'.

• •
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CALIFORNIA
, , FORM . 700 ~EMENT OF ECONOMIC INTEREspECEI "'([~~!y
~~ed

~ l1G~
FAIR-PPLITICAL PRACTICES COMMISSION

A PUBLIC DOCUMENT
COVER PAGE FEB .
Please type or print in ink.
NAME OF FILER ILAST) (FIRST) Bi: (MiDDLE)

Davis Mike
1. Office, Agency, or Court
Agency Name
California State Assembly
Division, Board, Department, District, if applicable Your Position
48th AD Assemblymember
~ If filing for multiple positions, list below or on an attachment.
~J -'.,
Agency: Position:
w ~._:;'0 {7-:
2. Jurisdiction of Office (Check at least one box) I :...r~-n!:}
[2lState o Judge (Slalewide Jurisdiction) .r:- ,_. cc ,',.
~. ~5:~c
D Multi·County _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ o County of - - - - - - - - - - - - . ; ; ; , . ; ; -.•---o~~ :n;~
o City of _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ o Other _ _ _ _ _ _ _ _ _ _ _-'S''''--'-';;':-:.'c.."_
3. Type of Statement (Check at least one box)
~ Annual: The period covered is January 1, 2010, through December 31, o Leaving Office: Date Left --1--1_ _
2010. (Check one)
·or·
The period covered is --1--1_ _, through December 31, o The period covered is January 1, 2010, through the date of
2010, leaving office.

o Assuming Office: Date --1--1_ _ o The period covered is --1--1_ _, through the date
of leaving office.

o Candidate: Election Year _ _ _ _ __ Office sought, if different than Part 1: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

4. Schedule Summary
Check applicable schedules or "None." ~ Total number of pages including this cover page: _4-,-_
o Schedule A·1 • Investments - schedule attached o Schedule C • Income, Loans, & Business Positions - schedule attached
o Schedule A,2 • Investments - schedule attached ~ Schedule 0 • Income - Gifts - schedule attached
o Schedule B ' Real Properly - SChedule attached ~ Schedule E • Income - Gifts - Travel Payments - schedule attached

-Of-
o None· No reporlable interests on any schedule

I certify under penalty of perjury under the laws of the State of California that

Date Signed _ _ _ _0;::2::,;:;0"'1,"'2=::0='1..:.1_ _ __

(month. day, year)
Signatur ‭‫⁦‮‬‭⁾⁾⁾⁾⁾⁙›⁾⁾⁾⁾›‼‧›※※›‽‽‭‭‭‭

FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov

 CALIFORNIA FORM 700
FAIR POliTICAL PRACTICES COMMISSION
SCHEDULE D
Income - Gifts

II>- NAME OF SOURCE Ii>- NAME OF SOURCE

Office of the Governor California State Protocol Foundation

ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable)

State Capitol, Sacramento, CA 95814

BUSINESS ACTIVITY, IF ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE

DATE (mmfddfyy) VALUE DESCRIPTION OF GIFT(S) DATE {mmfdd/yy} VALUE DESCRIPTION OF GIFT(S)

~~J.Q.. ,,_--=2:..:.1:.::.5::..3 State of the State Lchn ~~J.Q.. s..'_-=3.::.5.:...:4.:...7 State of the State Lchn

----1----1_ $ _ _ __

, $

... NAME OF SOURCE ~ NAME OF SOURCE

AT&T California California Restaurant Association

ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable)

1215 K st. 1800, Sacramento, CA 95814 621 Capitol Mall, 2000, Sacramento, CA 95814
BUSINESS ACTIVITY, IF ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE

DATE (mm/ddfyy) VALUE DESCRIPTION OF GIFT{S) DATE (mmldd/yy) VALUE DESCRIPTION OF GIFT(S)

~~J.Q.. $ 300.00 41 st NAACP Image A Reception at Mix

----1----1_ $ _ _ __ wards' Ticket ----1----1_ $, _ _ __

, ,
,.. NAME OF SOURCE ~ NAME OF SOURCE

Entertainment Software Association John A. Perez for Assembly 2010

ADDRES~ (Business Address Acceptable) ADDRESS (Business Address Acceptable)

575 7th st. NW, 300, Washington, DC 20004 777 South Figueroa St, 4050, Los ngeles, CA 90017
BUSINESS ACTIVITY, IF ANY. OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE

DATE (mmfddlyy) VALUE DESCRIPTION OF GIFT{S) DATE (mm/ddfyy) VALUE DESCRIPTION OF GIFT(S)

~~J.Q.., 102.96 Dinner .E.J~J.Q.. $ 110.00 Leather Portfolio

----1----1_ ,. _ _ __ ----1----1_ $ _ _ __

----1----1_ , _ _ __ ----1----1_ , _ __

Comments: __________________________________ ~ _______________________________________________

FPPC Form 700 (2010/2011) Sch. D

FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.goY
, '

CALIFORNIA FORM 700

FAIR POLITICAL PRACTICES COMMISSION
SCHEDULE D
Name
Income - Gifts
Mike Davis

.. NAME OF SOURCE .. NAME OF SOURCE

San Manuel Band of Mission Indians AES Southland

ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable)

26569 community Cenler Dr. Highland, CA 92346 690 N. Studebaker Rd., Long Beach, CA 90803
BUSINESS ACTIVITY, IF ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE

DATE (mmfddfyy) VALUE DESCRIPTION OF GIFT(S) DATE (mmfdd/yy) VALUE DESCRIPTION OF GIFT(S)

Dinner Tequila Tasting

---1---1_ 8.-$_ __ ---1---1_ $,_ _ __

.. NAME'OF SOURCE ,.. NAME OF SOURCE

AT&T Inc. California Democratic Party

ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable)

1215 K St. 1800, Sacramento, CA 95814 1401 21st st., 200, Sacramento, CA 95811
BUSINESS ACTIVITY, If ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE

DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S) DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)

~...!2J..2Q.. 8.-$_-",3",9.",0,,-0 Harold & bell's Restaur The Citizen Hotel, Sac

---1---1_ $,_ _ __

s $

.. NAME OF SOURCE ,.. NAME OF SOURCE

CFEE Universal Music Group

ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable)

Pier 35, Suite 202, San Francisco, CA 94133 701 8th St, 420, Washington, DC 20001
BUSINESS ACTIVITY, IF ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE

DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S) DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)

~ 20 1..2Q.. $ 103.00 Conference 2010 Grammy Awards

---1---1_ s;_ __ ---1---1_ $.$_ __

---1---1_' $,_ _ __

Comments: ___________________________________________________________________________________

FPPC Form 700 (2010/2011) Sch. 0

FPPC TolI~Free Helpline: 866/275~3772 www.fppc.ca.gov
 SCHEDULE E
CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION

Income - Gifts Name

Travel Payments, Advances, Mike Davis
and Reimbursements

• Reminder - you must mark the gift or income box.

• You are not required to report income from government agencies.
• You may mark the box 501(c)(3) for a travel payment received from a nonprofit 501(c)(3)
organization. When the payment is a gift it is reportable but is not subject to the $420 gift limit.

... NAME OF SOURCE ,.. NAME OF SOURCE

Office of the Mayor Antonio R. Villaraigosa .

ADDRESS (Business Address Acceptable) ADDRESS (Business Address kceptab/e)

1400 K St. 208

CITY AND STATE CITY AND STATE
Sacramento. CA 95814
BUSINESS ACTIVITY, IF ANY, OF SOURCE D 501 (0)(3) BUSINESS ACTIVITY, IF ANY, OF SOURCE D 501 (0)(3)

OATE(S)'~~~ _ ~~~ AMT, 20.oc,-"00"-

$, _ _-----'4= OATE(8),---1---1_ - ---1---1_ AMT, $. _ _ _ _ __
(If applicable) (If applicable)

TYPE OF PAYMENT: (must check one) D Gift 0 Income TYPE OF PAYMENT: (must check one) 0 Gift 0 Income

DESCRIPTION: Airport Parking DESCRIPTION: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

... NAME OF SOURCE ,.. NAME OF SOURCE

ADDRESS (Blisiness Address Acceptable) ADDRESS (BuSiness Address Acceptable)

CITY AND STATE CITY AND STATE

BUSINESS ACTIVITY, IF ANY, OF SOURCE D 501 (0)(3) BUSINESS ACTIVITY, IF ANY, OF SOURCE D 501 (0)(3)

OATE(S),---1---1_ - ---1---1_ AMT, $_ _ _ _ __ OATE(S),---1---1_ - ---1---1_ AMT, ~$_ _ _ _ __

(If appJic<lbla) (If applicable)

TYPE OF PAYMENT: (must check one) D Gift D Income TYPE OF PAYMENT: (must check one) 0 Gift 0 Income

DESCRIPTION: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ DESCRIPTION: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

Comments: ___________________________________________

FPPC Form 700 (201012011) Sch. E

FPPC TolI·Free Helpline: 866/275~3772 www.fppc.ca.gov
 to .20[D Annual
~CEIvEr@
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SCHEDULE C CALIFORNIA FORM 700

• FEB 4 2011 Income, Loans, & Business FAIR POLITICAL PRACTICES COMMISSION

Name
(c)(1) Positions
(Other than Gifts and Travel Payments) Mike Davis

.... 1. INCOME RECEIVED ... 1. INCOME RECEIVED

NAME OF SOURCE OF INCOME NAME OF SOURCE OF INCOME

University of Southern California

ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable)

University Park, Los Angeles, CA 90089

BUSINESS ACTIVITY, IF ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE

YOUR BUSINESS POSITION YOUR BUSINESS POSITION

GROSS INCOME RECEIVED GROSS INCOME RECEIVED

[8J $500 - $1,000 D $1,001 - $10,000 o $500 - $1,000 o $1,001 - $10,000 --,;>
_ _ 'A.. "
0$10,001 - $100,000 DOVER $100,000 o $10,001 - $100,000 DOVER $100,000 ':-.J ):~
f'" "..,.
---
J"'
if' Y ,",'

CONSIDERATION FOR WHICH INCOME WAS RECEIVED CONSIDERATION FOR WHICH INCOME WAS'RECEIVED a r~':"~:'
o Salary o Spouse's or registered domestic partner's income o Salary 0 Spouse's or registered domestic partner's~me'::::: ::i ~::
:!:. :=: :,:,,~
o Loan repayment o Partnership o Loan repayment o Partnership j"-; ,

D Sale of
(Properly, cal; boat, elc.)
o Sale of ------=-:----,-----,---,-7"7--.4"'"....-"--
(Property. car. boat, etc.) \D

o Commission or D Rental Income, list each source of $10,000 or more o Commission or 0 Rental Income,listeachsourceof$10,OOOormore ~~

~ Other Honorarium- MMM Health Care Reform o Olher _ _ _ _ _ _ _---,,==_______

(Describe) (Describe)

... 2. LOANS RECEIVED OR OUTSTANDING DURING THE REPORtiNG PERIOD 4" -

* 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 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* INTEREST RATE TERM (MonthslYears)

----'% 0 None
ADDRESS (Business Address Acceptable)

SECURITY FOR LOAN

BUSINESS ACTIVITY, IF ANY. OF LENDER D None o Personal residence

D Real Property -------o.;;;;;;-=c:::;:-------

Street address
HIGHEST BALANCE DURING REPORTING PERIOD

o $500 - $1,000
City
o $1,001 - $10,000
o Guarantor _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
o $10,001 - $100,000

DOVER $100,000 o Other _ _ _ _ _ _ _-;;==_______

(Descl1be)
(c)(1)

Comments:

FPPC Form 700 (2010/2011) Sch. C

FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
 ,
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CALIFORNIA FORM 700
2UIIFEB 10 PH 1:49 SCHEDULE D FAIR POllTlCAL PRACTICES COMMISSION

Name
Income - Gifts
Mike Davis

... NAME OF SOURCE ... NAME OF SOURCE

Shows Supreme Master TV Pacifica Institute

ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable)

BUSINESS ACTIVITY, IF ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE

DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S) DATE (mmlddlyy) VALUE DESCRIPTION OF GIFT(S)

145.00 Tiffany Water Pitcher Jl1l.J~...!Q.. $ 100.00 Frosted gold fruit bowl

----1----1_ .$-$_ __

$---

,.. NAME OF SOURCE ~ NAME OF SOURCE

Maritime e
ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable)

BUSINESS ACTIVITY, IF ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE

DATE (mmfddfyy) VALUE DESCRIPTION OF GIFT{S) DATE (mmldd/yy) VALUE DESCRIPTION OF GIFT{S)

----1----1_ >..$_ __ ----1----1_ $_ __

----1----1_ $ _ _ __ ----1----1_ $S-_ __

$ $

... NAME OF SOURCE ~ NAME OF SOURCE

ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable)

BUSINESS ACTIVITY, IF ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE

DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S) DATE (mmJddlyy) VALUE DESCRIPTION OF GIFT(S)

----1----1_ >-$_ _ __ ----1----1_ $-S_ __

----1----1_ SS-_ __ ----1----1_ $ _ _ __

----1----1_ ,"-_ __ ----1----1_ $ _ _ __

Comments: ____________________________________________________ ~ _____________________________

FPPC Form 700 (2010/2011) Sch. D

FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov