01 0 70 - NFH- 1 Date Initial Filing

Received CALIFORNIA FORM 700 STATEMENT OF ECONOMIC INT RESTS 0(6aaJ Use Only

FAIR POunCAL PRACTICES COMIIISSION

A PUBLIC DOCUMENT COVER PAGE 225923

Please type or print in ink

NAME OF FILER (LAST) (FIRST) (MIDDLE)

~edina Janec Gale

1 Office Agency or Court

Agency Name (Do not use acronyms)

iESTBOROUGE WATER DISTRI CT

Division Board Department District if applicable Your Position

Dire~ t o r

~ If filing for multiple positions list below or on an attachment (Do not use acronyms)

Position ____________ ______

2 Jurisdiction of Office (Check at least one box)

o State o Judge or Court Commissioner (Statewide Jurisdiction)

o MultlmiddotCounty ______ _ ____ _ _ ___ ~ County of _s_c_n_ _a_t_-_____________

o City of _____ _ ___ _ _______ []O~er _ _ _______ ____ ____ _

3 Type of Statement (Check at least one box)

o AnnualThe period covered is January 1 2018 through o Leaving Office Date Left -1-l__ December 31 2018 (Check one Circle)

-or- o The period covered is January 1 201 8 through the daleThe period covered is ----1---1_ _ ~rough or

December 31 201 8 leaving office

o Assuming Office Date assumed -----1--1__ o The period covered is ----1-1_ __ Lhrough ~e date of leaving office

o CandidateDate of Election_ _ _ _ ___ and office sough~ if different than Part 1 _ __________ ______ _

4 Schedule Summary (must complete) ~ Total number of pages including this cover page 3

Schedules attached

o Schedule Amiddot1 bull Investments - schedule attached o Schedule C bull Income Loans ampBusiness Positions - SChedule attached

o Schedule Amiddot2 bull Investments - schedule attached o Schedule D bull Income - Gifts - schedule attached

o Schedule B - Real Property shy schedule attached o Schedule E bull Income - Gifts shy Travel Payments shy schedule attached

-or-

O None - No reportable interests on any schedule

5 Verification MAILlNG ADDRESS STREET CITY STATE ZIP CODE (BuSifless or Agency Addross Recommended middot PublIc Documonl)

2263 Wescbo r ough Blvd Souch San Fr ancisco C1 9 4 80 DAYTIME TELEPHONE NUMBER E-MAIL ADDRESS

( 65 0 ) 589 -1 lt3 5 j anmedina ya oo com

I have used all reasonable diligence in preparing ~is statement I have reviewed this stalement and to ~e 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 fore

Date Signed 0 2 20 19 Signature --~ et Ga=lc ea n=_ __________Jan~ e ~ middoti(month day yeal) (File the oogmaIy SIgned p3piN statemenl W7lh your

FPPC Form 700 (20182019) FPPC Advice Email advicefppccagov

FPPC TolImiddotFree Helpline 866275middot3772 wwwfppccagov

------- -------

11 OO _70- NFH- 170

SCHEDULE B Interests in Real Property

(Including Rental Income)

~ ASSESSORS PARCEL NUMBER OR STREET ADDRESS

3348 Fa irfa- Iay

CITY

S u~h San Francis~o

FAIR MARKET VALUE

o $2000 - $10000

0$10001 - $100 000

[RJ $100001 - $1000000

D Over $1000000

NATURE OF INTEREST

o OwnershIpDeed of Trusl

o Leasehold Yes remm9 Othet

IF RENTAL PROPERTY GROSS INCOME RECEIVED

o SO - S499 o $500 - $1000 o $1001 $10000

o $10001 - $100000 DOVER $100000

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 $10000 or more

o None

IF APPLICABLE LIST DATE

ACQUIRED DISPOSED

o Easement

[K] 0 5 lt 12 3 ~

CAUFORNIA FORM 700 FAIR pounCAL PRACTICES COMMISSION

Name

Medina Jane~ Ga e

~ ASSESSORS PARCEL NUMBER OR STREET ADDRESS

CITY

FAIR MARKET VALUE o 52000 - $10000

o $10001 - $100000

o $100001 51000000

D Over $1 000000

NATURE OF INTEREST

o OwnershiplDeed of Trust

o Leasehold

IF APPLICABLE LIST DATE

ACQUIRED DISPOSED

o Easement

0 ------ shyYli remanng Oliler

IF RENTAL PROPERTY GROSS INCOME RECEIVED

0 50 middot 5499 0 5500 - $1 000 o $1 001 - S10ooO

o $10001 - $100000 DOVER $100000

SOURCES OF RENTAL INCOME If you own a 10 or greater

inte rest list the name of each tenant that is a single source of

incom e of $10000 or more

o None

~ You are not required to report loans from a commercial lending institution made in the lenders 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 lenders regular course of business must be disclosed as follows

NAME OF LENDER

ADDRESS (Business Address Acceptablo)

BUSINESS ACTIVITY IF ANY OF LENDER

INTEREST RATE TERM (MonlhsiYears)

---_ o None

HIGHEST BALANCE DURING REPORTING PERIOD

o $500middot $1 000 0 $1001 - 510000

o $10001 - $100000 D OVER S100OOO

o Guarantor If applicable

NAME OF LENDER

ADDRESS (Business Address Accoptable)

BUSI NESS ACTIVITY IF ANY OF LENDER

INTEREST RATE TERM (MonthsfYea rs)

---_ C None

HIGHEST BALANCE DURING REPORTING PERIOD

o $500 S 1000 0 $1001 - S10000

o $10001 - 5100000 DOVER $100000

o Guarantor If appliCltlble

Comments _______________________________ ____ ___________

FPPC Form 700 (20182019) Sch B FPPC Advice Email advicefppcca90v

FPPC Toll-Free Helpline 8661275-3772 wwwfppcca90v

01 17 00 170 - NFH- O 70

STATEMENT OF ECONOMIC INTERESTS CALIFORNIA FORM 700 FAIR POUTICAL PRACTlCES COIIIIlSSION COVER PAGE NameExpanded Statement Attachment

Ja net Gale Medina

Agency DivisionBoardDeptDistrict Position Type of statement

r~e stb ro go )a ter _s tr~c

Boara o f Directors Direc~ r lU1tual 1112 013 - 12 312 ]1

iE ST80ROUGH mTER DI STRIC

Board o f Directo r s DireC1or P~1nJel 111120 18 - 121 31 120 18

FPPC Form 700 (20182019) Expanded Statement FPPC Advice Email advicefppccagov

FPPC Toll-Free Helpline 866275-3772 wwwfppccagov