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Feeser, Nadia - Annual 2013-03-05City of4llsmvfflWW* W 00y aa". Vice Date Received STATEMENT OF ECONOMIC INTERESTS MAR COVER PAGE Received Please type or print in ink. NAME OF FILER (LAST) (FIRST) (MIDDLE) Feeser Nadia Khattak 1. Office, Agency, or Court Agency Name City of Pismo Beach Division, Board, Department, District, if applicable Your Position Administrative Services Department Administrative Services Director ► If filing for multiple positions, list below or on an attachment. Agency: 2. Jurisdiction of Office (Check at least one box) ❑ State ❑ Multi -County 0 City of Pismo Beach Position: ❑ Judge or Court Commissioner (Statewide Jurisdiction) ❑ County of ❑ Other 3. Type of Statement (Check at least one box) Annual: The period covered is January 1, 2012, through ❑ Leaving Office: Date Left —J— I -or- December 31, 2012. (Check one) The period covered is I I through O The period covered is January 1, 2012, through the date of December 31, 2012. leaving office. ❑ Assuming Office: Date assumed —J-1 O The period covered is I I through the date of leaving office. ❑ Candidate: Election year and office sought, if different than Part 1: 4. Schedule Summary Check applicable schedules or "None." P,. Total number of pages including this cover page: 3 © Schedule A-1 - Investments - schedule attached ❑ Schedule C - Income, Loans, & Business Positions - schedule attached Schedule A-2 - Investments - schedule attached ❑ Schedule D - Income - Gifts - schedule attached ❑ Schedule B - Real Property- schedule attached ❑ Schedule E - Income - Gifts - Travel Payments - schedule attached "Or. El None - No reportable interests on any schedule 5. Verification MAILING ADDRESS STREET CITY STATE ZIP CODE (Business or Agency Address Recommended - Public Document) -740 Moa tii t_ P_oM Pismo Beach CA 93449 DAYTIME TELEPHONE NUMBER I E-MAIL ADDRESS (OPTIONAL) ( 805 ) 773-7010 I have used all reasonable diligence in preparing this statement. I have reviewed this statement and to the best of my knowledge the information contained herein and in any attached schedules is true and complete. I acknowledge this is a public document. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct Date Signed 03/05/2013 Signature��' (morBh, day, year) (File the odginalty signed statement with your filing official) FPPC Form 700 (2012/2013) FPPC Advice Email: advice@fppc.ca.gov FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov SCHEDULE A-2 Investments, Income, and Assets of Business Entities/Trusts (Ownership Interest is 10% or Greater) 1- 1. BUSINESS ENTITY OR TRUST Mark R. Feeser, Attorney at Law Name 3940-7174 Broad Street, San Luis Obispo, CA Address (Business Address Acceptable) Check one ❑ Trust, go to 2 Business Entity, complete the box, then go to 2 GENERAL DESCRIPTION OF BUSINESS ACTIVITY law practice, legal services FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $0 - $1,999 ❑ $2,000 - $10,000 1. /12 1 112 ✓❑ $10,001 - $100,000 ACQUIRED DISPOSED ❑ $100,001 - $1,000,000 ❑ Over $1,000,000 NATURE OF INVESTMENT ❑ Partnership W] Sole Proprietorship ❑ Other YOUR BUSINESS POSITION None, spouse's business 1- 2. IDENTIFY THE GROSS INCOME RECEIVED (INCLUDE YOUR PRO RATA SHARE OF ••SS INCOME 10 THE ENTITY[TRUST) ❑ $0-$499 $10,001 - $100,000 ❑ $500 - $1,000 ❑ OVER $100,000 ❑ $1,001 - $10,000 1� 3. LIST THE NAME OF •••TABLE SINGLE SOURCE OF INCOME OF $10,000 OR MORE (Attach a separate sheet if necessary.) ❑ None State of California - Administrative Office of the Courts Legal Fees from Rodi'a Monterroso-Bragg 1� 4. INVESTMENTS • INTERESTS IN REAL PROPERTY..• LEASED BY THE BUSINESS ENTITY OR TRUST Check one box: ❑ INVESTMENT ❑ REAL PROPERTY Name of Business Entity, if Investment, pr Assessor's Parcel Number or Street Address of Real Property Description of Business Activity or City or Other Precise Location of Real Property FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 ❑ $1o,001 - $100,000 2 ❑ $100,001 - $1,000,000 ACQUIRED DISPOSED ❑ Over $1,000,000 NATURE OF INTEREST ❑ Property Ownership/Deed of Trust ❑ Stock ❑ Partnership ❑ Leasehold_] Other Yrs. remaining ❑ Check box if additional schedules reporting investments or real property are attached CALIFORNIA FORM 700 FAIR POLITICAL PRACTICES COMMISSION Name Nadia Feeser 10- 1. BUSINESS ENTITY OR TRUST Name Address (Business Address Acceptable) Check one ❑ Trust, go to 2 ❑ Business Entity, complete the box, then go to 2 GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $0 - $1,999 ❑ $2,000 - $10,000 --- i --- j 12 _/--j12 ❑ $10,001 - $100,000 ACQUIRED DISPOSED ❑ $100,001 - $1,000,000 ❑ Over $1,000,000 NATURE OF INVESTMENT EParne ❑ Sole Proprietorship ❑they SS POSITION 1- 2. IDENTIFY THE GROSS INCOME RECEIVED (INCLUDE YOUR PRO RA SHARE OF ••SS INCOME TO THE ENTITYITRUST) ❑ $0-$499 ❑ $10,001 - $100,000 ❑ $500 - $1,000 ❑ OVER $100,000 ❑ $1,001 - $10,000 0- 3. LIST THE NAME OF ••• OF INCOME OF $10,000 OR MORE (Attach a separate sheet if n cc, -Y.) None ■ INTERESTS IN REAL PROPERTY• OR LEASED BY THE BUSINESS ENTITY OR TRUST Check one box: ❑ INVESTMENT ❑ REAL PROPERTY Name of Business Entity, if Investment, or Assessor's Parcel Number or Street Address of Real Property Description of Business Activity or City or Other Precise Location of Real Property FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 ❑ $10,001 - $100,000 1 12 ___I__j12 ❑ $100,001 - $1,000,000 ACQUIRED DISPOSED ❑ Over $1,000,000 NATURE OFINTEREST ❑ Property Ownership/Deed of Trust ❑ Stock ❑ Partnership ❑ Leasehold-- easeholdF1Other Yrs. remaining ❑ Check box if additional schedules reporting investments or real property are attached FPPC Form 700 (2012/2013) Sch. A-2 Comments: FPPC Advice Email: advice@fppc.ca.gov FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov SCHEDULE B Interests in Real Property (Including Rental Income) ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS CITY San Luis Obispo FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 08 02112 2 ❑ $1o,00l - $100,000 -�-�- ® $100,001 - $1,000,000 ACQUIRED DISPOSED ❑ Over $1,000,000 NATURE OFINTEREST Ownership/Deed of Trust ❑ Easement ❑ Leasehold ❑ Yrs. remaining Other IF RENTAL PROPERTY, GROSS INCOME RECEIVED ❑ $0 - $499 ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 SOURCES OF RENTAL INCOME: If you own a 10% or greater interest, list the name of each tenant that is a single source of income of $10,000 or more. ❑ None Name Nadia Feeser ► ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS CITY FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 ❑ $10,001 - $100,000 1 112 __j .. J 12 ❑ $100,001 - $1,000,000 ACQUIRED DISPOSED ❑ Over $1,000,000 NATURE OF INTEREST ❑ Ownership/Deed of Trust ❑ Easement ❑ Leasehold ❑ Yrs. remaining Other IF RENTAL PROPERTY, GROSS INCOME RECEIVED ❑ $0 - $499 ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 SOURCES OF RENTAL INCOME: If you own a 10% or greater interest, list the name of each tenant that is a single source of income of $10,000 or more. ❑ None * You are not required to report loans from commercial lending institutions made in the lender's regular course of business on terms available to members of the public without regard to your official status. Personal loans and loans received not in a lender's regular course of business must be disclosed as follows: NAME OF LENDER" ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF LENDER INTEREST RATE TERM (Months/Years) ❑ None HIGHEST BALANCE DURING REPORTING PERIOD ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 ❑ Guarantor, if applicable Comments: NAME OF LENDER' ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF LENDER INTEREST RATE TERM (Months/Years) % ❑ None HIGHEST BALANCE DURING REPORTING PERIOD ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 ❑ Guarantor, if applicable FPPC Form 700 (2012/2013) Sch. B FPPC Advice Email: advice@fppc.ca.gov FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov