uc regent - pattiz - financial disclosure

22
. . I (j ' i7/!/CfI5'! r l . , . . ! CALIFORNIA FORM 700 FAIR POUTICAL PRACTI CES COMMISSION / STATEMENT OF ECONOMIC I NTERESTS L.;~! ") ' . COYER PAGE ,) ~ -i· ·lJ: ":'0  A Publ ic Document Pl ease type or pri nt in ink. (LAST) (FIRST) DAYTIME TELEPHONE NUMBER NAME PATTIZ NORMAN (MIDDLE) JOEL ( 818 )592-2000 X278 MAILING ADDRESS STREET (May use business address) CITY OPTIONAL: FAX IE-MAIL ADDRESS 8965 L1NDBLADE STREET CULVER CITY 1. Offi ce, Agency, or Cour t Name of Office. Agency, or Court : UNIVERSITY OF CALIFORNIA Divi sion, Board. Dist rict. if appl icable: BOARD Your Position: REGENT ~ If fil ing for mult iple posi tions, list addi tional agency( ies) / posi tion(s): (Attach a separat e sheet if necessar y.) Agency: Position: 2. Juri sdicti on of Office (Che ck at lea st on e bo x) ~ State o County of o City of _ U Multi-County _ o Other _ 3. Type of Statement (Che ck at leas t on e bo x) o Assuming Office/lnitial Date: ----.1----.1 __ ~ Annual : The peri od covered is Januar y 1, 2008. thr ough December 31, 2008. -or- O The peri od cover ed is -- -.1 -- -- .1_ _ . through December 31, 2008. o Leaving Off ice Date Lef t: ----.1----.1 __ (Check one) o The per iod cover ed is January 1, 2008, thr ough the date of leaving offic e. -or- o -;De peri od covered is -- -.1 -- -- .1_ _ , through -~5 c'a: e of leaving offic e. STATE ZIP CODE CA 90232 818-592-6363 4. Schedul e Summary ~ Total number of pages including this cover page: _ ~ Check applicable schedules or "No report able interests . " I have dis closed int er est s on one or more of the attached schedules: Schedule A- 1 ~Yes - schedul e att ached Investments (Less than 10% Ownership) Schedule A-2 0Yes - schedule att ached Invest ment s (70% or greater Owner ship) Schedule BOYes - sc hedule at tached Real Proper ty Schedule C ~Yes - schedule att ached Income, Loans, & Business Positi ons (Income Other than Gif ts and Travel Payments) Schedule D 0Yes - schedule att ached Inc om e - Gi ft s Schedule E 0 Yes - schedule att ached Inc om e - Gi ft s - Tr avel Payments -or- o No reportable interests on any schedule 5. Verification I hav e used al l reasonable di li genc e in pr epar ing this stal:" ement . I have rev iewed thi s statement and to the best of my knowledge the informat ion contained herein and in any attached schedul es is true and complete. I cer tif y under penal ty of perj ury under the laws of t he State of Cal if or nia that the foregoing is true and corr ect. Oat i_our filing offiCial.) I  FPP C Form 700 (20081200 9) FPP C T oll-Free Helpline: 866/ASK-F PPC www.fppc.ca.gov

Upload: spotus

Post on 30-May-2018

216 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: UC Regent - Pattiz - Financial Disclosure

8/14/2019 UC Regent - Pattiz - Financial Disclosure

http://slidepdf.com/reader/full/uc-regent-pattiz-financial-disclosure 1/22

.. I (j' i7/!/CfI5'!  r l . , . .

!

CALIFORNIA FORM 700FAIR POUTICAL PRACTICES COMMISSION

/

S T A T E M E N T O F E C O N O M IC IN T E RE S TS

L.;~! ")

'. C OY ER P AG E,) ~-i··lJ: ":'0

  A Public Document Please type or print in ink.

(LAST) (FIRST) DAYTIME TELEPHONE NUMBERNAME

PATTIZ NORMAN

(MIDDLE)

JOEL ( 818 ) 592-2000 X278

MAILING ADDRESS STREET

(May use business address)CITY OPTIONAL: FAX IE-MAIL ADDRES

8965 L1NDBLADE STREET CULVER CITY

1. Office, Agency, or Court

Name of Office. Agency, or Court:

UNIVERSITY OF CALIFORNIA

Division, Board. District. if applicable:

BOARD

Your Position:

REGENT

~ If filing for multiple positions, list additional agency(ies)/ 

position(s): (Attach a separate sheet if necessary.)

Agency: ___

Position: _

2. Jurisdiction of Office (Check at least one box)

~ State

o County of _

o City of _

UMulti-County _

oOther _

3. Type of Statement (Check at least one box)

o Assuming Office/lnitial Date: ----.1----.1__

~ Annual: The period covered is January 1, 2008.

through December 31, 2008.

-or-

O The period covered is ---.1----.1__ . through

December 31, 2008.

o Leaving Office Date Left: ----.1----.1__

(Check one)

o The period covered is January 1, 2008, through the

date of leaving office.

-or-

o -;De period covered is ---.1----.1__ , through

-~5 c'a:e of leaving office.

STATE ZIP CODE

CA 90232 818-592 -6363

4. Schedule Summary

~ Total number of pagesincluding this cover page: _

~ Check applicable schedules or "No reportable

interests. "

I have disclosed interests on one or more of theattached schedules:

Schedule A-1 ~Yes - schedule attached

Investments  (Less than  10%  Ownership)

Schedule A-2 0Yes - schedule attached

Investments (70%  or greater Ownership)

Schedule BOYes - schedule attached

Real Property 

Schedule C ~Yes - schedule attachedIncome, Loans, & Business Positions  (Income Other than Gifts 

and Travel Payments)

Schedule D 0Yes - schedule attached

Income - Gifts  

Schedule E 0Yes - schedule attached

Income - Gifts - Travel Payments 

-or-

o No reportable interests on any schedule

5. VerificationI have used all reasonable diligence in preparing this

stal:"ement. I have reviewed this statement and to the bes

of my knowledge the information contained herein and in an

attached schedules is true and complete.

Icertify under penalty of perjury under the laws of the State

of California that the foregoing is true and correct.

Oat

i_our filing offiCial.)

I  

FPPC F 00 (2008 2

Page 2: UC Regent - Pattiz - Financial Disclosure

8/14/2019 UC Regent - Pattiz - Financial Disclosure

http://slidepdf.com/reader/full/uc-regent-pattiz-financial-disclosure 2/22

SCHEDULE A-1

Investments

Stocks, Bonds, and Other Interests(Ownership Interest is Less Than 10%)

Do not attach brokerage or financial statements.

~ NAME OF BUSINESS ENTITY

AIRGAS INC

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

INDUSTRIAL EQUIPMENT WHOLESALE

FAIR MARKET VALUE

o $2,000 - $10,000

o $100,001 - $1,000,000

~ $10,001 - S1UU,UUU

DOver $1,000,000

NATURE OF INVESTMENT

IZ I Stock

(Describe)

IF APPLICABLE, LIST DATE:

---.! ---.!....QSLACQUIRED

__J---.!  ....QSL

DISPOSED

~ NAME OF BUSINESS ENTITY

HSBC HOLDINGS PLC

~ NAME OF BUSINESS ENTITY

CBS CORP

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

BROADCASTING TV

FAIR MARKET VALUE

n$2,000 - $10,000

o 5100,001 - $1,000,000

~ $10,001 - $100,000

DOver 51,000,000

NATURE OF INVESTMENT

IZ I Stock

o Other (Describe)

IF APPLICABLE, LIST DATE:

---.!---.! ....QSLACQUIRED

----.! ----.!....QSLDISPOSED

~ NAME OF BUSINESS ENTITY

INTERPUBLIC GROUP

~ NAME OF BUSINESS ENTITY

COMVERSETECHNOLOGY

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

TECHNOLOGY

FAIR MARKET VALUE

n52,000 - 510,000

I ! 5100,001 - S1,000,000

~ $10,001 - $100,000

DOver $1,000,000

.,:.. ;.n .;" '..= : 0:0 iNV!::STMENT

X 2=-

~  ~-~~

_ ,- ,- c := :-

CALIFORNIA FORM 700FAIR POUTICAL PRACTICES COMMISSION

arne

NORMAN JOEL PATIZ

~ NAME OF BUSINESS ENTITY

DISCOVER FINANCIAL SERVICES

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

FINANCIAL

FAIR MARKET VALUE

o $2,000 - $10,000

o $100,001 - $1,000,000

[g ] $10,001 - 3100,000

DOver 51,000,000

NATURE OF INVESTMENT

~ Stock

o Other (Describe)

IF APPLICABLE, LIST DATE:

----.! ----.!....QSLDISPOSED

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

FINANCIAL

FAIR MARKET VALUE

o $2,000 - $10,000

0$100,001 - $1,000,000

IZ I $10,001 - $100,000

DOver $1,000,000

NATURE OF INVESTMENT

IZ I Stock

(Describe)

IF APPLICABLE, LIST DATE:

----.! ---.!....QSLACQUIRED

----.! ----.!....QSLDISPOSED

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

ADVERTISING

FAi"'RMARKET VALUE

0 $2 ,0 00 - $ 10 ,0 00

o $100,001 - $1,000,000

[g] $10,001 - 5100,000

DOver 51,000,000

NATURE OF INVESTMENT

IZ I Stock

o Other (Describe)

IF APPLICABLE, LIST DATE:

---.! -----1....QSL

ACQUIRED

----.!----.!....QSL

DISPOSED

FPPC Form 700 (2008/2009) Sch, A

FPPC Toll-Free Helpline: 866/ASK-FPPC wwwJppc.ca.go

Page 3: UC Regent - Pattiz - Financial Disclosure

8/14/2019 UC Regent - Pattiz - Financial Disclosure

http://slidepdf.com/reader/full/uc-regent-pattiz-financial-disclosure 3/22

SCHEDULE A-1

Investments

Stocks, Bonds, and Other Interests(Ownership Interest is Less Than 10%)

00 not attach brokerage or financial statements.

~ NAME OF BUSINESS ENTITY

KEYCORP NEW

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

FINANCIAL

FAIR MARKET VALUE

o $2.000 - $10.000

o S100,001 - $1,000,000

IZ l $10,001 - $100,000

DOver $1,000,000

NATURE OF INVESTMENT

IZ l Stock

(Describe)

IF APPLICABLE, LIST DATE:

---.J---.J~

ACQUIRED---.J---.J~

DISPOSED

~ NAME OF BUSINESS ENTiTY

REPUBLIC SERVICES

~ NAME OF BUSINESS ENTITY

MORGAN STANLEY

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

FINANCIAL

FAIR MARKET VALUE

o $2,000 - $10.000

o $100,001 - $1,000,000

IZ l $10,001 - $100,000

DOver $1,000,000

NATURE OF INVESTMENT

~ Stock

o Other - -:=-_,---:- _(Describe)

iF APPLICABLE, LIST DATE:

---.J---.J~

ACQUIRED---.J ---.J-.!JJL

DISPOSED

~ NAME OF BUSINESS ENTITY

HENRY SCHEIN INC

~ NAME OF BUSINESS ENTITY

NAVIGANT CONSULTING INC

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

MANAGEMENT SERVICES

FAIR MARKET VALUE

o $2,000 - $10,000

LJ $100.001 - $1,000.000IZ l $10,001 - $100,000

DOver SI ,000,000

N.~illR.=Of l~rV~STMt:NI

X .3::c;;

CALIFORNIA FORM 700FAIR POLmCAL PRACTICES COMMISSION

Name

NORMAN JOEL PATTIZ

~ NAME OF BUSINESS ENTITY

PHILIP MORRIS INTL

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

CIGARETTES

FAIR MARKET VALUE

IZ l $2,000 - $10,000

o $100,001 - $1,000,000

o $10,001 - $100,000

DOver SI,OOO,Ooo

NATURE OF INVESTMENT

IZ l Stock

o Other _

(Describe)

IF APPLICABLE, LIST DATE:

---.J---.J~ACQUIRED

---.J --.l...!1!L..DISPOSED

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

WASTE MANAGEMENT

FAIR MARKET VALUE

o $2,000 - $10,000

o$100,001 - 51,000,000

IZ l $10,001 - S100,000

DOver 51,000,000

NATURE OF INVESTMENT

IZ l Stock

oOther --- _

(Describe)

IF APPLICABLE, LIST DATE:

---.J---.J~

ACQUIRED

---.J --.l-.!JJL

DISPOSED

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

MEDICAL EQUIPMENT

FAIR MARKET VALUE

o $2,000 - 510,000

0$100,001 - $1,000,000

~ $10,001 - $100,000

DOver 51,000,000

NATURE OF INVESTMENT

IZ l Stock

o Other (Describe)

IF APPLICABLE, LIST DATE:

---'---.J~

ACQUIRED

---.J --.l-.!JJL

DISPOSED

FPPC Form 700 (2008/2009) Sch. A-l

FPPC Toll-Free Helpline: 866/ASK-FPPC www.fppc.ca.gov

Page 4: UC Regent - Pattiz - Financial Disclosure

8/14/2019 UC Regent - Pattiz - Financial Disclosure

http://slidepdf.com/reader/full/uc-regent-pattiz-financial-disclosure 4/22

SCHEDULE A-1

Investments

Stocks, Bonds, and Other Interests(Ownership Interest is Less Than 10%)

Do not attach brokerage  or financial statements.

. . NAME OF BUSINESS ENTITY

3COM CORP

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

NETWORKING & COMMUNICATION

FAIR MARKET VALUE

o $2,000 - $10,000

o $100,001 - $1,000,000

IF APPLICABLE, LIST DATE:

~ S10,001 - $100,000

DOver 51,000,000

(Describe)

---1---1~

DISPOSED

CAUFORNIA FORM 700FAIR POunCAL PRACTICES COMMISSION

Name

NORMAN JOEL PATTIZ

.. NAME OF BUSINESS ENTITY

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

FAIR MARKET VALUE

o $2,000 - $10,000

o $100,001 - $1,000,000

0$10,001 - $100,000

DOver $1,000,000

NATURE OF INVESTMENT

o Stock

o Other _

(Describe)

IF APPLICABLE, LIST DATE:

---1---1~

ACQUIRED---1---1-.SJL 

DISPOSED

.. NAME OF BUSINESS ENTITY.. NAME OF BUSINESS ENTITY

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

FAIR MARKET VALUE

o S2,OOO - S10,OOO

o $100,001 - $1,000,000

NATURE OF INVESTMENT

o Stock

IF APPLICABLE, LIST DATE:

---1---1-.SJL ACQUIRED

o S10,001 - $100,000

DOver $1,000.000

{Describe)

---1---1~

DISPOSED

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

FAIR MARKET VALUE

0$2,000 - $10,000

0$100,001 - $1,000,000

o $10,001 - $100,000

o Over $1 ,000,000

NATURE OF INVESTMENT

o Stock

o Other ---- ---:::---::----: _(Describe)

IF APPLICABLE, LIST DATE:

---1---1-.SJL ACQUIRED

---1---1-.SJL DISPOSED

NAME OF BUSINESS ENTITY .. NAME OF BUSINESS ENTITY

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

FAIR MARKET VALUE

o 52,000 - 510,000

o S100,001 - SI,OOO,OOO

~-

o S10,001 - $100,000

DOver 51,000,000

~ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

-~--..---=--=-- ~-- ~  = -

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

FAtR MARKET VALUE

o $2,000 - $10,000

0$100,001 - $1,000,000

0$10,001 - $100,000

DOver 51,000,000

NATURE OF INVESTMENT

o Stock

o Other (Describe)

IF APPLICABLE, LIST DATE:

--.J--.J-.SJL AcaUIRED

---.J---.J~

DISPOSED

FPPC Form 700 (2008/2009) Sch. A-1

Page 5: UC Regent - Pattiz - Financial Disclosure

8/14/2019 UC Regent - Pattiz - Financial Disclosure

http://slidepdf.com/reader/full/uc-regent-pattiz-financial-disclosure 5/22

SCHEDULE A-I

·\nvestments

Stocks, Bonds, and other Interests(Ownership Interest is Less Than 10%)

00 not attach brokerage  or financial  statements

USINESS ENTITY

M TECHNOLOGY

DESCRIPTION OF BUSINESS ACTIVITY

ICAL SERVICES

KET VALUE

- S10,000

01 _ $1,000,000

IZ l $10,001 - $100,000

DOver $1,000,000

OF INVESTMENT

k

er--------------------~::~:;--------------(Describe)

CABLE, LIST DATE:

,

NORMAN JOEL PATTIZ-

l= = = = = = = = = = = - - - - -

.. NAME OF BUSINESS ENTITY

APPLE INCGENERAL DESCRIPTION OF BUSINESS ACTIVITY

PERSONAL COMPUTER SYSTEMS

FAIR MARKET VALUE

IZ l $2,000 - $10,000

o $100,001 - $1,000,000

o $10,001 - $100,000

DOver $1,000,000

NATURE OF INVESTMENT

IZ l Stock

o Other --------:;;-:-:::;:::;------ (Describe)

IF APPLICABLE, LIST DATE:

~~~ ACQUIRED

~~~ DISPOSED

~~.J2!LDISPOSED .. NAME OF BUSINESS ENTITY

CONOCOPHILLIPSOF BUSINESS ENTITY

OTT LABORATORIESAL DESCRIPTION OF BUSINESS ACTIVITY

UG MANUFACTURERS

MARKET VALUE

,000 - 510,000

100,001 - $1,000,000

I8 l $10,001 - $100,000

Dover $1,000,000

RE OF INVESTMENT

Stock

Other (Describe)

PPLICABLE, LIST DATE:

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

INTERGRATED OIL AND GAS

FAIR MARKET VALUE

I Z I $2,000 - $10,000

0$100,001 - $1,000,000

o$10,001 - S100,000

Dover $1,000,000

NATURE OF INVESTMENT~ Stock

o Other ----------------- (Describe)

IF APPLICABLE, LIST DATE:

~~~ ACQUIRED

~~.J2!LDISPOSED

.J2!LACQUIRED

~~.J2!LDISPOSED

.. NAME OF BUStNESS ENTITY

CANADIAN NATURAL RESOURCESME OF BUSINESS ENTITY

DOBE SYSTEMS INCENERAL DESCRIPTION OF BUSINESS ACTIVITY

APPLICATION SOFTWARE

AIR MARKET VALUE

g ; 52.000 - 510,000

i'5..00.001 - 51.000,000

o$10,001 - $100,000

DOver $1,000,000

,!!,-u=t 0::: 1I'.V;:St;..t.ENI

X S=,o

~-=---~ - = :r=-::;.~ ~ -..-=:

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

INDEPENDENT OIL AND GAS

FAIR MARKET VALUE

 \8 l $2,000 - $10,000

0$100,001 - $1,000,000

o510,001 - $100,000

DOver $1,000,000

NATURE OF INVESTMENT

~ Stock

o Other (Describe)

IF APPLICABLE, LIST DATE:

~~~ ACQUIRED

~~J2LDISPOSED

Page 6: UC Regent - Pattiz - Financial Disclosure

8/14/2019 UC Regent - Pattiz - Financial Disclosure

http://slidepdf.com/reader/full/uc-regent-pattiz-financial-disclosure 6/22

SCHEDULE A-1

Investments

Stocks, Bonds, and Other Interests(Ownership Interest is Less Than 10%)

00 not attach brokerage or financial statements.

~ NAME OF BUSINESS ENTITY

CELGENE CORP

BIOTECHNOLOGY

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

FAIR MARKET VALUE

o $2,000 - $10,000

U$100,001 - $1,000,000

NATURE OF INVESTMENT

~ Stock

~ $10,001 - $100,000

DOver $1,000,000

o Other --------r;:;;;;;;:;;;;;------- 

IF APPLICABLE, LIST DATE:

---.J---.J~

ACQUIRED

(Describe)

---.J---.J~DISPOSED

CAUFORNIA FORM 700'FAIR POUTICAL PRACTICES COMMISSION

arne

NORMAN JOEL PATTIZ

~ NAME OF BUSINESS ENTITY

MEDTRONIC INCGENERAL DESCRIPTION OF BUSINESS ACTIVITY

MEDICAL APPLIANCES AND EQUIPMENT

FAIR MARKET VALUE

D $2,000 - $10,000

0$100,001 - $1,000,000

~ $10,001 - $100,000

DOver $1,000,000

NATURE OF INVESTMENT

~ Stock

D Other (Describe)

IF APPLICABLE, LIST DATE:

---.J---.J~ACQUIRED

---.J---.J...JJLDISPOSED

~ NAME OF BUSINESS ENTITY

MICROSOFT CORP

~ NAME OF BUSINESS ENTITY

CISCO SYSTEMS INC

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

NETWORKING AND COMMUNICATION

FAIR MARKET VALUE

o $2,000 - $10,000

o $100,001 - $1,000,000

NATURE OF INVESTMENT

~ Stock

[g J $10,001 - $100,000

nOver $1,000,000

o Other --------m:;;;;;ji;)------

IF APPLICABLE, LIST DATE:

---.J---.J~ACQUIRED

(Oescribe)

---.J---.J~DISPOSED

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

APPLICATION SOFTWARE'

FAIR MARKET VALUE

D $2,000 - $10,000

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

~ $10,001 - 5100,000

DOver $1,000,000

NATURE OF INVESTMENT

~ Stock

o Other -------------:c:-------:-----:------(Describe)

IF APPLICABLE, LIST DATE:

---.J---.J~ACQUIRED

---.J---.J~

DISPOSED

~ NAME OF BUSINESS ENTITY

ILLUMINA INC

~ NAME OF BUSINESS ENTITY

NUVASIVE INC

BIOTECHNOLOGY

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

FAIR MARKET VALUE

o $2,000 - $10,000

o 5100,001 - $1,000,000

N,/I.TURE OF !NVESTMENT

~ Stock

I Z l $10,001 - 5100,000

DOver $1,000,000

~------------------------(Descrioo)

• 08------

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

MEDICAL INSTRUMENTS AND SUPPLIES

FAT", MARKET VALUE

~ $2,000 - $10,000

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

D$10,001 - $100,000

DOver $1,000,000

NATURE OF INVESTMENT

~ Stock

o Other -----------------(Describe)

IF APPliCABLE, LIST DATE:

___ I---.J~

ACQUIRED

---1~.Jlli.....

DISPOSED

FPPC Form 700 (2008/2009) Sch A-

Page 7: UC Regent - Pattiz - Financial Disclosure

8/14/2019 UC Regent - Pattiz - Financial Disclosure

http://slidepdf.com/reader/full/uc-regent-pattiz-financial-disclosure 7/22

SCHEDULE A-1

Investments

Stocks, Bonds, and Other Interests(Ownership Interest is Less Than 10%)

Do not attach brokerage or financial statements.

~ NAME OF BUSINESS ENTITY

NOKIA CORPORATION

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

COMMUNICATION EQUIPMENT

I"I'.IR MARKET VALUE

!X l S2,000 - $10,000

o $100,001 - 51,000,000

0$10,001 - $100,000

DOver $1,000,000

NATURE OF !NVESTMENT

!Xl Stock

UOther 

(Describe)

IF APPLICABLE, LIST DATE:

--1--1~

ACQUIRED

--1--1~

DISPOSED

~ NAME OF BUSINESS ENTITY

SCHLUMBERGER LTD

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

OIL & GAS EQUIPMENT & SERVICES

FAIR MARKET VALUE

I 2 S J $2,000 - S10,000

o $100,001 - $1,000,000

o $10,001 - $100,000

DOver $1,000,000

NATURE OF INVESTMENT

[g J Stock

n Other 

(DeSCribe)

IF APPLICABLE, LIST DATE:

--1--1~

ACQUIRED

--1--1~

DISPOSED

~ NAME OF BUSINESS ENTITY

SOUTHWESTERN ENERGY CO

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

INDEPENDENT OIL AND GAS

FAIR MARKET VALUE

o $2,000 - $10,000

o $100,001 - $1,000,000

[ Z J $10,001 - 5100,000

DOver $1,000,000

NATURE OF !NVESTMENT

IX! Stock

"=------------------------------

____ ..J!!L

CAUFORNIA FORM 700FAL~pounCAL PRACTICESCOMMISSION

arne

ORMAN JOEL PATTIZ

~ NAME OF BUSINESS ENTiTY

3M COMPANY

GENERAL DESCRIPTION OF BUSINESS ACTiVITY

CONGLOMERATES

FAIR MARKET VALUE

o $2,000 - $10,000

o $100,001 - $1,000,000

[ Z J $10,001 - $100,000

DOver $1,000,000

NATURE OF INVESTMENT

~ Stock

o Other ------------------(Describe)

IF APPLICABLE, LIST DATE:

--1--.-J~  

ACQUIRED

--1--1~

DISPOSED

~ NAME OF BUSINESS ENTITY

TEVA PHARMACEUTICAL

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

DRUG MANUFACTURERS

FAIR MARKET VALUE

IZ I $2,000 - $10,000

0$100,001 - $1,000,000

o $10,001 - $100,000

DOver $1,000,000

NATURE OF INVESTMENT

[g J Stock

o Other --------------------------------(Describe)

IF APPLICABLE, LIST DATE:

--1---1~

ACQUIRED

--1--1~

DISPOSED

~ NAME OF BUSINESS ENTITY

THERMO FISHER SCIENTIFIC

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

SCIENTIFIC & TECHNICAL INSTRUMENTS:::'i',

FAIR MARKET VALUE

[g J $2,000 - $10,000

o $100,001 - $1,000,000

0$10,001 - $100,000

DOver 51,000,000

NATURE OF INVESTMENT

[g J Stock

o Other ---------------------------------(Describe)

IF APPLICABLE, LIST DATE:

~---1~

ACQUIRED ~~~ DISPOSED

Page 8: UC Regent - Pattiz - Financial Disclosure

8/14/2019 UC Regent - Pattiz - Financial Disclosure

http://slidepdf.com/reader/full/uc-regent-pattiz-financial-disclosure 8/22

Page 9: UC Regent - Pattiz - Financial Disclosure

8/14/2019 UC Regent - Pattiz - Financial Disclosure

http://slidepdf.com/reader/full/uc-regent-pattiz-financial-disclosure 9/22

SCHEDULE

.Investments

Stocks, Bonds, and Other Interests(Ownership Interest is Less Than 10 0 /0 )

Do  not attach brokerage or financial statements.

~ NAME OF· BUSlt'-JESS ENTITY

WESTERN UNION. .

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

PERSONAL SERVICES-

F ,A J R rv1A~RKET\/ALUE

o $~,OOO - $10,000

o $100,001 - $1,000,000

. fX l $10,001 - $100,000t.: .4

DOver $1 ,000,000

NATURE OF fNVESTf\1ENT

1 8 l Stock

D Other .

(Describe)

IF APPLICABLE, LIST DATE:

  _.--if· /   08ACQUIRED

_-..",1/  I  08

DISPOSED

~~AME OF BUSINESS ENTITY

WAL-MART STORES. .

GENERAL DESCRIPTION OF BUS1NESS ACTIVITY

DISCOUNT VARIETY-STORE

FAIR MARKET .VALUE

[8 J $2,000 - $10,000

I I $100,001 - $1,000,000

D$10,001 - $100.000

DOver $1 ,000,000

NATURE OF INVESTMENT

.IX ) Stock

o Other . , .(Describe)

IF APPL.tCABLE, LIST DATE:

, / / 08_

ACQUIRED

_ I / 08

DISPOSED

.....,-

'N JOEL PATTlZ-

~ NAME OF BUSINESS ENTln-

-GENERAL DESCRIPTION OF B U S tN E S ·~,-·

-FAIR MARKET VALUE. . . . . . - . - - .. - - - . . . .

o $2.000 - $10,000

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

o $10,001 - $100,000

DOver $1,000,000

NATURE OF INVESTMENT

o Stock

[] Other __

(Describe)

IF APPLICABLE, LIST DATE:

----J./_= I  08 ACQUIRED

 _--....II  I  08 

DISPOSED

~ NAME OF BUSINESS ENTITY

-GENERAL DESCRIPTION OF BUSINESS ACTIVITY

. 1 . J' d •

FAIR MARKET VALUE

o $2,000 - $10,000

o $100,001 - $1,000,000

D $10,001 - $100,000

DOver $1,000,000

NATURE OF INVESTMENT

o Stock

o Other · - '(Describe)

IF APPLICABLE, LIST DATE:

---.I /   08AC·QUIRED

 _---.J1 I  08 DISPOSED

NAME OF BUSINESS EN-TITY

GENERAL DESCRIPTION OF BUStNESS ACTIVITY

FAIR MARKET VALUE

o $2,000-$10,000

o $100.001 - S1,OOO,OOO

o $10,001 - $100,000

nOver $1,000,000

if sl

III•

I I •

, I i ,,I I :, !I •I

1' 1 I I, . '

l ! : :. . .

:~·~)'It'

I

~ il\ 

~ f!'l~   I ) ' " _

" " , "

~ NAME OF BUSINESS ENTITY

. .

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

FAIR MARKET VALUE

D$2,000 - $10,000

o $100,001 - $1,000,000

D $1.0,001 - $100,000

DOver $1,000,000

NATURE OF INVESTMENT

o Stock

. -•

Orner (Describe)

J r - "  R ILE .. LI·ST D·ATE:

_ _ _ _ _ I   I 08  _-.4j. I 08 DISPOSED'ii' f J R · ~ E . , . , 1 1

U"L '!. I · ·il .\  

- . -III

. . .

FPPC Form 700 (2008/20 09) Schw A-1

Page 10: UC Regent - Pattiz - Financial Disclosure

8/14/2019 UC Regent - Pattiz - Financial Disclosure

http://slidepdf.com/reader/full/uc-regent-pattiz-financial-disclosure 10/22

SCHEDULE A-1

Investments

Stocks, Bonds, and Other Interests(Ownership Interest is Less Than 10%)

Do not attach brokerage or financial statements.

NAME OF BUSINESS ENTITY

ISHARES TR S&P

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

MUNICIPAL BOND FUND

FAIR MARKET VALUE

D52.000 - $10,000

~ $100,001 - 51,000,000

o $10,001 - $100,000

DOver  $1,000,000

NATURE OF INVESTMENT

o Stock

~ Other   BOND FUND(DesCribe)

IF APPLICABLE, LIST DATE

---1---1~ACQUIRED

---1---1~DISPOSED

~ NAME OF BUSINESS ENTITY

CGM FOCUS

NAME OF BUSINESS ENTITY

SECTOR SPDR TR SHS BEN INT ENERGY

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

ENERGY FUND

FAIR MARKET VALUE

0$2,000 - S10,000

o 5100,001 - $1,000,000

~ S10,001 - $100,000

DOver  $1,000,000

NATURE OF INVESTMENT

~ Stock

(Describe)

IF APPLICABLE, LIST DATE:

---1---1~

ACQUIRED

---.!---1~

DISPOSED

CALIFORNIA FORM 700FAIR POunCAL PRACTICES COMMISSION

Name

NORMAN JOEL PATTIZ

~ NAME OF BUSINESS ENTITY

NUVEEN TRADEWINDS GLOBAL

GENERAL DESCRIPTION OF BUSiNESS ACTIVITY

WORLD STOCK FUND

FAIR MARKET VALUE

o 52,000 - $10,000

o 5100,001 - $1,000,000

o $10,001 - $100,000

DOver  $1,000,000

NATURE OF INVESTMENT

o Stock

~ Other   MUTUAL FUND(Describe)

IF APPLICABLE, LIST DATE:

---1---1~ACQUIRED

---1---1~DISPOSED

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

LARGE BLEND FUND

FAIR MARKET VALUE

o $2,000 - $10,000

o $100,001 - $1,000,000

~ $10,001 - $100,000

DOver  $1,000,000

NATURE OF INVESTMENT

o Stock

1 Z J Other  MUTUAL FUND(Describe)

IF APPLICABLE, LIST DATE:

---1---1~

ACQUIRED

---1---1~

DISPOSED

NAME OF BUSINESS ENTITY

IVA WORLDWIDE FUND CL I

~ NAME OF BUSINESS ENTITY

FAIRHOLME FUND

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

WORLD ALLOCATION FUND

FAIR MARKET VALUE

0$2,000 - S10,OOO

o $100,001 - S1,000,000

o $10,001 - 5100,000

DOver  51,000,000

iV.A.IURE OF INVESTMENT

nStccl:

X ::5= ~)

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

LARGE BLEN FUND

FAIR MARKET VALUE

0$2,000 - 510,000

0$100,001 - 51,000,000

 jg] $10,001 - 5100,000

DOver  $1,000,000

NATURE OF INVESTMENT

o Stock

1 Z J Other  MUTUAL FUND(DesCribe)

IF APPLICABLE, LIST DATE:

---1---1~

ACQUIRED

---1---.!~

DISPOSED

FPPC Form 700 (2008/2009) Sch. A-1

FPPC Toll-Free Helpline: 866/ASK-FPPC wwwJppc.ca.gov

Page 11: UC Regent - Pattiz - Financial Disclosure

8/14/2019 UC Regent - Pattiz - Financial Disclosure

http://slidepdf.com/reader/full/uc-regent-pattiz-financial-disclosure 11/22

SCHEDULE A-1

Investments 

Stocks, Bonds, and Other Interests (Ownership Interest is Less Than 10%)

Do not attach brokerage or financial statements.NAME   OF B USI NE S S E NTI TY  

T ARGA RE PARTNERS LP

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

FAIR MARKET VALUE

o $2,000 - $10,000

$100,001 - Sl,OOO,ooo ~ S10,001 - $100,000

DOver  $1,000,000

ATURE OF INVESTMENT

o Stock

Other  .!:!MITED PARTNER  * 

(Describe)

APPLICABLE, LIST  DATE:

C A LIFO R N IA FO R M

FAIR POl/TICAL PRACTICES

-NORMAN PA

~ NAME OF BUSINESS  ENTITY

GPS NEW EQUITY  FUND LPGENERAL DESCRIPTION  OF BUSINESS ACTIVITY

MANAGED ASSET FUND

FAIR MARKET VALUE

0$2,000 - $10,000

~ $100,001 - $1,000,000

IF APPliCABLE, liST DATE:

--l--l--.!lL

ACQUIRED

~ NAME OF BUSINESS ENTITY

MKA GPS LENDING LLC

0$10,001 - S100,000

DOver  51,000,000

NATURE OF INVESTMENT 

o Stock

f2 j  Other  LIMITED PARTNER-= 

(Describe)

MANAGED ASSET FUND

FAIR MARKET VALUE

0$2,000 - 510,000

0$100,001 - 51,000,000

IF APPliCABLE, LIST  DATE:

--l--l--.!lLACQUIRED

E  OF BUSINESS ENTITY

PS INCOME FUND

F BUSINESS ENTITY 

HIGH YIELD EQUITY  FUNDDESCRIPTION OF BUSINESS ACTIVITY

GED ASSET FUND

KET VALUE

- $10,000

- $1,000,000o $10,001 - $100,000

~ Over $1,000,000

ERAL DESCRIPTION OF BUSINESS ACTIVITY

NAGED ASSET FUND

MARKET VALUE

,000 - $10,000

00,001 - $1,000,000 o $10,001 - $100.000

DOver  $1,000,000

E OF INVESTMENT

tock

ther  LIMITED PARTNER *

(Describe)

CABLE, liST DATE:

----I--l--.!lLDISPOSED

GENERAL DESCRIPTION OF BUSiNESS ACTIVITY

~ $10,001 - $100,000

DOver  $1,000.000

NATURE  OF INVESTMENT 

o Stock

Ig j Other . . 0 MITED PARTNER * 

(Describe)

F INVESTMENT

LIMITED PARTNER *-------{:::-De-scri-::-be7') _

~

--l----l--.!lLDISPOSED

~ NAME OF BUSINESS ENTITY 

GENERAL DESCRIPTION  OF BUSINESS ACTIVITY

FAIR MARKET  VALUE

o $2,000 - 510,000

0$100,001 - 51,000,000 0$10,001 - $100,000

DOver  $1,000.000

NATURE OF INVESTMENT

o StOck

o Other 

-----------------~(D~e~sc=H~be~)----------- '-

IF APPLICABLE, liST DATE:

Page 12: UC Regent - Pattiz - Financial Disclosure

8/14/2019 UC Regent - Pattiz - Financial Disclosure

http://slidepdf.com/reader/full/uc-regent-pattiz-financial-disclosure 12/22

Page 13: UC Regent - Pattiz - Financial Disclosure

8/14/2019 UC Regent - Pattiz - Financial Disclosure

http://slidepdf.com/reader/full/uc-regent-pattiz-financial-disclosure 13/22

SCHEDULE A-1

Investments

Stocks, Bonds, and Other Interests(Ownership Interest is Less Than 10%)

Do not attach brokerage or financial statements.

~ NAME OF BUSINESS ENTITY

ESC CONSECO

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

CORPORATE BOND

FAIR MARKET VALUE

$2,000 - $10,000

IXi S100,001 - 51,000,000

o $10,001 - S100,000

DOver  $1,000,000

NATURE OF INVESTMENT

o Stock

~ Other   FIXED INCOME(Describe)

IF APPLICABLE, LIST DATE:

~~~ ACQUIRED ~~~ DISPOSED

~ NAME OF BUSINESS ENTITY~ NAME OF BUSINESS ENTITY

SOUTHPORT CLO LTD

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

CORPORATE BOND

FAIR MARKET VALUE

o $2,000 - $10,000

o S100,001 - S1,OOO,Ooo

1 8 1 510,001 - 5100,000

DOver  $1,000,000

NATURE OF INVESTMENT

o Stock

~ Other   FIXED INCOME(Describe)

IF APPLICABLE, LIST DATE:

~~~ ACQUIRED

~~~ DISPOSED

CALIFORNIA FORM 700FAIR POUTICAL PRACTICES COMMISSION

Name

NORMAN JOEL PATTIZ

~ NAME OF BUSINESS ENTITY

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

FAIR MARKET VALUE

0$2,000 - $10,000

o S100,001 - $1,000,000

o $10,001 - $100,000

DOver  $1,000,000

(Describe)

IF APPLICABLE, LIST DATE:

~~~ ACQUIRED ~~~ DISPOSED

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

FAIR MARKET VALUE

o S2,000 - $10,000

o S100,001 - $1,000,000

o $10,001 - $100,000

DOver  $1,000,000

(Describe)

IF APPLICABLE, LIST DATE:

~----.I~

ACQUIRED

----.I----.I~

DISPOSED

~ NAME OF BUSINESS ENTITY ~ NAME OF BUSINESS ENTITY

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

FAIR MARKET VALUE

o52,000 - 510,000

0$100,001 - 51,000,000 o$10,001 - $100,000

DOver  $1,000,000

NATURE OF !NVESTMENT

o Stock

o Other (Describe)

-----1---1~

::;;S?OS:::O

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

~,

FAIR MARKET VALUE

o $2,000 - $10,000

o $100,001 - $1,000,000 o$10,001 - S100,000

DOver  $1,000,000

NATURE OF INVESTMENT

o Stock

o Other ----- _

(Describe)

IF APPLICABLE, LIST DATE:

~~~ ACQUIRED

----.I----.I~

DISPOSED

~~_.~.L5; _

FPPC Form 700 (2008/2009) Sch. A-1

FPPC Toll-Free Helpline: 866/ASK-FPPC www.fppc.ca.gov

Page 14: UC Regent - Pattiz - Financial Disclosure

8/14/2019 UC Regent - Pattiz - Financial Disclosure

http://slidepdf.com/reader/full/uc-regent-pattiz-financial-disclosure 14/22

SCHEDULE A-1

Investments

Stocks, Bonds, and Other Interests(Ownership Interest is Less Than 10%)

Do not attach brokerage or financial statements.

NAME OF BUSINESS ENTITY

PIMCO CALIF MUN INCOME FUND II

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

NON DIVERSIFIED INVESTMENT CO

FA!R MARKET VALUE

I I S2,OOO - $10,000

o S100,001 - $1,000,000

~ $ 10 ,0 01 - S IO O,O OO

DOver  $1.000,000

NATURE OF INVESTMENT

I X ! Stock

o Other ----------;;:::::::;;;:::::;-------(Describe)

IF'APPLICABLE, LIST DATE:

-.--1 ~....illLACQUIRED

  __ I-.--1....illL

DISPOSED

~ NAME OF BUSINESS ENTITY

WESTWOOD ONE INCNAME OF BUSINESS ENTITY

PIMCO CALIF MUN INCOME FUND

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

NON DIVERSIFIED INVESTMENT CO

FAIR MARKET VALUE

o $2,000 - $10,000

o $100,001 - $1,000,000

~ 510,001 - S100,OOO

DOver  $1,000,000

NATURE OF INVESTMENT~ Stock

o Other ---------::::---.::-::-:-------(Describe)

!F APPLICABLE, LIST DATE:

-.--1~....illLACQUIRED

----1----1....illL

DISPOSED

~ NAME OF BUSINESS ENTITY~ NAME OF BUSINESS ENTITY

S & P 500 DEPOSITORY RECEIPT

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

INDEX FUND

FAIR MARKET VALUE

o $2,000 - S10,000

!Z l $100,001 - $1,000,000

o $10,001 - $100,000

DOver  $1,000,000

NATURE OF INVESTMENT

~ Stock

LJ Omer  ~==~--------(Describe)

_____ f~ ~~....illLCIS?OS:::D

CALIF ORNIA FORM 700FAIR POUnCAL PRACTICES COMMISSION

Name

NORMAN PATTl

~ NAME OF BUSINESS ENTITY

VANGUARD EMERGING MKTS VIPERS

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

INDEX FUND

FAIR MARKET VALUE

o $2,000 - $10,000

0$100,001 - $1,000,000

I X l $10,001 - $100,000

DOver  51,000,000

NATURE OF INVESTMENT

~ Stock

o Other ------------:::--::-:-----------(Describe)

IF APPLICABLE, LIST DATE:

-.--1-.--1~ DISPOSED

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

RADIO BROADCASTING

FAIR MARKET VALUE

o 52,000 - $10,000

05100,001 - $1,000,000

I X l $10,001 - 5100,000

DOver  $1,000,000

NATURE OF INVESTMENT

I X l Stock

o Other --------------::::---.::-::-:---------(Describe)

IF APPLICABLE, LIST DATE:

~~....illLACQUIRED

-.--1-.--1....illLDISPOSED

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

FAIR MARKET VALUE

0$2,000 - $10,000

0$100,001 - $1,000,000

0$10,001 - $100,000

Dover  $1,000,000

NATURE OF INVESTMENT

o Stock

o Other ------------------(Describe)

IF APPLICABLE, LIST DATE:

~----1....illL

ACQUIRED

-.--1-.--1....illL

DISPOSED

~~~~: ---------------------------------------------------~--------

FPPC Form 700 (2008/2009) Sch

Page 15: UC Regent - Pattiz - Financial Disclosure

8/14/2019 UC Regent - Pattiz - Financial Disclosure

http://slidepdf.com/reader/full/uc-regent-pattiz-financial-disclosure 15/22

SCHEDULE A-1

Investments

Stocks, Bonds, and Other Interests(Ownership Interest is Less Than 10%)

00 not attach brokerage or financial statements.

~ NAME OF BUSINESS ENTITY

INTEL CORP

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

FAIR MARKET VALUE

U$2,000 - $10,000

nS100,001 - 51,000,000

o $10,001 - $100,000

DOver  $1,000,000

NATURE OF INVESTMENT

!Xi Stock

(Describe)

IF APPLICABLE, LIST DATE:

~~~1 ~~~ACQUIRED DISPOSED

CALIFORNIA FORM 700FAIR POUTICAL PRACTICES COMMISSION

Name

NORMAN JOEL PATTIZ

~ NAME OF BUSINESS ENTITY

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

FAIR MARKET VALUE

0$2,000 - $10,000

o $100,001 - $1,000,000

0$10,001 - $100,000

DOver  51,000,000

NATURE OF INVESTMENT

o Stock

o Other -- _

(DeSCribe)

IF APPLICABLE, LIST DATE:

-..-J-..-J~ACQUIRED

-..-J-..-J~DISPOSED

~ NAME OF BUSINESS ENTITY

INTEL GAME TECHNOLOGY

~ NAME OF BUSINESS ENTITY

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

FAIR MARKET VALUE

D $2,000 - 510,000

0$100,001 - $1,000,000

D $10,001 - S100,000

DOver  $1,000,000

NATURE OF INVESTMENT

~ Stock

o O~er __

(Describe)

IF APPLICABLE, LIST DATE:

~~t:1f:a1 ~~~  ACQUIRED DISPOSED

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

FAIR MARKET VALUE

D $2,000 - $10,000

o $100,001 - $1,000,000

D $10,001 - $100,000

DOver  $1,000,000

NATURE OF INVESTMENT

oStock

D Other-- _

(Describe)

IF APPLICABLE, LIST DATE:

-..-J-..-J.§LACQUIRED

-..-J-..-J~DISPOSED

~ NAME OF BUSINESS ENTITY

PEPSICO

~ NAME OF BUSINESS ENTITY

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

FAIR MARKET VALUE

D $2,000 - $10,000

D S100,001 - 51,000,000

D $10,001 - $100,000

DOver  $1,000,000

,\lATURE OF INVESTMENT

~ Stock

[ J O~er ~-~-------_

(DeSCribe)

r;:'.??UCABL::.US, JATE:

~O ____ ' .!m _:!J_LE...i.§L

J!SPOS::D

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

FAIR MARKET VALUE

D $2,000 - $10,000

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

D $10,001 - $100,000

DOver  $1,000,000

NATURE OF INVESTMENT

D Stock

D Other ------------- ~-----------(Describe)

IF APPLICABLE, LIST DATE:

-..-J-..-J.§L

ACQUIRED

-..-J-..-J~DISPOSED

FPPC Form 700 (2008/2009) Sch. A-1

FPPC T ll F H l li /ASK FPPC f

Page 16: UC Regent - Pattiz - Financial Disclosure

8/14/2019 UC Regent - Pattiz - Financial Disclosure

http://slidepdf.com/reader/full/uc-regent-pattiz-financial-disclosure 16/22

SCHEDULE A-1

Investments

Stocks, Bonds, and Other Interests(Ownership Interest is Less Than 10%)

Do not attach brokerage or financial statements.

~ NAME OF BUSINESS ENTITY

ABERCROMBIE & FITCHGENERAL DESCRIPTION OF BUSINESS ACTIVITY

CLOTHING RETAILER

FAIR MARKET VALUE

0$2,000 - $10,000

nS100,001 - 81,000,000

~ S10,001 - $100,000

DOver $1,000,000

NATURE OF INVESTMENT

I X ! Stock

U Other ---------::::-:-:::::;:-::-;-------(Describe)

IF APPLICABLE, LIST DATE:

IO r'?

~ /~ {i'S" ~~~  

ACQUIRED DISPOSED

CALIFORNIA FORM 700FAIR POUTICAL PRACTICES COMMISSION'

Name

NORMAN JOEL PATTIZ

~ NAME OF BUSINESS ENTITY

FLUOR CORPGENERAL DESCRIPTION OF BUSINESS ACTIVITY

CONSTRUCTION

FAIR MARKET VALUE

o 82,000 - $'10,000

o $100,001 - $1,000,000

~ $10,001 - $100,000

DOver $1,000,000

NATURE OF INVESTMENT

~ Stock

o Other ------- _

(Describe)

IF APPLICABLE, LIST DATE:

~~-..mLACQUIRED

~~~ DISPOSED

~ NAME OF BUSINESS ENTITY

ACE LIMITED

~ NAME OF BUSINESS ENTITY

MARRIOTT INTL

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

FINANCIAL

FAIR MARKET VALUE

o $2,000 - $10,000

0$100,001 - $1,000,000

~ $10,001 - $100,000

DOver $1,000,000

NATURE OF INVESTMENT

~ Stock

o Other -----------------(Describe)

IF APPLICABLE, LIST DATE:

0 ' 1VI(V/~ 

ACQUIRED

~~~ DISPOSED

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

LODGING

FAIR MARKET VALUE

o $2,000 - $10,000

o $100,001 - $1,000,000

~ 510,001 - $100.000

DOver $1,000,000

NATURE OF INVESTMENT

~ Stock

D Other (Describe)

IF APPLICABLE, LIST DATE:

0 ' 7 J 2 5 .J (V/ ,-98'- J. .2 . . .J~~

ACQUIRED DISPOSED

~ NAME OF BUSINESS ENTITY

AIR PRODUCTS & CHEMICALS

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

CHEMICALS

FAIR MARKET VALUE

o $2,000 -510,000

o $100,001 - 51,000.000

~ 510,001 - $100,000

DOver $1,000,000

N.t\TURE OF INVESTMENT

~ Stock

o Other (Describe)

~!~~

OlS?DS=~ 

~ NAME OF BUSINESS ENTITY

MEMC ELECTRONICS

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

SEMI-CONDUCTOR MFG

FXlR MARKET VALUE

~ $2,000 - $10,000

o $100,001 - $1,000,000

0810,001 - $100,000

DOver $1,000,000

NATURE OF INVESTMENT

~ Stock

o Other -'-----------------(Describe)

IF APPLICABLE. liST DATE:

L-) ~~/   (> 9" ~~ ~ACQUIRED DISPOSED

Page 17: UC Regent - Pattiz - Financial Disclosure

8/14/2019 UC Regent - Pattiz - Financial Disclosure

http://slidepdf.com/reader/full/uc-regent-pattiz-financial-disclosure 17/22

SCHEDULE A-1

Investments

Stocks, Bonds, and Other Interests(Ownership Interest is Less Than 10%)

Do not attach brokerage or financial statements.

~ NAME OF BUSINESS ENTITY

TRANSOCEAN INC

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

OIL AND GAS DRILLING

FAIR MARKET VALUE

oS2,000 - 510,000

nS100,001 - S1,000,000

o 510,001 - $100,000

DOver 51,000,000

NATURE OF INVESTMENT

!X i Steck

(Describe)

IF APPLICABLE, LIST DATE:

~I.l7.,'L~ ACQUIRED

~~~ DISPOSED

~ NAME OF BUSINESS ENTITY

GOODRICH CORP

~ NAME OF BUSINESS ENTITY

WESTERN UNION

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

PERSONAL SERVICES

FAIR MARKET VALUE

! X I 82,000 - $10,000

o $100,001 - 51,000,000

o $10,001 - S100,000

DOver $1,000,000

NATURE OF INVESTMENT

IX ] Stock

o Other (Describe)

IF APPLICABLE, lIQ,T DATE:

L/1/ I  j_~ ~~~ACQUIRED DISPOSED

I  

CALIFORNIA FORM 700FAIR POLITICAL PRACTICES COMMISSION

Name

NORMAN JOAL PATTIZ

~ NAME OF BUSINESS ENTITY

CISCO SYSTEMS

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

NETWORKING AND COMMUNICATION

FAIR MARKET VALUE

0$2,000 - 510,000

o 5100,001 - $1,000,000

I X I 510,001 - $100,000

DOver 51,000,000

NATURE OF INVESTMENT

~ Stock

o Other - --:::- _

(Describe)

IF APPLICABLE,}I~T DATE:

~7ACQUIRED

~~~ DISPOSED

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

INDUCTRIAL GOODS

FAIR MARKET VALUE

o $2,000 - $10,000

o $100,001 - $1,000,000

~ $10,001 - S100,000

DOver $1,000,000

NATURE OF INVESTMENT

1 8 1 Stock

o Other (Describe)

IF APPLICABLE, LIST DATE:

~Z-f/...QLACQUIRED

~~~ DISPOSED

~ NAME OF BUSINESS ENTITY

SPX CORP

~ NAME OF BUSINESS ENTITY

EXELON CORP

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

APPLIANCES

FAIR MARKET VALUE

o $2,000 - S10,000

o S100,001 - $1,000,000

I X I 510,001 - $100,000

DOver $1,000,000

NATURE OF INVESTMENT

~ Stock

(DeScribe)

~ 08 r...QL~IS?OSEO

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

UTILITIES

FAIR MARKET VALUEo 52,000 - $10,000

o S100,001 - $1,000,000

1 8 1 510,001 - 5100,000

DOver S1,000,000

NATURE OF INVESTMENT

~ Stock

o Other (Describe)

IF APPLICABLE, LIST DATE

Jj~c:i ACQUIRED

~~~ DISPOSED

FPPC Form 700 (2008/2009) Sch. A-1

FPPC Toll-Free Helpline: 866/ASK-FPPC www.fppc.ca.gov

Page 18: UC Regent - Pattiz - Financial Disclosure

8/14/2019 UC Regent - Pattiz - Financial Disclosure

http://slidepdf.com/reader/full/uc-regent-pattiz-financial-disclosure 18/22

SCHEDULE A-1

Investments

Stocks, Bonds, and Other Interests(Ownership Interest is Less Than 10%)

Do not attach brokerage or financial statements.

~ NAME OF BUSINESS ENTITY

PNC FINANCIAL

FINANCIAL

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

FAIR MARKET VALUE

052,000 - $10,000

0$100,001 - 51,000,000

NATURE OF INVESTMENT

!Xi' Stock

~ 510,001 - S100,000

DOver $1,000,000

o Other (Describe)

IF APPLICABLE, LIST Dp,TE:

fJ  1 ] ,£ : 1

~ ...::-. J ..J ~ ACQUIRED ~~~ DISPOSED

CALIFORNIA FORM 700FAIR POLITICAL PRACTICES COMMISSION

Name

NORMAN JOEL PATTZ

~ NAME OF BUSINESS ENTITY

AMERICA MOVIL

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

WIRELESS COMMUNICATIONS

FAIR MARKET VALUE

o S2,000 - $10,000

o S100,001 - $1,000,000

~ $10,001 - $100,000

DOver $1,000,000

NATURE OF INVESTMENT

~ Stock

o Other -----------------(Describe)

IF APPLICABLE, LIST DATE:. _ -'r   

~ p,: I "0 ...1

ACQUIRED ~~~ DISPOSED

~ NAME OF BUSINESS ENTITY

TORCH MARK CORP

LIFE INSURANCE

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

FAIR MARKET VALUE

0$2,000 - $10,000

0$100,001 - $1,000,000

NATURE OF INVESTMENT

!X l Stock

~ $10,001 - $100,000

DOver S1,000,000

o Other ------------------

IF APPLICABLE, LIST DATE:

 Lt/l/~ACQUIRED

(Describe)

.J.2..J~~DISPOSED

~ NAME OF BUSINESS ENTITY

CHEVRON CORP

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

OIL AND GAS

FAIR MARKET VALUE

0$2,000 - $10,000

0$100,001 - $1,000,000

IZ l $10,001 - $100,000

DOver $1,000,000

NATURE OF INVESTMENT

IZ l Stock

o Other ------------------(Describe)

IF AP~lICABLE, .•L~ST DATE:

~.1.!i;  ~8 ~~~ ACQUIRED DISPOSED

~ NAME OF BUSINESS ENTITY

XILINX

SEMICONDUCTORS

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

FAIR MARKET VALUE

0$2,000 - $10,000

0$100,001 - S1,000,000

NATURE OF INVESTMENT

lZ i Stock

~ $10,001 - $100,000

DOver 51,000,000

: A..=:?~3L:::. l;ST DATE:

o Other (DesCribe)

> 1 ,./  14 :Qr --_._-

.:::::. .....~=::!

.J.Q..;~~DIS?OSED

~ NAME OF BUSINESS ENTITY

EXXON MOBIL

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

OJI..,ANDGAS

FAIR MARKET VALUE

o 52,000 - $10,000

05100,001 - $1,000,000

! Z I $10,001 - $100,000

DOver S1,000,000

NATURE OF INVESTMENT

~ Stock

o Other -----------------(Describe)

IF APPLICABLE, LIST DATE:

07  _ 1 : :. . . /Z - I(~  

ACQUIRED

~~~ DISPOSED

FPPC Form 700 (2008/2009) Sch. A-

FPPC Toll-Free Helpline: 866/ASK-FPPC www.fppc.ca.gov

Page 19: UC Regent - Pattiz - Financial Disclosure

8/14/2019 UC Regent - Pattiz - Financial Disclosure

http://slidepdf.com/reader/full/uc-regent-pattiz-financial-disclosure 19/22

SCHEDULE A-1

Investments

Stocks, Bonds, and Other Interests(Ownership Interest is Less Than 10%)

Do not attach brokerage  or financial statements.

NAME OF BUSINESS ENTITY

EXPRESS SCRIPTS

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

MANAGEMENT SERVICES

FAIR MARKET VALUE

o S2,000 - $10,000

o S100,001 - 51,000,000

~ $10,001 - 5100,000

DOver $1,000,000

NATURE OF INVESTMENT

Xi Stock

o Other (Describe)

F APPLICABLE, liST DATE:

07

L~~ACQUIRED~~~ 

DISPOSED

CALIFORNIA FORM 700FAIR POUnCAl PRACTICES COMMISSIO

Name

NORMAN JOEL PATIIZ

~ NAME OF BUSINESS i::NTITY

ORACLE CORP

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

APPLICATION SOFTWARE

FAIR MARKET VALUE

o $2,000 - $10,(WO 

o 5100,001 - $1,000,000

igj 510,001 - $100,000

DOver 51,000,000

NATURE OF iNVESTMENT

~ Stock

o Other (Describe)

IF APPLICABLE, LIST DATE:

_L-1-iJ  p ; ~ ~ ~  ACQUIRED DISPOSED

~ NAME OF BUSINESS ENTITY

NEWS CORP

NAME OF BUSINESS i::NTITY

FIRSTENERGY

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

UTILITIES

AIR MARKET VALUE

$2,000 - $10,000

o S100,001 - $1,000,000

I 2 : $ l 510,001 - $100,000

DOver 51,000,000

ATURE OF INVESTMi::NT

Stock

o Other (DeSCribe)

F APPLICABLE, LIST DATE:

., _ <1/  ~QI>

ACQUIRED

~~~ DISPOSED

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

ENTERTAINMENT SERVICES

FAIR MARKET VALUi::

o $2,000 - $10,000

o $100,001 - $1,000,000

~ $10,001 - 5100,000

DOver $1,000,000

NATURE OF INVESTMENT

Igj Stock

o Other (Describe)

IF APPLICABLE, L1;;T DATE:

3-·r  a~~ ~~-'-

ACQUIRED~~~ 

DISPOSED

AME OF BUSINESS ENTITY

GENERAL CABLE~ NAME OF BUSINESS ENTITY

THERMO FISHERENERAL DESCRIPTION OF BUSINESS ACTIVITY

NDUSTRY ELECTRICAL

AIR MARKET VALUE

j $2,000 - $10,000

o $100,001 - $1,000,000

o $10,001 - 5100,000

DOver $1,000,000

ATURE OF iNVESTMENT

Stock

(Describe)

10/~~ 

---==S?GS:::J

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

SCIENTIC AND TECHNICAL EQUIPMENT

FAIR MARKET VALUE

o $2,000 - $10,000

o $100,001 - $1,000,000

IZ l $10,001 - $100,000

DOver $1,000,000

NATURE OF INVESTMENT

1 8 I Stock

o Other - ::-- _

(Describe)

IF APfLiCABLE, ~!ST DATE

~ I& t_-d _r ~~~ACQUIRED DISPOSED

~~\...1. II,\:YL.vll\"lIC.lliT

Page 20: UC Regent - Pattiz - Financial Disclosure

8/14/2019 UC Regent - Pattiz - Financial Disclosure

http://slidepdf.com/reader/full/uc-regent-pattiz-financial-disclosure 20/22

SCHEDULE A-1

Investments

Stocks, Bonds, and Other Interests(Ownership Interest is Less Than 10%)

Do not attach brokerage or financial statements.

~ NAME OF BUSINESS ENTITY

EMERSON ELECTRIC

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

INDUSTRIAL EQUIPMENT

FAIR MARKET VALUE

o 82,000 - $10,000

o $100,001 - S1,000,000

I X i S10,001 - $100,000

DOver $1,000,000

NATURE OF INVESTMENT

I X i Stock

(Describe)

IF APPLICABLE, LIST DATE:

-a? ~~~ .J.Q..;..Q§0...illL

ACQUIRED DISPOSED

CALIFORNIA FORM 700FAIR POLITICAL PRACTICES COMMISSION

Name

NORMAN JOEL PATTZ

~ NAME OF BUSINESS ENTITY

CVS CAREMARK

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

DRUG STORES

FAIR MARKET VALUE

0$2,000 - S10,000

o 8100,001 - 81,000,000

~ S10,00'1- $100,000

DOver $1,000,000

NATURE OF INVESTMENT

I X i Stock

o Other (Describe)

IF APPLICABLE, LIST DATE:

,...----- 07~~~ .J.Q..;.2G~  

ACQUIRED DISPOSED

~ NAME OF BUSINESS ENTITY

NORTHERN TRUST

~ NAME OF BUSINESS ENTITY

GENERAL MILLS

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

FINANCIAL

FAIR MARKET VALUE

o $2,000 - $10,000

o 8100,001 - $1,000,000

o $10,001 - S100,000

DOver $1,000,000

NATURE OF INVESTMENT

~ Stock

(Describe)

IF APPLICABLE, LIST DATE:

07 

~.!2J~ ACQUIRED

~~...illLDISPOSED

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

CONSUMER GO.ODS

FAIR MARKET VALUE

o $2,000 - $10,000

0$100,001 - $1,000,000

I X i $10,001 - $100,000

DOver $1,000,000

NATURE OF INVESTMENT

I X ! Stock

o Other (Describe)

IF APPLICABLE, LIST DATE:

.. 07  . - ! : : : . . J  l: . . i. J  ,Q8

ACQUIRED

~~...illLDISPOSED

~ NAME OF BUSINESS ENTITY

FOREST LABS

~ NAME OF BUSINESS ENTITY

GENZYME CORP

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

DRUG MFG

FAIR MARKET VALUE

~ $2,000 - S10,000

o 5100,001 - 51,000,000

0$10,001 - $100,000

DOver $1,000,000

NATURE OF INVESTMENT

I X ! Stock

n Other (Describe)

IF A??UCABL'::. liS-:- DAT':::

~ , , , , , , ? ~~~...illL

DiSPOSED

s VESTMENT

FPPC Form 700 (2008/2009) Sch. A-1FPPC Toll-Free Helpline: 866/ASK-FPPC www.fppc.ca.gov

H.B

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

BfOTECH

FAIR MARKET VALUE

o82,000 - $10,000

o S100,001 - 51,000,000

~ $10,001 - $100,000

DOver 81,000,000

NATURE OF INVESTMENT

I Z I Stock

o Other --------~-,-------(Describe)

IF APPLICABLE, LIST DATE:

~(:r;~7 ~~~

ACQUIRED DISPOSED

Page 21: UC Regent - Pattiz - Financial Disclosure

8/14/2019 UC Regent - Pattiz - Financial Disclosure

http://slidepdf.com/reader/full/uc-regent-pattiz-financial-disclosure 21/22

SCHEDULE A-1

Investments

Stocks, Bonds, and Other Interests(Ownership Interest is Less Than 10%)

Do not attach brokerage or financial statements.

~ NAME OF BUSINESS ENTITY

MEDTRONIC INC

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

MEDICAL APPLIANCES

FAIR MARKET VALUE

n$2.000 - 510,000

i 1$100,001 - $1.000,000

~ $10,001 - 5100,000

DOver  51,000,000

NATURE OF INVESTMENT

!Xl Stock

n Other  (Describe)

IF APPLICABLE, LIST DATE:

2/"2.0 /~ ~~~

ACQUIRED DISPOSED

CALIFORNIA FORM 700. FAIR POLITICAL PRACTICES COMMISSION

Name

NORMAN JOEL PATTIZ

~ NAME OF BUSINESS ENTITY

PROCTOR AND GAMBLE

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

CONSUMER GOODS

FAIR MARKET VALUE

0$2,000 - $10,000

o 5100,001 - 51,000,000

Igj $10,001 - $100,000

DOver  51,000,000

NATURE OF INVESTMENT

~ Stock

o Other ------------------(Describe)

IF APPLICABLE, LIST. DATE:

->-~~llL; ~ 7'ACQUIRED

~~~ DISPOSED

~ NAME OF BUSINESS ENTITY

MERCK& CO

~ NAME OF BUSINESS ENTITY

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

DRUG MFG

FAIR MARKET VALUE

o 52,000 - $10,000

0$100,001 - 51,000,000

~ $10,001 - $100,000

DOver  $1,000,000

NATURE OF INVESTMENT

~ Stock

o Other ------------------(Describe)

IF APPLICABLE, LIST DATE:

C-- 07 

~~~ ACQUIRED

J_l.J __~~DISPOSED

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

FAIR MARKET VALUE

o $2,000 - $10,000

o $100,001 - $1,000,000

0$10,001 - $100,000

DOver  $1,000,000

NATURE OF INVESTMENT

o Stock

o Other ---------::::--::-c------(Describe)

IF APPLICABLE, LIST DATE:

.----J.----J ~

ACQUIRED

.----J.----J ~

DISPOSED

~ NAME OF BUSINESS ENTITY

PEPSICO

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

CONSUMER GOODS

FAIR MARKET VALUE

o 52,000 - 510,000

o $100,001 - 51,000,000

[g J 510,001 - $100,000

Dover  $1,000,000

NATURE OF !NVESTMENT

~ Stock

I i Other {Des::nbe} 

o< I { ~

~ NAME OF BUSINESS ENTITY

GENERAL DESCRIPTION OF BUSINESS ACTIVITY

FAIR MARKET VALUE

o 52,000 - 510,000

o $100,001 - $1,000,000

0$10,001 - 5100,000

DOver  $1,000,000

NATURE OF INVESTMENT

o Stock

o Other -----------------(Describe)

IF APPLICABLE, LIST DATE

.----J.----J~

ACQUIRED

.----J.----J . . . . . i l l L .DISPOSED

~~ s.~ OF I"'VESTMENT

FPPC Form 700 (2008/2009) Sch. A

FPPC Toll-Free Helpline: 866/ASK-FPPC www-Fppc.ca.go

Page 22: UC Regent - Pattiz - Financial Disclosure

8/14/2019 UC Regent - Pattiz - Financial Disclosure

http://slidepdf.com/reader/full/uc-regent-pattiz-financial-disclosure 22/22

SCHEDULECIncome, Loans, & Business

Positions

(Other than Gifts and Travel Payments)

CALIFORNIA FORM 700FAIR POLITICAL PRACTICES COMMISSION

Name

NORMAN JOEL PATTIZ

NAME OF SOURCE OF INCOME

1. INCOMERECEIVED ~·1.INCOME RECEIVED

NAME OF SOURCE OF INCOME

WESTWOOD ONE

ADDRESS

8965 LlNDBLADE ST, CULVER CITY, CA 90232

3US!NESS ACTIVITY, IF ANY, OF SOURCE

RADIO BROADCASTING

YOUR BUSINESS POSITION

CHAIRMAN OF THE BOARD

GROSS INCOME RECEIVED

I i S500 • 51,000 0 $1,001 - $10,000

0510,001 - $100,000 ~ OVER $100,000

CONSIDERATION FOR WHICH INCOME WAS RECEIVED~ S al ary 0Spouse's or registered domestic partner's income

o Loan repayment

o Sale of(Properry, car, boat. etc.)

o Commission or 0Rental Income, lis[ each source  of 510,000 or more 

o Other (Describe)

NORMAN PATTIZ 1996 CHARITABLE TRUST

ADDRESS

21731 VENTURA BLVD #300, WOODLAND HILLS

BUSINESS ACTIVITY, IF ANY, OF SOURCE

YOUR BUSINESS POSITION

TRUSTEE

GROSS INCOME RECEIVED

0$500 - $1,000 0 $1,001 - $10,000

~ $10,001 - $100,000 0 OVER $100,000

CONSIDERATION FOR WHICH INCOME WAS RECEIVED

o Salary 0Spouse's or registered domestic partner's income

o Loan repayment

o Sale of(Property. car boar. etc)

o Commission or D Rental Income, list eech source of $10,000  or more 

~ Other TRUST DISTRIBUTION(Describe)

~ 2. LOANSRECEIVEDOR OUTSTANDING:DURINGTHE,REPORTINGPERIOD'

* 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 termsavailable 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 ACTiVITY, IF ANY, OF LENDER

HIGHEST BALANCE DURING REPORTING PERIOD

o 5500 - $1,000

o $1,001 - $10.000

o $10,001 - $100,000

DOVER 5100,000

INTEREST RATE TERM (MonthslYears)

_____ % 0None

SECURITY FOR LOAN

o Personal residence

o Real Property Street address 

City

o Guarantor ---------------------

o Other (Describe)

Comments: