RECEIVED 700...SCHEDULE A·2 Invesbnents, Income, and Assets of Business EntitlesfTrusts (OWnership Interest Is 10% or Greatar) Rowena Donnelly TIEE Faa Daniel Donnelly …

RECEIVED

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)


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)


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: [email protected]

FPPC ToII-Free Help"n., 8S812715-3772 www.lppc.ca.gav

(d)(5)


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)

...


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)

· .


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: [email protected]

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


GENERAL DESCRIPTION OF BUSINESS ACTIVITY

FAIR MARKET VALUE o $2,000 • $10,000

D $100,001 - $1,000,000


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



FAIR MARKET VALUE

0$2.000 • $10,000

0$100.001 . $1,000,000


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



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


~~.1L ACQUIRED

~~.1L DISPOSED



FAIR MARKET VALUE

D $2.000 • $10,000

D $100,001 . $1.000,000


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


~~.1L ACQUIRED

~~.1L DISPOSEO


GENERAl DESCRIPTION OF BUSINESS ACTIVITY

FAIR MARKET VALUE

D $2.000 . $10,000

D $100.001 • $1,000,000


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: [email protected]

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


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


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: [email protected],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


OATE (mmlddlyy) VALUE DESCRIPTION OF GIFT(S)

~~~ $ 20.00 Reception

~~~ $ 30.00 Breakfast

~~~ 20.00 Cowboy Hat

Asm. Tim Donnelly


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


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_

~~- .. $_---

~~- >-$_---


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: [email protected]

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)


DATE (mmlddfyy) VAlUE DESCRIPTION OF GIFT(S)

~~- '-,----

~~- .. $ ___ _

$

~ NAME OF SOURCE

ADDRESS (BusIness Address Accspt8bfa)


DATE (mm/dd1yy) VAlUE DESCRIPTION OF GIFT(S)

~~- .. $ ___ _

~~- $~---

~~- $'-__ _

~ NAME OF SOURCE

ADDRESS (Business Mdf9~ Accsptabls)


DATE (mm/dd1yy) VAlUE DESCRIPTION OF GIFT(S)

~~_ '-s ___ _

~~- $'--__ _

~~- $'-__ _

~ NAME OF SOURCE

ADDRESS (Businass Address Acceptable)


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.


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


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


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)


D Made a Speech/Participated In e Panel

D Other - Provide Descnptlon


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')


D Made a Speech/Partlclpaled In a Panel

D Other· Provide Description

Commen~: ______________________________________________________________________________ _

FPPC Form 700 (201212013) Sch. E FPPC Advice Email: [email protected]

FPPC TolI·Free Helpline: B66/275·3772 WW'WJppc,ca,gov

Documents

RECEIVED 700...SCHEDULE A·2 Invesbnents, Income, and Assets of Business EntitlesfTrusts (OWnership Interest Is 10% or Greatar) Rowena Donnelly TIEE Faa Daniel Donnelly …