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Statement of Economic Interest CALIFORNIA FORM 700 FAIR POLITICAL PRACTICES COMMISSION (MIDDLE) STATEMENT OF ECONOMIC INTE COVER PAGE AUG 1 1 2005 Please type or print in ink A Public Document NAME (LAST) (FIRST) Dolores CITY Sandoval MAILING ADDRESS STREET (May use business address) 10720 Alderbrook Lane Cupertino 1. Office, Agency, or Court Name of Office, Agency, or Court: City of Cupertino Division, Board, District, if applicable: Your Position: Councilmember - 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) o State o County of [JClty of Cupertino o Multi-County o Other 3. Type of Statement (Check at least one box) o Assuming Officellnitiai Date: ---1---1_ o Annual: The period covered is January 1, 2004, through December 31, 2004. -or- C The period covered is ---1----1_. through December 31, 2004. o Leaving Office Date Left: ---1---1_ (Check one) a The period covered is January 1, 2004, through the date of leaving office. -or- a The period covered is ---1---1_, through the date of leaving office. [J Candidate Ann 725-8939 STATE ZIP CODE OPTIONAL: FAX { E-MAIL ADDRESS CA 95014 4. Schedule Summary (Check applicable schedules or "No reportable interests. ") .. During the reporting period, did you have any reportable interests to disclose on: Schedule A-1 ~es - schedule attached Investments (Less than 10% Ownership) Schedule A-2 0 Yes - schedule attached Investments (10% or greater Ownership) Schedule B ~es - schedule attached Reat Property Schedule C ~es - schedule attached Income, Loans, & Business Positions (Income Other than Gifts and Travel Payments) Schedule D (Eliminated - report loans on Schedule C) Schedule E 0 Yes - schedule attached Income - Gifts Schedule F 0 Yes - schedule attached Income - Travel Payments -or- .. 0 No reportable interests on any schedule Total number of pages Ù completed Including this cover page: - \ 5. Verification I have used aU 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 certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date Signed August 9. 2005 Signature ( FPPC Form 700 (2004/2005) FPPC TolI~Free Helpline: 866/ASK~FPPC SCHEDULE A-1 Investments Stocks, Bonds, and Other Interests (Ownership Interest is Less Than 10%) Do not attach brokerage or financial statements. CALIFORNIA FORM 700 FAIR POLITICAL PRACTICES COMMISSION Name Dolores Sandoval )0 NAME OF BUSINESS ENTITY The Walt Disney Company )0 NAME OF BUSINESS ENTITY GENERAL DESCRIPTION OF BUSINESS ACTIVITY GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE ~ $2.000 . $10,000 0$100,001 - $1,000,000 D $10,001 . $100,000 DOver $1,000,000 FAIR MARKET VALUE D $2,000 . $10,000 0$100.001 . $1.000,000 0$10,001 . $100,000 DOver $1,000,000 NATURE OF INVESTMENT [R Stock o Other NATURE OF INVESTMENT o Stock o Other (Describe) (Describe) IF APPLICABLE, LIST DATE: IF APPLICABLE, LIST DATE: ---1---1...M... ACQUIRED ---1---1...M... DISPOSED ---1---1...M... ACQUIRED ---1---1...M... DISPOSED )0 NAME OF BUSINESS ENTITY )0 NAME OF BUSINESS ENTITY GENERAL DESCRIPTION OF BUSINESS ACTIVITY GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE o $2,000 - $10,000 D $100.001 . $1.000.000 0$10,001 - $100,000 DOver $1,000,000 FAIR MARKET VALUE D $2,000 . $10.000 0$100.001 . $1,000,000 o $10,001 - $100,000 DOver $1,000,000 NATURE OF INVESTMENT o Stock o Other NATURE OF INVESTMENT o Stock o Other (Describe) (Describe) IF APPLICABLE, LIST DATE: IF APPLICABLE, LIST DATE: ---1---1...M... ACQUIRED ---1---1....M... DISPOSED ---1---1...M... ACQUIRED ---1---1....M... DISPOSED ) NAME OF BUSINESS ENTITY ) NAME OF BUSINESS ENTITY GENERAL DESCRIPTION OF BUSINESS ACTIVITY 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 $1,000,000 FAIR MARKET VALUE D $2.000 . $10,000 0$100,001 . $1,000,000 0$10.001 . $100.000 DOver $1,000,000 NATURE OF INVESTMENT D Stock D Other NATURE OF INVESTMENT D Slock o Other ([)ascribe) (Describe) IF APPLICABLE, LIST DATE: IF APPLICABLE, LIST DATE: ---1---1...M... ACQUIRED ---1---1....M... DISPOSED ---1---1...M... ACQUIRED ---1---1...M... DISPOSED Comments: FPPC Form 700 (2004J2005) Sch. A-1 FPPC Toll-Free Helpline: 866/ASK-FPPC CALIFORNIA FORM 700 FAIR POLITICAL PRACTICES COMMISSION SCHEDULE B Interests in Real Property (Including Rental Income) ). STREET ADDRESS OR PRECISE LOCATION 10720 Alderbrook Lane CITY Cupertino Name Doiores Sandovai > STREET ADDRESS OR PRECISE LOCATION CITY FAIR MARKET VALUE IF APPLICABLE, LIST DATE: FAIR MARKET VALUE IF APPLICABLE, LIST DATE 0$2,000 - $10,000 -'-'~ -'-'~ 0$2.000. $10.000 -'-' 04 _I-'~ o $10,001 - $100,OGO ACQUIRED DISPOSED 0$10,001 - $100,000 ACQUIRED DISPOSED IKI $100,001 - $1,000,000 0$100,001 - $1,000,000 DOver $1,000,000 DOver $1,000,000 NATURE OF INTEREST NATURE OF INTEREST ~ OwnershipfDeed of Trust o Easement o Ownership/Deed of Trust D Easement 0 leasehold 0 0 Leasehold 0 Yrs. remaining Other Yrs. remaining Other IF RENTAL PROPERTY, GROSS INCOME RECEIVED 0$0 - $499 0 $500 - $1,000 0 $1,001 - $10,000 0$10,001 . $100,000 0 OVER $100,000 SOURCES OF RENTAL INCOME: If you own a 10% or greater interest, list the name of each tenant that Îs a single source of income of $10,000 or more. NAME OF LENDER* Wells Fargo ADDRESS P.O. Box 14411, Des Moines, IA BUSINESS ACTIVITY OF LENDER Financial Institution INTEREST RATE TERM (Months/Years) 4.875 % 0 Non, 15 years HIGHEST BALANCE DURING REPORTING PERIOD 0$500 - $1.000 0 $1.001 - $10,000 o $10,001 . $100,000 ~ OVER $100.000 D Guarantor, if applicable Comments: IF RENTAL PROPERTY, GROSS INCOME RECEIVED 0$0. $499 0 $500 - $1,000 0 $1,001 - $10.000 0$10,001 - $100,000 0 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. NAME OF LENDER* ADDRESS BUSINESS ACTIVITY OF LENDER INTEREST RATE TERM (Months/Years) % D None HIGHEST BALANCE DURING REPORTING PERIOD 0$500 - $1,000 0 $1,001 . $10.000 0$10,001 - $100,000 0 OVER $100,000 D Guarantor, if applicable * 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 are not reportable. FPPC Form 700 (200412005) Sch. B FPPC Toll-Free Helpline: 866/ASK-FPPC SCHEDULE C Income, Loans* & Business Positions (Other than Gifts and Travel Payments) » 1 NAME OF SOURCE OF INCOME Los Gatos Saratoga Jt. Union High School Dist. ADDRESS 20 High School Ct. LosGatos, CA BUSINESS ACTIVITY, IF ANY, OF SOURCE Education YOUR BUSINESS POSITION Math Teacher GROSS INCOME RECEIVED/HIGHEST BALANCE DURING REPORTING PERIOD, IF LOAN D $500 - $1,000 D $1,001 - $10,000 ~ $10,001 - $100,000 0 OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED IKI Salary 0 Spouse's income 0 Loan repayment o Sale of (Property, car, boat, ete.) D Commission or 0 Rental Income, list each source of $10,000 Of more o Other (Describe) D LOAN RECEIVED (complete box 2) CALIFORNIA FORM 700 FAIR POLITICAL PRACTICES COMMISSION Name Doiores Sandovai » 1 NAME OF SOURCE OF INCOME SLI Systems ADDRESS 350 Sansome St. SF CA 94104 BUSINESS ACTIVITY, IF ANY, OF SOURCE Software YOUR BUSINESS POSITION VP Sales GROSS INCOME RECEIVED/HIGHEST BALANCE DURING REPORTING PERIOD, IF LOAN D $500 - $1,000 D $1,001 - $10,000 o $10,001 - $100,000 ~ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED o Salary IKI Spouse's income 0 Loan repayment o Sale of (Property, cer, boat, etc.) o Commission or 0 Rental Income, list each sOl/rea of $10,0Q{) or more o Other (Describe) o LOAN RECEIVED (complete box 2) » 1 NAME OF SOURCE OF INCOME )0 2 LOAN RECEIVED TERM (MonthslYears) ADDRESS BUSINESS ACTIVITY, IF ANY, OF SOURCE YOUR BUSINESS POSITION GROSS INCOME RECEIVED/HIGHEST BALANCE DURING REPORTING PERIOD, IF LOAN D $500 - $1,000 D $1.001 - $10.000 0$10,001 - $100,000 0 OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED o Salary 0 Spouse's income 0 Loan repayment o Sale of (Property, car, boat, etc.) o Commission or 0 Rental Income, list each source of $10,000 or more o Other (Describe) o LOAN RECEIVED (complete box 2) INTEREST RATE % o None SECURITY FOR LOAN o None 0 Personal residence o Real Property Street eddress City o Guarantor o Other (Describe) . You are not required to report loans from commerciai 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 terms availabie to members of the public without regard to your officiai status. Comments: FPPC Fonn 700 (200412005) Sch_ C FPPC Toll-Free Helpline: 866/ASK·FPPC