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CALll'LlI<NIAFORM 700 "';r.1R ~u .. IT1~'" P"'flot.: n:..::::::. (JP...A;;l "':<ilfl¥
STATEMENT OF ECONOMIC INTERESTS COVER PAGE
Dole Rncalved Q11--.'Ollhl: ~
JUN 04 2013 AMENDMENT
PI.""" rype or prlnI In Ink. "". \. - ,: \" \: ~ :PUBLIC DOCUMENT I' ' ..J BY:=- bTII
1. OffIce, Agency. or Court AgIIICY Name California Slat Assembly
District 33
~ W 1iIng lor muliiple posillonl, 1101 below or on an attslhnanl
IfIR!I)
Timothy
Your Posllon
Assemblyman
(IIIIJDlfI
Michael
~-------------------------- p~~:----------------------------
2. Jurisdiction of Office (Chock ot I_lone boll}
181sta1e O~ ____________________ --O~d ______________________ ___
3. Type of Statement (Chock oIlfut OM boxJ 181 Annual: 1Iui paIlad mveted 10 January 1, 2012, thrclJgh
De_or 31, 201:L -or-
1Iui period covered 10 --1--1' ____ lIvough Detember 31, 201:L
o ADurnlng OfIIot: Il1IIA 0ISUIIIed --1--1 ___ _
o Judge or Court CorMlIs5Ioner (li\8IBwIde JlIi8dIcUon) o Courtly 01 _____________ _
OOO~ ______________ _
o \.eYing 0I!Ice: Ili1a L.efI--1--.J __ __ (Chedc_J
011>0 perlod ~ Is J8IlU81}' 1,2012, illtt>uj1I tho date 01 IeaYlng oIIICe.
o Tho ptriod covered Is --1--1 ____ Ihro~ the dab! 0I1eav1ng oIIca.
o Condlclata: Socii"" V .... _______ __ and oftice sooghI, r cWferonIlhen Part 1: ___________________ _
4. Sehellule Summary Chock oppllcoble ..modulu or "Htme.· ~ Total number of flQlJet Including thIs cover page: _...;.10.;;....._
181 lIchedulo .... 1· /nvootmont. - ..treduIe elleohad 181 Schedule M· Cn .... _ -1ChoduIe atIadled
o Sohedule B • Real PropMy - sohedu1o 8lIOched
·or·
o Sdlt1lula C • 1n<:omo, Loons. & BusiJ .... /'o$I!/ona _ ldIoduio _chod
o Sohedulo D • /ncOmo - GIlls - ochedule aItathed o 5thodull E • Income - Glib - Ttol'Wl PoynMllls - .cI1eduie atIIIched
o NODe. No mpOltabie /nl6tDs1s on any ~
⁾† •‧⁾†
⁗⁑‱‱‱‱⁾† ⁾•†
⁰⁾⁵⁹† ⁃⁉⁉⁾†
Dale stgnod Jc),.Ii:;" fi ~ 17 slune⁕‧".., .... _ †‧⁽‱‽‹‹‹‹‹‹ ⁾⁐⁉‾⁃†⁶
SCHEDULE A·1 Investments
Stocks, Bonds, and Other Interests (OWnef8hlp Inle!est Is Less Than 10%)
Do not .lIBch brok9l9go or tlmtncf.r 8I8!amenta.
GENERAl. DESCRIPTION OF .USIESS ACTIVITY
FAIR MAftKET VALUE o 52,000 - liD_ O $100.001 - 11.000.000
NATURE 01' I~
0110,001 - 1100.000 o o..r 11.000.000
o '""'" 0 Other ------,::-,,-.,.----1"""",,,1 o P__ 0 Income Rocolvod of 60 - S4~
o Int:aIM R8ce{vod at UOO ar MDrtI (1bpott lit' ~ OJ
IF APPUc.<IIU!, UST DAlE:
~ rIANE OF BUSINess EIoITI1Y
FAIR MARKET VAlUE
o 12.000 - $ I 0.000 o 1100.001 - 11.000,000
NATURE of INVESTMENT
0$10.001 - 1100.000 o over 11,000.000
o --. 0 Othco-___ --;;;=::;-__ _ _I o ... _ 010.."". _ed of so -.1499
o rnoorn. AllceIYwd at eoo ar Mcrw (tfyaIt ~ ~ Cf
'" APPlICABlE. U5T DAre
----1----1...sL ----1----1...sL ACQUIReD DISPOSED
.. NAME OF 1!U5INESS ENllTY
FAIR tMRl(ET VAlUE o 52,000 - 110,000 o 1100,001 - 11.000.000
IU\T\JRI! oF IN\IES1MENT
0110.001 - $100,000 o ovor It .000.000
o 8I0oI< 0 OIher ___ --=_--::-:I----o "._ 0 I""",," _ .. so -14 ..
o mrnt Reoetvad or:!SOD or ~ ~ DfI ftIJftuJtI. CJ
IF APPUCABlE,. LIST 0All!::
COmmanm: ______________ ___
QENEIW. DESCRIPTION OF BUSINESS ACTWITY
,.AlR MARKET VAlue o 52,000 - 110.000 o $10.001 - 1100.000 o 1100.001 - $1.000.000 o o....r $1,000,000
NATU~ OF INV!!BTMefr o s_ 0 ou.., ___ --;:== ___ _ -'1 o Pon.-. 0"""" -.0 .. 10 - 14011 o InUIrnI RlOIfvId of !SOO or Mer. ~ ClI'I SI:tIad'uIII ~
IF APPliCABLe. LIliY OAlE:
~ NAME OF BUSlNEliS eNTITY
QENEIW. OEBCRIPT1ON OF BUSl'jESS ACTMTY
FAIR t.I.ARI<I'T VALUE o $2,000 - SI0.000 0$100.001 - $1,000.000
0110.001 - 1100.000 o a- $1,000,000
NATUReOl'~ o _ 0 OItWI, ___ --;:== ___ _ _I o PartnorIhIp 0 loco ... _ of 150 - 1499
o Ir.oof'nc. ~ at $SQO ar Mole (14epoIf DfI ~ Q
IP APPLICABLE, LIST OAlE:
Filer's Verification
Print Nam. TImothy Donnelly
~ AgonOY Cellfomla State Assembly
_mont Typ. 181201212013 Annual 0 Aooumlng 0 Laavlng
0"""7iir AntTU81 0 CAndIdoIo
I hovo uoed an rusomobl. dill_in propotlrlg this otatemonl. I hove r.vI.......s thIs.latement end to the btoaI 01 my knowledge the Infomtallon conIaInod _ and In any otlaohod _ 10 true ond compIe1e.
I .. rtJfy under penalty of perjury undor u.. 1_ '" tho State 01 C_ml. _ tho foregoing 1.1",. and camod.
Data Slgn.d ...Jy,.42:- ~ U
F1'PC Form 700 Amolldmom (201212013) FPPCAdv1ca Email: BIMce@lppc:.CO.gov
FPPC ToII-Free HelpU"", ee&l275-3m www.fppc.co.gov
(d)(5)
SCHEDULE A·2 Invesbnents, Income, and Assets
of Business EntitlesfTrusts (OWnership Interest Is 10% or Greatar)
Rowena Donnelly TIEE Faa Daniel Donnelly - Coogan Nomo
P.O. Box 426, Twin Peaks, Ca. 92391
- --.. 4 m'JESliJiB.jT~ .A,l'-40 ~4TEftEST;; l~.,. ~"'AL I"'HQ~RTY HEW O~
L{li.I;,a:b!' 9'1 THE BU'5:Nh;;;~ S§tJjffV OR TRL:'.liT
CII-ak DnI box;
Il!IINVESTMENT
Apple INC
o REAl. PROPERTY
C/w:dt; QrW NJme of BusitlNa EntIty, V ~ant. m: o TN'" go /0 2 0 Bu.,_ 1WIy, """'fJ/oIo Iho bolC, Ill ..... 10 2 ........... _ Numw ... _01 Addruo of Rool Property
~ DESCRIP1ION OF BUBI/eSS ACTMTY
PAR MARKIiT VALUe. I" APPUCABlE. UST DAre
~ :'~IO':~O,OOO $10.001 - l100,am $100.001 - 51,OOD.OOD Owot 11.000,000
NAl'URe Of' INVeSTMENT o Solo p",~ 0 P_lp 0 ______ _ Oht
YOUR BUSINESS POSmOH
". 2 mE~n~'( itt:: C.ROS2- NCQ'Ult :H:ECE \;'1:11 ~I~~' tu:,F' YOuR PRO fiiHti. "!il~4Ar..f: GF T;"E G~O;;';li N-::m.t=: TO ~H:F 1'~,,';li'([tR!JST!
8 SO - S499 eoo - $1,000 $1.001 • $10.000
o $10,001 - $100.000 o OV~ $100,000
J!o- J UST '!'~ ~.dH,tE OF i::Al~ll r:;J~f'-o"'fABLE S,NGLt; "'bl:!J~C~ li:)l'
~,;;t:CliME: Of !! El,!};1::. Oh ~1i~H::::. ,.IIo~~.1 "'., 1'-''-'-_ d_", oj ~~ ...... J
o HOllO
~umerProdu~~nctogy-O~n of BUIklIu ActMty m: CRy <>< 0Ihw ",..""" I.a<3fon or Reel Propl'ly
FAIR MARKET VALUE
~ Sl.OOO - 110.000 S10,001 - 5100.000 1100.001 • $1,000.000 OVW $1,000,000
NATURE OF INTEReST
o PIopo<1y~"" or1iuJt
FAPPUCABLe. UST DATE:
__ L.....JSL ..M.J...11JSL ACOUIREO DI5I'05m
0_
o Ltuohdd === Yii: ......... DOIher-_____ _
o ~ bOX ~ addIIIonollCh __ '''.''''01111 <>< _ propony ... _001
Commen~:: ________________________________ __
- - -
Filer's V.mficatlo[1
PMt Name Timothy Donnelly
O/Ii An C urt Cellfornla State Assembly I;M:J ~Dnc:y or 0
CIa_t Typo ~ 201212013 Annual 0 -o;rAnnual 0 AsaUInlng 0 Loavi>g 0 CandIdata
I havo used .. rea=ble diligence In pnil>lIIIn!IltVIlltltemem. , ___ d tIIIa "linemen I and to the bHl of my owiedge 11>0 infonnetlon lXI11Id1od honoil and In OIlY llllached _,.. Is '"'" and COI1lflIet ..
I co"ifY u",1or pOhOlty of peiju!}' undet tho Iowa 01 tho state of ⁃⁾‴⁴⁾†⁏ Date Signed ;Ji!,..e.- 'i 2-0 1.3 FII."o ⁓-,,..- †⁽⁵
FPPC Form 700 Amondmonl (201212013) FPPC AdvIce EmeII; 8dvIceGfPPO.co.\IOv
FPPC ToII-F"'e HoIpllne: 8661275-3772 www.fppo."..gov
(d)(5)
SCHEDULE A·2 Investments, Income, and Assets
of Business EntitleslTrusls (Ownel1lhlp Interest Is 10% or Greater)
... 1 EUSlfl!:SS I.:tHlTV (m Tl1usT
Rowena OonneUy TTEE FBO Danlal DonneUy - Coogan No<no P.O. Box 426, Twin Pe8ks, Ca. 92391 ~A (BumNs ~ddn:tU Acc.pabIe)
C/m;k """ o Trust. go 10 2 0 BuoI_""1Ity. """'1'1<10 tho bOlt, ilion go ., 2
GEN5AAL DESCRIf'T1ON of BUSlNE6S ACTMTY
FAIR t.IARI<ET VALUE
~ :.;':::~O.OOO 110.001 - SI00.000 SI00.001 • $1.000,000 OVer S1.000.ooo
NATURE 01' INI/ESThIENT
til" APPLICABLE. UST O.t.Te:
0 .... __ 0 Po_ 0----:=:---OIW
YOUR BUSINESS POSITION
1It-.2 If)E~H F¥ .... He: {l.fHl~5 .NCOl\,lf ~~ 1:~f;.Iffi tl~"C:.. un~ VOtlt"; PRQ f;:ATlL SH~\,"U: '-* TH~ ""~O:S:5 1~c:nM, !Q 'Hf EN-:-frr'tffi~l~11
Oso-_ o SI0.001 - S100,am o '""" -S 1.000 o '1.001 - Slo.000
o OVER SI00,ooo
II!' J r;", T~E W' .. M~ OJ: tACH R-Ef'oF{fA~U :::'!NGlE Sou~::-:E OF lti[ Of\~E OF ~ 1 <l iltltl OP MOR [ ,~_1 ,'~ ~<-,-,.,~ ",.1 f' ,r ""~~ .. ~'"
DNono
Filer'~ Verification
Print Nomo Timothy Donnelly
- -.. 4. j~NE:!rT~.!§E~.,;'S lihl) ) ... lfRFST!l IN ~t::.lI. .... ~liOPEf.tTY H~' nOR
t=:AS,EO ID" TMt': AU.!]."NC,S,S; f.l'UITY ('.~ ''''<lIST
o REAl. f'ROI'emY
calW.1II Bancorp
Retail Banking
FAIR MARKEr VALUE
~ S2.000 - SI0.000 SI0.001 - Sloo,OOO $100,001 - 51,000,000 Ovwt $1,000.000
HA,T\JIU! OF 1tflERE6T
IP API'UCABI.E. LIST OAJE:
D __ ...... TNot
00Ch0r-_____ _
Conune~~' ________________________________ _
ornu,Agonoy 0' COU"_Ce....:.,Ufo:..:....m_lu;....S-te_te_Ass_smb:..:....::..I::..y _____________________ _
S_tTypo tiSJ201212013Annual O __ AnnuoJ OAuumlng OlaaVing OC8ndld .... QrI
I havo _ III reeoonaillo dllIgonce In ~ tI1Ia 8laIOmenL 1 ___ thIa lIOlemenl and 10 the _01 my ~odgo the ~ con!aInod _ and In .ny .n>dled _ 10 1Ju. ond compIeIe.
I centfv undo' po~ of porjury Wldo, 1110 Iawo 0' tho alii'" 01 CaU‼⁾⁊‾⁍‱ ⁾‧⁉⁉•†
OIitoSlgned J II;.!! 'CwtJ PDor'oS ⁾⁷†-~-
FPPC Fonn 700Amendmont (201212013) F1'PC AdvIco EmoII, advIceOfppe.co.gov
FPPC ToII-Free flolpflns: B('BI275-3m www.lppc.ca.gov
(d)(5)
SCHEDULE A·2 Investments, Income, and Assets
of Business EnlitieslTrusts (OWnership Interest Is 10% or Greater)
.. I n\J~mES~ ErJTlTY f)h' IF;:II~T •
Rowena Donnelly TTEE FBO Daniel Donnelly. Coollan N""",
P.O. Box 426, Twin Peaks, Ca. 92391
- -.. 4- IN\lE.filN~ NT~ MID lN~ER~~ 'f~ IN REA] "~Q~E~UY H.fUl L'H
LEA:1.~n flY THE OU~l;o .. ~!.:S F"',rar-f 01'} 7f<UST Chd __
I8IINIIESllASNT 0 REAl. PROPERTY
Ceterpillar INC ctr.dr one Name at BuoIn ... !n6ty. rt 1nVN1rnent. lU o Tnut. go /0 2 0 1IUIIn ... Entity. _e IIIe ~ Ihon go fD 2 A>n_1 Porcol ~mbor I>' _I A<ld .... or AasI Propeny
OONERAl. DESCRIPTION OF aUSINESS ACT1VIlY
,.AlR ~ VALU~ If N'PUCA8lE, UST DATE:
~ :;.!,1.~0.000 $10.001 - 5100.000 $100,001 - 51,000.000 Owt $1,000,000
NATURE OF INVESTMENT o ""'" ~Ip 0 PatInorIhIp 0 __ --,= __ _ ""-
YOUR auSINESS POSITION
... :2 lOt: ""In HiE:: GRO:s~ r..!COME RIEC€ lV£(} jl~JCLlnj;~ '(!'Jtm: "'a:O fi:iHA !!:Hi~"'E 01= -ni~ fj~n$.a l1 ... r..ot.Hc 1!!: THt' E"!HITYffnUEoT)
$D-$4Ql1
U S!Ioo - 51.000 051.001 .510.000
0510.001 - $100.000 o ovm 5100.000
.. J ... IST THE ~HLM~ o~ EACH REPOhlfABLE 5l~ .. ut~ StJ-tJRGI: OF tJ\!-CO~"g Of' ~1Ut:!)O OR MQh1~ ,~'" .~~~~>'~u" ~ ~l"'''P~ ~~1'
0-·
Equipment Mfg. DN~ Of 8ualn ... Activil)l tz CIt)' or Olnar FftoIH ~ 01 Rat Proptrty
PAll< MA1\KET VAlUE
~ $2.000 - 110,000 510.001 - 5100.000 5100.001 - '1.000.000 over 51.000.000
NATURI! Of MEREST
o plopo<1y~"" afT .....
.. APPUCABt.E. UST DATE:
Dp.-...up
o lMHhoId Y ... ;oMjIj\fijj 0 Othor ________ _
o ~ boo< r __ odo .. _ _ '*'11_ 1>', .. 1-">, "'"-Commenm~' ______________________________ _
-- --
FiLer's V~rltlcatio!l
Print Name Timothy Donnelly
Offioa, Ag.ncy or Court C.Ufomla State Asaembly
htam.nt Typo 1&\201212013 Annual 0 -o;r-Annuel 0 AaaUInIng 0 Leovlng 0 Condldobr
I have uood .. roaaonable dlgenooln preparing tIU mtemonL I hoW M _emen< 01 my conlIIlnod herein .nd In any III1IIdled _01 .. 10 tnJ. ond complete.
I .. l1Ity under- Ponahy 01 perjUry under tho low. of \he GIllie of ⁾‱⁴⁉⁉† ‧⁴⁽※※⁴⁽‧⁉ ⁾
Dot. Silined &~ !': ~ I:? AI ... ⁉ ⁾⁾ ⁾†‹‹‹⁽⁽‹‹‹‹‽‽‽‽‽⁌‱⁴※‱†⁽⁷rn;ooi\ if_
FPPC Form 700Amendmonl (201212013) FPPC Advice Email: edvIceGfI>pr:.c;I.QoV
FPPC Toil-Froo HoIplna: 886f275·3m www.lppo.ca.gov
(d)(5)
SCHEDULE A·2 Investments, Income, and Assets
of Business Entities/Trusts (Ownership Intare&t is 10% or Greater)
~ I BUSit/ESS !!rHlTY em m.U::'l
Rowe ..... Donnelly TTEE FBD Daniel Donnelly - Coogan rum. P.O. Box 426, Twin Peaks, Ca. 92391 Add<_ (Bu--~) CI='< OlIO o Trwt,. QO to 2 0 8ulin.n. Enlty, ~. 1M bcP, then go 10 2
GEJr£RAL OESCR1PT1QN 01"" I!UstNESS ACTMn"
FAIR rAARKET VALli'
~ ~~;~~~ SI00.001 - 11._ ovor SI.000.000
NATURE OJ' INIIESTMENT
IF APPI.ICA8lE. LIST CATE:
o SOlo __ 0- 0-----,=--""-
.. 2. mENr~'f jUre GH{l5S NO;::::OM~ fl:~.:'t:rVL[] ttNCtJJbI~ YOUR 1'''':0 R!!;Td S~AR~ ttl" THe ~R::l'b-::i !~,j; !:lM~ !£ THE E ... ~nYn~I;;;Tl
8 SO - S4Q11 $500 - SI.000 11.001 - 810,000
o 810.001 - SI00.OIIO o OVER ,100,000
... ) _!S"f 'THE ~M~~l:i: or EAe ... R~PI;]~'AiH_E smGC~ ~QU~cE o~ -N(:fjUl!: ~~ :.:ttU.1JU UR MflRb 1'" ,~. ~~Jl-"'<" ,-,., ,,~ ~~-''''1
o NIlIIO
- - --,. 4 tM/ES1M",WS 1',,N[} ~4U:fll::Sllli I~ I1fA!.. !'FtQf"ENT'i l1~j!) O~
r EASEl) ~ Y -!'it fMSlNJE S:~ ~hfln OR TRUS r
Chack OM box;
IRiINVESTMENT Ceterpillar INC
o REAl. PROPERTY
N_ of I!U:H'IAI Entity. If Imoastmmd. J:I: -....-. ParooI _ or SIrOol AddroN 0/ Reo! _f Equipment Mfg. ~ or 1Iuo_ AoIIv/ty lit CIty ~ 01h0r Pn_ '-tan 0/ RHI _
FAIR MAI\KET VALUE
§ S2,DOO - 110.000 S10,001 - Sloo.ooo $100.001 • 81.000.000 0vIr S1.000,OOO
NArUREOFI~
o ,,",_~d ofT ....
IF APPlICABLE. LIST OATE:
0-_ DOIhor ______ _
Conunenm~' _________________ _
Filer's Verification -
Print Nome Timothy Donnelly
am ... Agon.y or Court Centomla State Assllmbly
S"lomont Typo ~2012,12013_1 D--Annuol DAaaumlng DL.eeving DCondIdaIa iJ'j
I haw UO<Id all ~o <i\lgonco In PfOp8fing \hi. _mont. I ha"" reviowedthlo _ and to the betl of my knowlodgo tho lnIom1atlon oont.Inod herein sod In any ottoChOd ec!1_ '" truo an<! com
I oortlfy undor P~ poojury undor the low. of tho Slo ⁾⁾†
00'" algnod Jvf.J::,,! ,..,WI] ⁓⁴⁵ⁱ›′‽›---1 †‹‽ ⁽⁽‽⁽
FPPC Fonn 700Amendmonl (201212013) FPPC AcMco Email: adYico@fppc.ca.gov
FPPC ToII-Free Help"n., 8S812715-3772 www.lppc.ca.gav
(d)(5)
SCHEDULE A·2 Investments, Income, and Assets
of Business EntitieslTrusts (Ownarahlp Interest Is 10% or Greater)
... 1 Elu;.nu::ss l"NTITY fJF." l~IJST
Rowena Donnelly TTEE FeD Danl,,1 Donnelly - Coogan N_
P.O. Box 426, Twin P..aks. Ce. 92391
"" 4. ~NVEt. tf,'ENfG AND 'l'ffl~J".~fii3 It..J REAL ~l1fiVE.IHY Hi:lfi OK i £1l.~~D :BY tH E BU;J~~Jt ~rl. [:l'iTITY 0."'1: T"'U,,/f
o REAl. PROPERlY
Green Mountain Colfee arer:k OM N.nc a/8ulJMu EnVIy, II InvAtrnutt. At o TnISt, go to 2 0 BUlIn", EnIky, ~e ",. box, rIwn go to 2 ~. p~ Nooiblt' Qr Bt;eet Addrau of RuI Prvpmy
GI!NI<RAL OESCRIPTION OF BUSI/£SS ACTMTY
MfdR MARKI!T VAlliIii
~ :;,: ~"ODD SI0.001 • $100.000 $100.001 - $1,000,000 Choat 11,000,000
~T\JRI! 01' INVESTMENT
IF APPLICABLE. UST O"T&:
o Solo ~ 0 PiI_ 0---",.----""'" yOUR BUSJNeS6 POSITION
.. .::: !O.E~n'F''''' illL GROSS t~~'.OMF R_cn"'~bl :.NCLUfiE YOO~ PRO RA;ij, ""U..t.R:c OF 1"11~ t-;'Wof.","'<'1ll!~-COl;,~ W if Hi' I-N)IT'1'1fftU~;!
§ $0. ",g~ S500 • 11.000 $1,001 - $10,000
o 510.001 • SI<11.OOO o OVER ~100.000
.. :; l 51 THE N;H.·~ {]!' t:A::H <:I,EJ'QNiAth ... E smGLE 'j,(1;lRC-E OF 1~",'~f1MC Of ~:J_ ~ OR MORE .. "," •• ~ ~~ "J,.J '-, -= "~<'---~,.
o Nono
Filer's Verification ' -
Print N ..... l1mothy Donnelly
OIIIce,Agoncyorcoun Callfomla State Assembly
Consumer Calfee & Equipment Producl8
""'" MAR""" VALUE
~ S2.000· 110.000 $10.001 • 1100.000 1100.001 • SI.ooo.ooo Ovor 11,000.000
HATUfUi; 01"" INTeRSST
'I"' APPLICABLE. LIST DAlE:
MJ..1Qj..R ...1lJ...1fu~ ACQUIRED DI9POIIm
o _ ~ood orr ....
o Leao<hcld il1'::;:";; o DIhor ______ _
o ~ bot< ... dIIIo",,1 _ 1OPO'1In\I- or lOIII _ •• lII1ac:t1ed
Comnwnm~' ______________________________ _
BtalomontTyPe 18] 201212013 Annuol D-c;;rAmuol DAmImIng Dt..aving DcondidBlv
I _ UO<Id at relllOl!8hle diYganca In preparing IhIs _men!. I have reviewed U1ls stIlamonl and to the best of aJntaInod ho'" and In lIllY .ttaotrod 0Ch0d .... I. tru. and """!'I<oIo.
Do .. Signod -"""'---=,.-"d:t=--...... <:....
FPPc Form 700Amendmont (201212013) I'PPC Advlco ErruoU: _Qlppo.eo.gov
FPPC ~Pta. Halpin.: 8661275-3772 www./ppc.c:aOOV
(d)(5)
SCHEDULE A-2 Investments, Income, and Assets
of Business EntitieslTrusts (Ownerahlp Interest Is 10% or Greater)
Rowena Donnelly TTEE FBO Daniel Donnelly - Coogan N ....
P_D, Box 426, Twin Peaks, Co, 92391 "" _ __ .<a:._J
CfleCl< .",. o Trw\. 110 t:I 2 0 Bualn.A~. oomp.fIte 1M bo~ them 00 to 2
GENIlRAL OESCRlP11ON OF .UBlNESS AOTIVITY
rnR /MRKIOT VALU1!
~ :'~I:~O,OOO 110,001 ' 1100,000 $100.001 - $1.000.000 0 .... $1.000,000
~TURE 01' INVES1J.IENT
I,. APPUCABLE, U8i DAre
o SOlo PIOP_'"1Ip 0 ~ 0 ---...,::::-::---Ohr
YOUR BUSINESS I'05ITIOH
.. 2 U][NTIFY 'M~ GJ'O!!l5 l~~r:DME R'::CE.iViEt. i.1~j(tUnF '(OUR PhO Rilt.r.. SHf,RE Of' !'Hi§ GJ'l:tl~~ 1t~(OME::& ,H'" b~~Tli¥r.i1USll
o SO-S400 o 110,001 - 1100.000 o ~-t1,1100 o 01150 $I 00,000
o $1,001 - 110,000
... '1 UsI THE r·u,M~ Dr ~tJ.LH FfEPORTABL£ ~:f~~t'! ~nURCE Of 1~,.I-flM!E ~F ,~U nlJ~ QH MGRE ;~"g, ~ ~,..".,-,,,- tc".' t"'":~r •• ~
o Nono
Filer's Verific .. tUln
Print Nama Timothy Donnelly
om ... Agency or Coun Cellfornla stete Asaembly
--- -
,. " !~JV~Sj,,~e:r-HS ANIl lH1E~~~;~ IN ;';;::/l.L PROPEP-TV ;lEU} CIl lEASED E3;Y THf BU~~Jt~.;;;, ~m,i'l' O~ THUST
o REAL PROPERlY
Green Mountain Calfee
Consumer Coffee & Equipment Products 0aaiptb1 01 BUalnlWl ActIVIty lI:[ cay at other Pnoln l~ of R,ctIIII Pmp.-ty
FAIR MAAKET VAlUE
~ $2,000 - 110,000 110.001 - 1100.000 $100,001 - 11.000.000 o....r 51.000,000
NATURE OF INTEilEST
II' !\PPlICA8l.E. U5T DATE:
o Proptl1y 0wn0i>hIpID00d of TRill
DOIhot ______ _
Commenb: _______________ __
_om'JYPa tiS! 201212013 Annuol 0 -c;;;-AnnUot 0 Aloumlng 0 L.eevlng 0 candidate
I hava uoad d ... _Ia cNgence In pIWIlQI1ng this _ I have lWIIlowad thIa atatement and to ilia be&t 0( my knawlodga Illa informaUon COI'11IIi1ed _ ond In any _led _ 10 tnJ. end CIJIll!'Io
I certlfy undor ~onaIty of porjury unci., tha lowe 0' \he SIabt ‿‱⁾⁏†
Dat.lIlgnad \/ vtJfi:;. J. ... ?! t ? I'll . ⁾⁉‧•••‽‽›››‡‡››››››››†‧ ‽‹‹‹‹‹‹‹‼⁴⁊
FPPC Form 700_1 (201212013) FPPC Mllice EmoI: advIcwCIfpPc.co,gov
FPPC Tol~",. Holpine: 8661275-3172 IIIWWJppC..,.,goII
(d)(5)
...
SCHEDULE A-2 Investments, Income, and Assets
of Business EntitieslTrusts (Own9/l!hlp Interest Is 10% or Greater)
,. I !:IU~.lNFSS ErHITY em TRUST
Rowena Donnelly nEE FBe Denlel Donnelly. Coogan Nwmo
P.O. Box 426, Twin Peaks, Ca, 92391 ......... (BUtlM"-__ J
CIood< """ o Tnnt. go /0 2 0 au ...... """'Y • • amp.". tho bolr. _ go ID 2
GENf!RAl.. ~PTlON OF 8lJStNe.SS ACYMTY
FAIR WJlJ<ET VALUE
~:.~~o,ooo 510.001 - 5100,000 $100.001 - 11.000,000 o..r 51.000.000
NAJl..IRi OF ~~
IF APPlJCABl.E, usr DAlE:
o Salo p, ..... "'~... 0 '''''mhIp 0 ----=---""'"
I> 2" lDE~HJ"'V THe: vh'Q3:S ~C,QMt ~t{;Ll',r~o [I1J{;:tUD~ '(OJ~ PRe RATA S-HARF fl~ THE" GROSS 't.;;cm.l~ ;JJ • H~ ~"-l!T l,rlf~Ull t:
§ SD - $o4G11 5000 - 51,000 51,001 - 510,000
o $'10.001 - $'100.000 o QVI;R 1100,000
,. J: .. 1~jflH.E ~-.\,il,¥t or: C':'CH REPOR7AEiLE SINGLE SOURCE Ql';
iNCOMt: g~ S HI 1::1.)" OR: MOF.E l':'lL.o~ , ~ •• "", .1, <L," ,I. ~ < "I'
DNono
FIle"". Verification
PrInt Name Timothy Donnelly
--
II!- tj lJ;jv~§iri!.t:Nl~ ANU mU:::Ht::"!:lI;:; Iii ~t:A.L~}H.H"I:~:~ HELD OR l :r;;1i.",~fJ HV ,uJO: f:l.,;£INi::SS E~~-IT""'- Or.l T"'!;£T
Greenbrier COS INC """'" af BusIono E...,.. ff I_nt. '" ~ PI1DI:I N\I1\hIt tr 5nel Addrus at RaaI Pt1)party
Transporletlon Equipment Mfg, ~on gI 8uIInoA ,,~vfty II[ Cit)' or ott.. P..w.o lOt:atlOn Of R.eQI PJOPOrlY
FAIR MARKET VALUE
~ 52,000 - 510,000 510.001 - 5100.000 $100.001 - 11.000,000 OAr $1.000.000
NATURE OF INTEREST
o Pt<>POI1)/ ~d afT ....
IF API'IJCAELE. usr DAlE:
..M.J...11112 ..11J. 13112 ACQUIRED OISPOSEO
0_ DOllar _______ _
c~n~~-_______________ _
-------
A_ Co California state As&embly OflI ... ,,....,,oy or urt _________ -''--_______________________ _
Statement Typo 1&12012l2013Annuoi D~ArwJoI DAaaumJng DLeaving DClI/1dldate
FPPC Fonn 700 Amondmonl (201212013) FPPC AdvIco Email: odvlco@lpp •• ca.gav
FPPC Toil-Froo Holplinr. eelll275-3772 wwwJppc.ca.gov
--(d)(5)
· .
SCHEDULE A-2 Investments, Income, and Assets
of Business Entities/Trusts (Ownership Interest Is 10% or Greater)
.. 1 EuSIIH:5S Er.TlrY (Jk lkU3T
Rowena Donnelly TTEE FaD Daniel Donnelly - Coogan Nlmo
P.O. Box 426, TwIn Peek~, Ca. 92391 ~ (8uaJn ... AddIvu ~p~)
ChOCk""" o lMI. go I. 2 0 "-EnIIIy, r:cmpMlo IIH b ..... IIHn II" 10 2
QENERAL OESCRIP11ON OF BUSINESS ACTMTY
FAIR MARKIlT VALue IP Af'PLlCAllLE. UST DAn;;
~:~~~o,ooo $10.001 - $100,000 &100,001 - $1.DOD,OOO
av... $1.000.000
NATUI'\e 0,. INVESNeIT
---1---1..9.... ---1---1Jl... ACQUIRUO OLliiPQSIiD
o Solo __ 0 Pal1IWohIp 0 ----:::;-,---""'" YOUI\ !!US1NE9S POSmON
"" ~, ,m:~;;w't -PoE GROS .. IN: ~.r,~1:. ffi:.C!:;;I>J~U HN.;LtH.M: \'QUt,t I"kO f'.A1A ;SH""'l~ Of' THE GFH)~:iii j~,JCOM'!= ril T~" :!"~-rn,T"'fT!:HH.n
o SO-$4 .. o ~lo.001 - 5100.000 o SlIOO - 51,000 o O'm'l51OO.ooo
o 51,001 • SI0.000
I.. l. U£~ Tilt NA:,1'=: Of ~ar.,H ,-:HuIir/U;ll~ SU~(; .... £ SC!!.Hl:cE: OF -lNCQM~ (.F t~Q '1;!il oi't MU;E r"""'~" ~"f'''~~ ~"~~,t""F""'·",,"~
ON ...
- -
Filer's Verification
Print Ham. TImothy Donnelly
om.o, Agonoy or Court Callfomla State Assembly
.... -4. lNVe~'HJ!PH~ At.J1) ,m~r:F'iTS IN .. ~ru flBJ"JPEfH\' HELl; OR t.;;:lL:'J,bU 0'1 Til£: OtHl1Nr:::;J,~ DJTHY or. jPiJ:,;,
CilK:k on. bo.JC:
I8IINVESmENT o REAl. PROPERTY
Smllh & Wesson ...". of ~ Iintity, If In\ot;ISSment. m: Atausor. Parc4I Numller or Streu AddrI!SS Of RuI Pl'Op.tIy
Flreenn Mfg. o Iptjoo1 gil!wlnoU AQNky SI! cuy 01 0Ihti PreCIM l.Ocdon Of Raj Proi*t'.f
FAIR MARKET VALUE
~ $2.000 - 510,000 510,001 - 5100,000 $100,001 • $1,000,000 ov.r 51,000.000
NATURE OF ItflEREST
IF APPUCABLE, LIST DATE:
o Pmpll1y ewn.r>hlp,O .. d PIT_ OP~
o OIhor - ______ _
CO~nu·~ __________________________ __
s ........ nt l'yp. I&J 201212013 AnnuBi 0 --o;r-Annuel 0 A .. umlng 0 I.eovlng 0 Candldota
I have ",,00 l1li re_ <llllge".,. In preparing ihlo otolomonl I ~ ...... YIowvd IhIa _tnt and 10 Iho boat 01 my knOwIodg. Iho Wannollcn COltolnon! hondn ond In eny al1aChoO _eo Is hue and 00ftlI)I
I cenJfy un~ pen, ~ ofee<JlrJ ,~~"'" of tho State ⁾※⁴•†⁾⁉† Dot. Signod ~ _ nO F ⁉•‧⁾‽‽‽‽‽†‽‹‹‹‹‹‽‽⁽ †
cdq.yar}
FPPC F<lfm700Am.ndntont (201212013) FPPC AdvIce EmaIl: .dvlceCfppo. ... gov
FPPC Toil-Free Helpline: B!I6I275-3m www,fppc.oa.gov
(d)(5)
CA,lfi'ORNfA FORM 700 F'AIR POUT1,A-i: P:Hi'iCTIC-g" !:OMM S510~
A PUBLIC DOCUMENT
STAT~~H~IOF ECONOMIC INTERESTS I " ~_: .\ t
'COVER PAGE , C'
I I,~
Please typo or print In Ink.
NAME DF FIlER C" c. 0 I. i" {FIRS1]
Donnelly
1, Office, Agency, or Court kJency Name
Callfomla State Assembly
Division, Board, Department, District, ff applicable
District 33 (Fonner District 59)
.. ~ filing lor multiple positions, fISt below or on an attachment
Timothy
Your Position
Assemblyman
Michael
kJency: _______________ _ Pos~: ______________ _
2. Jurisdiction of Office (Check al lesst one box)
III State o Multi-County ______________ _
oC~of----------------
3, Type of Statement (Check al least one box)
III Annual: The period covered Is Jenuary 1, 2012, through December 31, 2012.
-Or' The period covered is ~~, ____ through Deoember 31, 2012.
o Assuming OffIce: Date assumed ~~ ___ _
o Judge or Court Commissioner (Statewide Jurisdiction)
o County of _____________ _
ornoor ______________ _
o Leaving OffIce: Oate Left ~~ ___ _ (Check one)
o The peIiod covered Is January 1, 2012, through the date of leaving offioe.
o The period covered ~ ~~, ____ through the date 01 lea~ng offioe.
o Candidate: EIacUon year _____ _ and office sought, ~ different than Part 1: ______________ _
4, Schedule Summary Check applicsble schedules or ·None.·
~ Schedule A-1 • Investmen/5 - schedule attached
o Schedule A·2 • Investmenls - schedule ettached o Schedule B • Real Property - schedule atteched
-or·
~ Total number of pages including this cover page: _;~ __
III Schedule C • Income. Loans, & BUSiness Posnions - schedule attached
III Schedule 0 • Income - Gifts - schedule attached
III Schedule E • Inoome - Gifts - Travel Paymenls - schedule attached
o None· No reponabJe inleresl5 on any schedule
5. Verification
herein and in any attached schedules is true and complete. I acimll'Medge thi
I certify under penalty of pe~ury under the lews of the Stele of ~omla† ‱‧⁊‡⁜⁉⁕⁾⁾⁾⁴※›››※⁾⁾ ※⁆†⁽⁽
Date Signed 03/01/2013 Sig I""""" ",JWI
FPPC Form 700 (201212013) FPPC Advlce Email: edvlce@fppc.ca.gov
FPPC Toll-Free Helpline: 8661275-3772 www.fppc.ca.gov
(d)(5)
(d)(5)
SCHEDULE A-1 Investments
CALIFORNIA FORM 700 fM~ f'DU-;l{;AL pFrACHCES <;{ffiMMI5",IQI'll
Stocks, Bonds. and Other Interests (Ownership Interest is Less Than 10%)
Name
Asm. Tim Donnelly DD nDt attach brokeraga Df financiaf statements.
~ NAME OF BUSINESS ENTITY
Morgan Stariley GENERAL DESCRIPTION OF BUSINESS ACTIVITY
Investment Account of minor child
FAIR MARKET VALUE
D $2,000 • $10.000
D $100,001 • $1,000,000
NATURE OF INVESTMENT
III $10,001 • $100,000
D Oller $1,000,000
III Slock D 0""" --___ ---,-,-___ _ IDescrtbal
D Pannershlp 0 Income Recetved of $0 • $499 o Income Racatved of $500 or Mora fRepCft on ~ CI
IF APPUCABlE, LIST DATE:
~~.1L ACQUIRED
~~.1L DISPOSED
~ NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
FAIR MARKET VALUE o $2,000 • $10,000
D $100,001 - $1,000,000
NATURE OF INVESTMENT
D $10,001 • $100,000
D Over $1,000,000
D Slocl< D 0Ihe< -----:==----(-, o Pannerstup o Income Received of $0 - $499 o Income Rccetved of $500 or Morc fReporl 011 ~ CI
IF APPLICABLE. LIST DATE:
~~.1L ACQUIRED
~~.1L DISPOSED
~ NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
FAIR MARKET VALUE
0$2.000 • $10,000
0$100.001 . $1,000,000
NATURE OF INVESTMENT
D $10,001 • $100,000
D Ollor $1,000,000
D Slock D O!h<rr ----==:-___ _ I_I
D Pannersttlp 0 Incomo Received of $0 . $499 o Incoma ReceNed of $500 or MOfe fR~ on SchedtJIe CI
IF APPLICABLE, LIST DATE:
~~.1L ACQUIRED
~~.1L DISPOSEO
~ NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
FAIR MARKET VALUE
D $2,000 • $10,000
D $100,001 . $1,000,000
NATURE DF INVESTMENT
D $10,001 • $100,000
D Oller $1,000,000
D S,ock Do""', ------:::c==------ {Oe:!.cribel
D Partnership 0 Income Received of SO • $499 o Income Recetved of $500 or More fR&pOIt 011 SdteduItJ CJ
IF APPLICABLE, LIST DATE:
~~.1L ACQUIRED
~~.1L DISPOSED
~ NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
FAIR MARKET VALUE
D $2.000 • $10,000
D $100,001 . $1.000,000
NATURE OF INVESTMENT
D $10,001 . $100,000
D Oller $1,000,000
D Slock D 0Ihe< -----:::cc:-:::7-----, D Panncrshlp o Income Received of $0 . $499 o Income Rccolved of $500 Of MOfC f~ 011 ScheduM CJ
IF APPLICABLE, LIST DATE:
~~.1L ACQUIRED
~~.1L DISPOSEO
~ NAME OF BUSINESS ENTITY
GENERAl DESCRIPTION OF BUSINESS ACTIVITY
FAIR MARKET VALUE
D $2.000 . $10,000
D $100.001 • $1,000,000
NATURE OF INVESTMENT
D $10,001 . $100,000
D Ov", $1,000,000
D Slock D 01"'" -----=---,------, D PaMOIshlp 0 Income Received of $0 • $499
o Incoma Recaived of $500 or MOTa f~pott on ScMd1.M CI
IF APPUCABLE, LIST DATE:
~~.1L ACQUIRED
~~.1L DISPOSEO
Comments: This Is a coogan Investment account of minor child D. Donnelly. Awaiting Investment data from broker.
FPPC F0011700 (2Dl212013) Soh, A·1 FPPC Advice Email: advlce@fppc.ca.gov
FPPC Toll· Free HelpUne: B661275·3772 WINW.fppc.ca.gov
SCHEDULE C Income, Loans, & Business
Positions
CALIFORNIA FORM 700 FAIR Fat TiC;!,;L PRi!,ctIC~'" cor.1MISSION
Name
(Other than Gifts and Travel Payments) Asm. Tim Donnelly
Ii"' 1 INCQM[ r~EC[IVED ".. 1 INCOME Fo![CE!V[D
NAME OF SOURCE of INCOME
Infant Hearing Screening Service ADDRESS (Bu5lnes.! Addf8s$ Accaptable)
1867 Callfomle Ave, Corona, CA 92881 BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOUR BUSINESS POSITION
Spouse - Hearing Screener
GROSS INCOME RECEIVED
o $500 . $1,000
D $10,001 • $100,000
III $1,001 • $10,000
o OVER $100,000
CONSIQERATION FOR WHICH INCOME WAS RECEIVED
D Satary III Spouso's or registered domastic partner's Income
D loan repaymenl D Partnership
D Cornmlsskm or D Rantal Income, ~sf MCh .soun:e 01 $10,000 or mor&
O~------------~==~-----------(Desetj!lel
• 2 LOI\NS R[£:EIV[n on OUl STr.NOING Dur~IN(j Hi[ REPORTING PERIOD
NAME OF SOURCE OF INCOME
ADDRESS (Busin6" AddrBss AcreptBble)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOUR BUSINESS POSITION
GROSS INCOME RECEIVED
o $500 - $1,000
D $10,001 • $100,000
D $1,001 - $10,000
o OVER $100,000
CONSlDERATION FOR WHICH INCOME WAS RECEIVED
D Salary D Spousa's Of regislered domastic parmer's Income
D Loan rapaymenl D Pannershlp
o S,le of _____ ---;;;:=====:-::;::-;-____ _ (ResJ prop&11y. car, boat, etc,1
D Commission Of D Ranlal Income, bt each ~ 01 $ ro.D!Xl or I7lOf8
oo~------------~~~------------(Describel
• 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 tenms 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 (BuM1eSS Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF LENDER
HIGHEST BALANCE OURING REPORTING PERIOD
0$500' $1,000
o $1,001 - $10,000
o $10,001 • $100,000
DOVER $100,000
Comments:
INTEREST RATE TERM (MonlhsIYears)
____ % ONooo
SECURITY FOR LOAN
D None D Personal resKleoce
o Ren! Propeny _________ --:=,--,--,=:-_______ _ Sff9£l(~
D Guarantor ________________ __
o ~ ------------"'7"--,,---:----------(O<wibel
FPPC FOO11 700 (201212013) Sch. C FPPC Advice Email: adllice@fppc.ce,gov
FPPC Toll·Free Helpline: 8661275-3772 www,fppc_ce.gov
CALlFORNIAFORM 700 SCHEDULE 0 Income - Gifts
"A.n ""aur.r:Al ?RIU'::J.:[':£s Cl)Mlil'SSIDN
Name
~ NAME OF SOURCE (Not lin Acronym)
Pasadena Toumament of Roses
ADDRESS (Buslnes& Add"'$B Accep~bI")
391 S Orange Grove Blvd, Pasadena, CA 91184 BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mmlddlyy) VALUE DESCRIPTION OF GIFT(SI
~~~ $ 400,00 Tickets and parking
~~- $,---
~~- >-$----
~ NAME OF SOURCE (Not en Acronym)
Council for Legislative Excelience
ADDRESS (Bu~n"S& Addr&! Acceptable)
2150 River Plaza Dr, #150, Sacramento, CA 95833
BUSINESS ACTIVITY, IF ANY; OF SOURCE
DATE (mmJddlyy) VALUE DESCRIPTION OF GIFT(S)
~~~ >-$ __ 8_0._51_ Dinner
~~- .. $_---
~~_ $S-__ _
~ NAME OF SOURCE (Not an Acronym)
Califomla Cattlemen's Association
ADDRESS (BIW~" Address Acceptable)
1221 H Street. Sacramento, CA 95814
BUSINESS ACTIVITY, IF ANY, OF SOURCE
OATE (mmlddlyy) VALUE DESCRIPTION OF GIFT(S)
~~~ $ 20.00 Reception
~~~ $ 30.00 Breakfast
~~~ 20.00 Cowboy Hat
Asm. Tim Donnelly
~ NAME OF SOURCE (Not en Acronym)
John A. Perez for Assembly 2012
ADDRESS (BusJnes& Address Acrephlb(eJ
777 S Figueroa St, #4050, Los Angeles, CA 90017 BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mmfcldlyy) VALUE
39.00 ~~~$
5~~ >-$ __ 8_5._8_0
~~_ $S-__ _
DESCRIPTION OF GIFT(S)
Engraved Box
Personalized Bowl
~ NAME OF SOURCE (Not en Acronym)
Califomla Forestry Association ADDRESS (Susinesa Address AcreptBblfJ)
1215 K Street, Suite 1830, Sacramento, CA 95814 BUSINESS ACnVITY, IF ANY, OF SOURCE
DATE (mmJddlyy) VALUE
~ 22 I~ ... $ __ 54_._50_
~~- .. $_---
~~- >-$_---
~ NAME OF SOURCE (Not en Acronym)
Fleldstead & Company
DESCRIPTION OF GIFT(S)
Reception
ADDRESS (Business Addresa Ar:cepIBbIe)
PO Box 19599, Irvine, CA 92623
BUSINESS ACTIVITY. IF ANY; OF SOURCE
OATE (mmlddlyy) VALUE DESCRIPTION OF GIFT(S)
~~~ $>-_5_3._0_0 Reception
~~- $_---
~~- >-$----
Commen~: ____________________________________________________________________________ _
FPPC FOO11 700 (2DI212013) Soh, D FPPC Advlce Email: advlce@fppc.ca.gov
FPPC Toll-Free Helpline: B661275-3772 WINW.fppc.ca.gov
CALIFORNIA I'ORM 700 SCHEDULE D Income - Gifts
I".Al~ P'O ..... nCAL PRACTICES C'(l1,!I"lHi51ON:
Name
~ NAME OF SOURCE
CTIA - The Wireless Association ADDRESS (Bus/nass Address Accsptable)
1400 16th SI. NW, Suite 600, Washington, DC 20036 BUSINESS ACTIVITY, IF ANY, OF SOURCE
Wireless Industry Trade Association DATE (mmlddfyy) VAlUE DESCRIPTION OF GIFT(S)
~291JL $ 82.31 Reception
~~- $
~~- $
~ NAME OF SOURCE
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mmlddfyy) VAlUE DESCRIPTION OF GIFT(S)
~~- '-,----
~~- .. $ ___ _
$
~ NAME OF SOURCE
ADDRESS (BusIness Address Accspt8bfa)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/dd1yy) VAlUE DESCRIPTION OF GIFT(S)
~~- .. $ ___ _
~~- $~---
~~- $'-__ _
~ NAME OF SOURCE
ADDRESS (Business Mdf9~ Accsptabls)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/dd1yy) VAlUE DESCRIPTION OF GIFT(S)
~~_ '-s ___ _
~~- $'--__ _
~~- $'-__ _
~ NAME OF SOURCE
ADDRESS (Businass Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mmlddlyy) VAlUE DESCRIPTION OF GIFT(S)
~~- '-$ ___ _
~~- .. $ ___ _
$
~ NAME OF SOURCE
ADDRESS (Buslne.ss Address AccaptBb/e)
BUSINESS ACTlVlTY, IF ANY, OF SOURCE
DATE (mmJddlyy) VAlUE DESCRIPTION OF GIFT(S)
~~- ,-$_--
~~- .. $ ___ _
~~- >-$---
Commenm: __________________________________________________________________________________ _
FPPC Fonn 700 (201112D12) Sch. D FPPC Toll-Free Helpline: 8661275-3772 www.fppc.ca.gov
-
SCHEDULE E Income - Gifts
CALlFQRNIAFORM 700 F,I\IR prn.nI!CAL ?E<AC. 'iICE!> C:OMM;S~lnr~
Name
Travel Payments, Advances, and Reimbursements
Asm. Tim Donnelly
• You must mark either the gift or income box .
• Mark the "S01(c)(3)" box for a travel payment receIved from a nonprofit S01(c)(3) organization or the" Speech" box jf you made a speech or participated in a panel. These payments are not subject to the $440 gift limit, but may result In a disqualifying conflict of Interest.
~ NAME OF SOURCE (Not an Acronym)
City of Los Angeles - Mayor's Office ADDRESS (Business Address Acceptable)
1400 K Street, Suite 208 CITY AND STATE
Sacramento, CA 95814 BUSINESS ACTIVITY. IF ANY, OF SOURCE D 501 (e)(3)
OATE(5).~~..E. . .EJ~..E AMI. $>-3_7_0_.0_0 __ _ (if (l1li)
TYPE OF PAYMENT: (mus1 check one) III Gift D Income
D Made a SpeechlPartfdpaled In a Panel
III Other· Provide Descrlptlon
Airport parking and shuttle service In connection with official govemment business
~ NAME OF SOURCE (Not en Acronym)
ADDRESS (Business Address Ar:cepteblej
CITY AND STATE
BUSINESS ACTIVITY, IF ANY, OF SOURCE o 501 (e)(3)
DATE(5). ---1---1_ . ---1---1_ AMI. $ _____ _ (If (l1li)
TYPE OF PAYMENT: (must check one) D Gift D Income
D Made e SpeechiPertlcipaled In a Panel
D Other - Provide Description
~ NAME OF SOURCE (Not en Acronym)
ADDRESS (Business Address Acceptable)
CITY ANO STATE
BUSINESS ACTIVlTY, IF ANY, OF SOURCE o 501 (e)(3)
DATE(5). ---1---1_ . ---1---1_ AMT. >.$ _____ _
(lfgltf)
TYPE OF PAYMENT: (must check one) D Gift D Income
D Made a Speech/Participated In e Panel
D Other - Provide Descnptlon
~ NAME OF SOURCE (Not an Acronym)
ADDRESS (BWJiness Address Acceptable)
CITY AND STATE
BUSINESS ACTIVITY, IF ANY, OF SOURCE o 501 (e)(3)
OATE(5).---1---1_. ---1---1_ AMT. $>-____ _ (if (II')
TYPE OF PAYMENT: (must check one) D Gift D Income
D Made a Speech/Partlclpaled In a Panel
D Other· Provide Description
Commen~: ______________________________________________________________________________ _
FPPC Form 700 (201212013) Sch. E FPPC Advice Email: advlce@fppc.ca.gov
FPPC TolI·Free Helpline: B66/275·3772 WW'WJppc,ca,gov
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