose the following:
Salary or reimbursements for expenses and per diem received from a state or local
government agency.
Reimbursement for travel expenses and per diem received from a bona fide education-
al, academic or charitable organization.
Campaign contributions.
Devise or inheritance.
Dividends, interests or other return on a secur~ which is registered with the Securities
and Exchange Commission of the U,S, Government.
Interest, dividends or premiums on a time or demand deposit in a financial institution,
shares in a credit union or insurance policy, payments received under an insurance
policy, bond or other debt instrument issued by a government agency.
SAMPLE
(Assume that the income below is made reportable by your Conflict of Interest Code.)
Designated Official X owns stock in California Widget Corporation, a large publicly owned
company listed on the New York Stock Exchange end doing business in the Authority'e jurisdiction.
He received $2,000 during the period in dividends on his stock. He also received $15,0o0 salary
income from his Insurance business, and $1,500 interest income from a plumbing business, Both the
insurance business end the plumbing business operate in the Authority's jurisdiction, He need not
report the dividend as income since his stock is registered with the Securities end Exchange
Commission.
The income schedule would be completed as fellows:
~mi[h and ,.1ones Insurance Co. Check
[ ] Amount or Value received was not
(Name of ~ S~u~ce of I~ome) greater than $1,000
1~.0 Naln Street []Amountorvaluereceivedwasgreater
than $1,000 but not greater than
~ludvJlle, califomfa $10,000
D] Amount or value received was greeter
(Address of th~ $~Jrce of Inceme) than $10,~30
insurance brokerage
(E,~$1ne~,s Activity of ~ Seu~¢e of
~.D..escriot~on of the ¢~nsideratJorl, if anyr for the
Check One
Hunk's Plumbing Supply [ ] Amount or Value received was not
(Name of t~e S~ce o~ Income) greater than $1
]04 Main St~,'eet ~Amountorvaluereceivedwasgreater
than $1,000 but not greater than
$1o,000
, ~udv~ 1 le, Ca1 i fomla [ ] Amount or value received was greater
(Addte.~ of ~ $ou~c~ ef [r~'ne) than $10,000
Plmlblng supplx
(Bu~nesa Ac~vity ¢,~ the ~;o~n=e of Income)
Ret:um on 'rnvestmen:
fOe~riotion of t~e qon~Iderad~ if anyr for the i~ome)
GIFTS
Gifts which have an aggregate value of $50 or more, received from reportable sources of income,
during the reporting period must be reported.
6 ~292,6
~OOg ~ .... / __ruee #, ~-~
NOTE: Check your disclosure cate.qory to determine what Income, if any, you are required tn
disclose.
For each reportable gift you must disclose the following:
Name of the donor,
Address of the donor,
Business activity, if any, of the donor.
Dam(s) gift(s) received.
Description of the gift(s).
EXCEPTIONS: You are net required to disclose the following:
Gifts from your spouse, child, parent, grandparent, grandchild, brother, sister, parent-
in-law, brother-in-law, sister-in-low, aunt. uncle or first cousin or the spouse of any
such person, provided float a gift from any such person shall be considered income if
the donor is acting as an agent or intermediary for any person who is a reportable
source of income.
Gifts of informational material, such as books, pamphlets, reports, calendars or
periodicals.
Gifts which are not used and which, within 30 days after receipt, are returned to the
donor or delivered to a charitable organization without being claimed as a charitable
contribution for tax purposes.
G~ts become reportable when the value received from one reportable source of income during the
reporting pedod totals $25 or more.
SAMPLE
(Assume that the g~ts were received from sources mede reportable by your Conflict of Interest Code.)
You received complimentary season tickets worth $100 from your local professional football
team. You also received a complimentary dinner certificate worth $75 from a lo,al restaurant. The gm
schedule would be completed es follows:
liangtmm ltomets 3/1/93
(Name ~f D~,') Date(s) of
~ ~in Street, ~dvtlle
~d~ess) V~ Of Gift(s)
Football Tea~ Season Tickets
Le Connoisseur ~s~u~ant 9/Z5/93
1100 Fifth Street, H~dvi~le $75
(~d;~s) V~ue ~ Gift(s)
Restaurant Food and DHnk
INCOME OF A BUSINESS ENTITY IN wHICH THE DESIGNATED EMPLOYEE, OR
SPOUSE~ OWNS A 10% OR GREATER INTEREST AND WHICH PROVIDE,~
LEGAL OR BROKERAGE SERVICER
(The flier's pro rata share of the fees paid to the business entity which provides legal or brokerage
services must be at least $1,000.) You may be required to report the name, address and business
7 U222'6
/ #
APR 13 '94 16:46 CAHFIELD&CH~ISTOPHER
activity of a business entity which provides legal or brokerage services and the name of persons~ who
paid fees to the business entity if all the following conditions are met:
1. Your disclosure category makes sources of income disclosable.
2. The persons who paid fees to the business entity are reportable sources of income
pursuant to your income reporting requkements as set froth in the code:
3. You or your spouse owns. directly, indirectly or beneficially, a 10% interest or greater
of the business entity; and
4. Your pro rata share of fees which a person paid to the entity was $1,000 or more,
during the period covered by the statement.
SAMPLE.
(Assume that Brown, Black and Green are reportable sources of income.)
Smith and Jones, an insurance firm in which you have a 50% interest, received a commission
of $2,000 from Brown, commission ef $5,000 from Green and a commission of $1,500 from Black.
(You need not list Black's name because your share W~s only $750, less than $1,000.) This schedule
would be completed as follows:
Sat'ch and ,,]ones
(Name ~f Business Enmy)
7. ZO Hath Stmet. ~udville, Callfomia
(Addr~s of ~ Ena~)
Insurance b~rs
~ ~ ~e of ~h i~id~ ar ~a~ who p~d f~ ~ ~e ~ b~n~e en~ if your
~S Alan B~
Paul Eve~e~t 6teen
INCOME OF A BUSINESS ENTITY IN WHICH THE DESIGNATED EMPLOYEE,
OR SPOUSE. OWNS A 10% QR GREATER INTEREST AND WHICH DOES NOT
PROVIDE LEGAL OR BROKERAGE 8ERVICE,~
(The flier's pro rata share of the fees paid to the business entity which does not provide legal or
brokerage services must be at least $10,ooo.)
You may be required to report the name, address and business activity of a business entity which
does not provide legal or brokerage services and the name of persons4 who paid fees to the business
entity if all the following conditions are met:
1, Your disclosure category makes sources of income diselosable;
2. The persons who paid fees to the business entity are reportable sources of income
pursuant to your income reporting requirements as set forth in the code;
3 "Person" means an individual, proprietorship, firm, partnership, Joint venture, syndicate, business
trust, company, corporation, association, committee, and any other organization or group of persons
acting in concert,
~' "Person" means an individual, proprietorship, firm, par[nership, joint venture, syndicate, business
trust, company, corporation, association, committee, and any other organization or group et persons
acting Jn concert.
8 W~22~6
3. You or your spouse owns, directly, indirectly or beneficially, a 10% interest or greater
of the business entity; and
4. Your pro rate share of fees which a person paid to be entity was $10.000, or more,
during the period covered by the statement.
SAMPLE
(Assume that Super Hotel Corporation and Mudville Construction are reportable sources of income.)
You own one-third of Hank's Plumbing Supply which sold $30,000 worth of equipment to
Super Hotel Corporation. You own 5% et California Lumber Company which sold $200,000 worth of
lumber to Mudville Construction Company. You need not report information concerning the California
Lumber Company since you own less tt~an 10% interest in the business, but you must list Super Hotel
Corporation since you own more than 10% of Hank's Plumbing Supply and your pro rata share el'
gross receipts from Super Hotel Corporation was $1o,o0o. This schedule would be completed as
foliov.~:
Hunk's Plumbing Supply
(Name of B~lne~ Entry)
104 ilain Street, ~ville, California
(~dr~s ~ ~N~ ~)
PlYing supply
~t ~ ~e ~ ~h J~J~d~ ~ en6~ w~ p~d f~s ~ ~ ~e b~in~s ~ if y~r pm r~ $~e ~ ~e gross
Super Hotel ~.
EMPLOYMENT AND MANAGEMENT POSITIONS IN BUSINESS ENTITIFR
NOTE: Complete only those schedules which Your disclosure cateaorv reauires. {Most coda,~
will not reouire the disclosure of 'management positions,'
You may be required to report your employment or holding of management p~itions in a business
entity, including a position as a director, officer, partner, trustee, employee or any position of
management. When employment and management positions in business entities are required to be
reported, you must disclose the/ollowing:
Name of the entity,
Address of the entity.
General description of the business active.
Your position within the entity.
SAMPLE
(Assume that the management positions held in business entities of the kind litted h~,lnw ar~, marl~
repo~ble by your Conflict of Interest Code.)
You are vice president of General Widgets, Inc., a corporation within the Authority's jurisdic-
tion. This schedule would be completed as follows:
General t~idgets, [nc. Z07 S. Broadway, Los Angeles
(Name of Company) ($b'eet Addrea, City, $~t~)
I~anufactures and distributes Vfdgets Vice Presiden[
Genera Descrlefion of Buaine~. A~llvi[y) {¥o~r Job Title or Po§itiqn)
9 ~222-6
BoOk # .... r~t&e &'
SHORT FORM STATEMENT OF ECONOMIC INTERESTS
If you have no interests to report, as required by your Conflict of Interest Code, or, if there has been
no change Jn your reportable Interests since the previous statement filed, you may complete the Short
Form. If you are declaring that there has been no change in your reportable interests, you must
attach a copy of the statement, filed previously, which states your economic interestS.
10 u222. ~
STATEMENT OF ECONOMIC INTERESTS SHORT FORM
FOR DESIGNATED EMPLOYEES
(With no reportable interests or no change from immediate past filing of
Statement of Economic Interests)
See Instrument Manual/or Statement of Economic Interests
1, Name:
2, Address:.
3, Department: ..
4. Designated Position:
5. Check the appropriate box:
( ) This is my initial statement. (File within 30 days after the effective date of the Conflict of
Interest Cede,)
( ) I have been appointed to the above-named position and will assume the position on _
(date), (File 10 days prior to assuming position.)
( ) I have been transferred to the above-named position and will assume the position on -
(date), (File within 30 days after assuming position.)
( ) This is my anniveraa~ statement. (File dudng the month of
( ) I left: the above-named position as of (date), (File within 30
days of leaving office.)
6. Period covered by the Statement: (Not applicable for initial or appointed Statements)
to
7. Check the appropriate box:
( ) There has been no change in my reportable interests since the previous Statement
aed by me on . (Date of filing with your agency). My
previous Statement, copy attached, is Incorporated into this Statement.
( ) I have no repo~able economic interests,
VERIFiCATION
I understand that this Statomer~ is filed pursuant to a Conflict of Interest Code and requires that I
disclose certain economic interests established by the Conflict of interest Code for my position.
I declare under penalty of perjury that I have used ell reasonable intelligence in preparing this
Statement and to the best of my know~edge it is true and complete.
EXecuted on ,19~, at , California.
(Signature)
STATEMENT OF I~CONOMIC INTEREST~ FOR DESIGNATED EMPLOYEES
(NOTE: Complete only those schedules applicable to your disclosure categon/)
See Instruction Manual for Statement of Economic Interests
1. Name:
2. Address:
3. Department:
4. Designated Position:,
5, Check the appropriate box;
( ) This is my initial Statement, (File within 30 days after the effective date of the Conflict
of Interest Code.)
( ) I have been appointed to the above-named position and will assume the position on --
(date). (File 10 days pdor to assuming the position.)
( ) I have been transferred to the above-named position and will assume the position on _
,(date). (File within 30 days after assuming the position.)
( ) This is my anniversary Statement. (File during the month of )
( ) I lett the above-named position as of (date). (File within 30
days of leaving office.)
6. Period covered by the Statement: (Not applicable for initial er appointed Statements)
,to
VERIFICATION
J understand that this Statement Is flied pursuant to a Confliot of Interest Code and requires that I
disclose certain economic interests established by the Conflict of Interest Code for my po~ion, I have
declared all such reportable e~onernic interests.
I declare under penalty of perjury that I have used all reasonable diligence In preparing this statement
and ilo the best of my knowledge it is true and complete.
Executed on ,19_, at , California.
(Signature)
INVESTMENTS
(Over $1,000, as required by Conflict of Interest Code)
See Instruction Manual for Statement of Economic Interests
NOTE: if your position requires the disclosure of Investments, you should complete this schedule. It
you have nothing to report, you should indicate 'none'.
Check One
[ ] Value does not exceed $10,000
(Name Of C.~mpany)
[ ] Value exceeds $10,000 but does not
(Nature o~ interests, e.g. C~mmo~ Stock, Pextnersh~p tn~'emt, ate.) exceed $100,000
Data Acqui~l [ ] Value exceeds $1oo,000
Check One
, , [ ] Value does not exceed $10,0oo
[ ] Value exceeds $10,000 but does not
: (Nm~re of inte,,~*, e,g. Camr~n Stoc.~, Pa~,,=hip ~ter*~, e'~.) exceed $100,000
Date A~qulr~¢l [ ] Value exceeds $100,000
(Gener~d Oeicripf~e~ Of B~.~ine$$ Activity) D~
Check One
[ ] Value does not ex¢~ $10,~
(N~e ~
[ ] Value exc~ds $10,~ but does not
O~ ~q~r~ [ ] Value exceeds $1oo,~0
Check One
[ ] Value does not exceed $1o,0o0
(N~e of ~p~y)
[ ] Value exceeds $10,~ but does not
(N~te of ~res~, ~g. ~mon S~k, P~rship in.eat, e~.) exceed $1~,~
, Oa~quir~ [ ] Value exceeds $1~,~0
Check One
[ ] VaJ~ue does not exceed $10,000
[ ] Value exceeds $10,~ but does not
(N~ture o~ intreat, e.g. Com~n~ 3~k, P~ship interesl, e~,) exceed $100,~0
. Oa~ulr~ [ ] Value exceeds $10o,000
INTEREST~ IN RI~AI~ PROPI~RTY
(In Housing Authority project area or over $1,000, as required by Conflict of Interest Code)
See Instruction Manual for Statement of Economic Interests
NOTE: If your position requires the disclosure of interests in real property, you should complete this
scheduJe. If you have nothing to report, you should indicate
Check One
[ ] Value does not exceed $10,0oo
(Sti'eet Address or Precise Location et Prope.-ty) [ ] Value exceeds $1o,000 but does not
exceed $100,000
D~t. Acquit~ [ ] Value exceeds $100,000
(Nacre of lnteru~, e,g. Equity. Opec;n) Date Oispc~ad [ ] Property is my principal residence
Check One
[ ] Value does not exceed $1o,ooo
(Street Ac~ees ~r Prec=l~e Location af Property)'
[ ] Value exceeds $10,000 but does not
exceed $100,000
Date A~cluifed [ I Value exceeds $100,000
(Nature of Interest. e.g. E~ulty. O~tJ~m) Date
Check One
[ ] Value does not exceed $10,000
{S~eet Addree8 o~ Pre~lse Lecat~n of Properly)
[ ] Value exceeds $10,000 bm does not
exceed $100,000
Date Acquired [ ] Value exceeds $100,000
(Nature of Ir~rest. e.g. Equity, 09~o~) Date
Check One
[ ] Value does not exceed $10,0C0
($t~t A~dree$ ~ I~,'e,=lsa Lo~ali~ ~f Prol~erty)
[ ] Value exceeds $10,000 but does not
exceed $100,000
Date Acciui~ed [ ] Value exceeds $100,000
(Nature c~f Inte~eet. e.g. Equity. Opt{o~l) Da~e
Check One
[ ] Value does not exceed $10,0o0
[ ] Value exceeds $10,000 but d~es not
exceed $100,00o
. Date,~qu~ed ... [ ] Value exceeds $100,000
(Nature of Interest. e.g. Equity. Option) Date Diepc~ed
Check One
[ ] Value does not exceed $10,000
(Street Addrees or Pre~t~e Locaflcn c~
[ ] Value exceeds $10,000 but does not
exceed $100,000
Oate Acquired [ ] Value exceeds $100,000
(Nature of Interest. e,g. Equity, Option) Date
APR 13 ~9~ 16:5~ CAHFIELD~CHRISTOPHER p.~?
INVESTMENTS AND INTERESTS IN REAL PROPE~RTY
HELD BY BUSINE,C~;~ ENTITIES YOI~ CONTROl
(Over $1,ooo, as required by Conffict of interest Code)
See Instruction Manual for Statement of Economic Interests
NOTE: If your position requires the disclosure of certain investment and interests in real preperbj,
disclose those kind of investments and interests in real property held by business entities you
control on this schedule. If you have nothing to report, you sttould indicate "none'.
Name of Business Entity
INVESTMENTS HELD BY BLiSINESS ENTITY
Check One
[ ] Value does not exceed $10,000
(Name, of Company)
[ ] Value exceeds $10,00o but does not
(Nature c~ interests, e.g. Common Stuok, PaYole~shJp interest, e~o.) exceed $100,000
Date ~q~,KI [ ] Value exceeds $100,000
(Cseneral De,:tip,ion of Bueineee Ao'dvity) Date
Check One
[ ] Value does not exceed $10.ooo
[ ] Value exceeds $10,000 but does not
(Nat~e of intMe4t~, s,g, Common ~ock, Pattr~rship interest, otc,) exceed $100,000
Date A,~ul~ad [ ] Value exceeds $100,000
(Gener~J Oeeoripiion of 8~in~ Activity) Date
Check One
[ ] Value do~ not exceed $10,000
~me of Coml~y)
[ ] Value exceeds $10,ooo but does not
(Na~o of inter.ts, e,g. Commo~ Stook, Pa~ership interest, etc.) exceed $100,000
om A~qui,ad [ ] Value exceeds $1oo,ooo
(Geeetal Descdption el BuNny. A~d~ty) Dete
Attach additional information off apprc:~'iately lab°led ~ontlnuatJon ~hee~.
INTERESTS IN REAL PROPERTY HELD BY BUSINESS ENTITY
Check One
[ ] Value does not exceed $10,000
(Street Add~ o~ Prect~ !.~oadon of Prol:~ly)
[ ] Value exoeeds $1o,ooo but does not
exceed $100,000
i~,te Acquit'ed [ ] Value exceeds $100,000
Check One
[ ] Value does not exceed $10,0oo
(Street Add,eec or Pre~L~e Location of Ptope~/)
[ ] Value exceeds $10,000 hut does not
exceed $10Q,O00
ome Acquired [ ] Value exceeds Sl00,0OO_
(Nature of Jnteceet. o.g. ~qu~ty. Of°don) Date Olalaoeed BOOK ~ -/
INCOME {OTHER THAN GIFTS)
(Aggregating $250 or more from reportable sources of income as required by Conflict of Interest
Code)
See instruction Manuel for Statement of Economic Interests
NOTE; If your position requires the disclosure of income, you should complete this schedule. If you
have nothing to report, you should indicate "none'.
Check One
[ ] Amount or Value received was not
(Name of the $<~rce of Income) greater than $1,000
, , [ ] Amount orvaJue received was greater
(A~d~.e of tho Source of income) than $1,000 but not greater than
$10,000
, , [ ] Amount er value received was greater
than $10,ooo
~sl'~e''"=' Acl~ity of ~ Source of Income) .....
Che~k One
[ ] Amount or Value received was not
['Name of ~le 8e~.lrOe of Income) greater than $1,000
.... [ ] Amount orvalue received was greater
~:ld~m of the ~ce of Income) than $1,000 but not greater than
$1o,ooo
[ ] Amount orvalue received was greater
then $10,000
(B~islne~ A~NIty of ~ So.ce of Income) ....
(Description of the ~oneideration~ if a~y, for 1he income) .... '"'
Check One
[ ] Amount or Value received was not
(Name of the Source of Income) greater than $1,000
[ ] Amount or value received was greater
(~dreea c~f the S~rce of Income) than $1 ,o00 but not greater than
$10,000
[ ] Amount or value received was greater
than $10,000
(Busfrle~e Activity of the Gou~ce of Incom~)"
(Oe,lcriofion of the qqngideratton~ if e~¥1 9qf' the incq, me)
(Aggregating $50 or more from reportable sources of Income as required by Conflict of Interest Code)
See instruction Manual for Statement of Economic Interests
NOTE: If your pos~on requires the disclosure of income, you should complete this schedule. If you
have nothing to report, you should indicate 'none'.
(Name of Ooner) nam(s) of Gift(s)
(Add~e~) VaJue of
(~ of ~) D~(~) ~ Gi~(s)
INqOMI~ OF A BUSINESS ENTITY IN WHICH THE DESIGNATED EMPI~OYE~{[ OR SPOUSE, OWNS A
lO% OR GREATER INTEREST AND WHICH PROVIDES LEGAL OR BRQKERAGE SERVIC~'fi
(The flier's pro rate share of the fees paid to the business entity which provides legal or brokerage
services must be at least $1,000,)
See Instruotion Manual for Statement of Economic Interests
(O~cril~lon of its E~inM~s Actfvity)
list ~e name of each i~livid~ ~' entity whe F~d fee~ to lhe ebeve businM~ entity if y~ur pro ra~a share of ~ fees wa~
INCOME OF A BUSINESS ENTI'FY IN WHICH THE DESIGNATED EMPLOYE[I[ OR SPQU$i~, OWNS A
10% OR GREATER INTEREST AND WHICH DOES NOT PROVID{~ LEGAL' OR BROKERAGE SERV!CE,q
(The flier's pro rate share of the fees paid to the business entity which does not provide legal or
brokerage services must be at least $10,00o,)
See Instruction Manual for Statement ot Economic Interests
(Name of l~.miness Entry)
(Address of ~siness Entity)
(Descrii3tJon of its Business Activity)
IJst the name of each individual or entity who paid fees to ~he above business entity if your pro *'ara share ot the gross
re~=elpts from the individual or entity was $10,000 or more:
(Name of Business Entity)
(Address of Business Entry)
(Oosrr~ptlon o! its Business Activity)
List the name of each Individual or e~Uly who pa~d fees to the above business ~ntJty if yo~r pro rata she~e of the gross
receipts from ~s indlvldue{ or entity wee Sf0,0~O or more:
APR 13 '94 16:~. CAMFIELD&CHRISTOPHER P.3~
EMPLOYMENT AND MANAGEME~NT POSITIONS IN [~USINESS ENTITIE~
(As required by Conflict of Interest Code)
See Instruction Manual for Statement of Economic Interests
NOTE: If your position requires the disclosure ot management positions in business entities, you
should complete this schedule. If you have nothing to report, you should indicate "none".
(Name ef Company) (Street Addfe~, C~ty, State)
General O~crl t~on of ~k~$ine~s Ac~ivtt~ our ~b ~e o~ P~iti~