REC:I:OliMtiB

CALIfORNIA" FOR~ 700 STATEMENT OF ECONOMIC INTERESTS Officia' Use 0",

FAIR POLITICAL PRACTICES COMMISSION

A PU IC D~CUMENT ~ COVER PAGE @ FEB -·7 2011

Pfea,:<>B type or print in ink. BY:
NAME OF FILER (FIRST) (MIDDLE)
2UII(m 10 PH I: 49
Nielsen James w.
1. Office, Agency, or Court
Agency Name
CA State Assembly
Division. Board. Department. Distnct. if applicable Your Position
District 2 Assembly Member
.. If filing for multiple positions. list below or on an attachment.

Agency: Position: _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

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

1&1 State o Judge (Statewide Jurisdiction)
o Multi-County _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ o County of _ _ _ _ _ _ _ _ _ _ _ _ _ __
o City of o Other
3. Type of Statement (Check at least one box)
1&1 Annual: The penod covered Is January 1. 2010. through December 31. o Leaving Office: Date Left ---'---'_ _
2010. -or- (Check one)
The pertod covered is - - - ' - - - '_ _• through December 31. o The penod covered is January 1. 2010. through Ihe date of
2010. leaving office.

o Assuming Office: Date ---'---'_ _ o The period covered is ---'---'_ _• 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 Includtng this cover page: _ __

o Schedule A-1 - Investments - schedule attached 1&1 Schedule C - Income. Loans. & Business Posffions - schedule attached
o Schedule A-2 - Investments - schedule attached 1&1 Schedule 0 - Income - Gifts - schedule attached
o Schedule B - Real PropeTly - schedule attached o Schedule E - Income - Gifts - Travel Payments - schedule attached
-or-
O None - No reportable interests on any schedule

5. Verification \

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

Date Signed _ _ _--,0"'1':':/2""5~/=20=:171'-----

(month, day. YElsr)

11)
gov
 SCHEDULE C CALIFORNIA FORM
FAIR POLITICAL PRACTICES COMMISSION
700
Income, Loans, & Business
Name
Positions
(Other than Gifts and Travel Payments) James W, Nielsen

~ 1, INCOME RECEIVED ~ 1, INCOME RECEIVED

NAME OF SOURCE OF INCOME NAME OF SOURCE OF INCOME

ADDRESS (Business Address Acceptable) ADDRESS (Business Address Accepf!lble)

BUSINESS ACTIVITY, IF ANY, OF SOURCE ,BUSINESS ACTIVITY, IF ANY, ?F SOURCE

YOUR BUSINESS POSITION YOUR BUSINESS POSITION

GROSS INCOME RECEIVED GROSS INCOME RECEIVED

0$500. $1,000 0 $1,001 • $10,000 o $500. $1,000 0 $1,001 • $10,000
o $10,001 • $100,000 0 OVER $100,000 o $10,001 • $100,000 0 OVER $100,000

CONSIDERATION FOR WHICH INCOME WAS RECEIVED CONSIDERATION FOR WHICH INCOME WAS RECEIVED
o "Salary 0 Spouse's or registered domestic partner's Income D S~lary 0 Spouse's or registered domestic partner's Income

o Loan repayment 0 Partnership o Loan repayment 0 Partnership

o Sale of _ _ _ _ _--;==-==:;-:;:-;-_____
(Property. cat; boat, etc.)
o Sale of ------...,:--:--.,-,..-,"'7"'-----
(Property, car, boat, etc.)

o Commission or D Rental income, list each source of $10,000 or mOte o Commission or o Rental Income. list each source of $10,000 o~ mom

o Olher _ _ _ _ _ _ _-,==.,-_______ o Olher _ _ _ _ _ _ _-,==.,-_______

(Describe)
(Describe)

.. 2. LOANS RECEIVED OR OUTSTANDING DURING THE REPORTING PERIOD

/ * 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 (MonthsIYears)

Larry Van Dyke

ADDRESS- (Business Address Acceptable)
__6::;':,::5__,% o None 30 years

PO Box 8703, Red Bluff CA 96080 SECURITY FOR LOAN

BUSINESS ACTIVITY, IF ANY, OF LENDER o None o ~ersonal

residence

Retired o Real Property _ _ _ _ _ _===::::-______ Street Bddress

HIGHEST BALANCE DURING REPORTING PERIOD

0$500. $1,000
City .'-"~:
o $1,001 • $10,000 o Guarantor _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _-'-_
-- --- ,

o $10.001 • $100,000 .
181 OVER $100,000
o Other --------;;;-=;::;-------- (Describe)

Comments:

FPPC Form 700 (2010/2011) Sch, c

FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
 CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
SCHEDULE D
Name
Income - Gifts
James W. Nielsen

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

California Tribal Alliance Regional Council of Rural Counties

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

1530 J SI. Ste. 400, Sacramento, CA 95814 1215 K SI. Ste. 1650, Sacramento, CA 95814
BUSINESS ACTIVITY, IF ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE

DATE (mm/ddlyy) VALUE DESCRIPTION OF GIFT(S) DATE (mm/dd/yy) VALUE DE.SCRIPTION .oF GIFT(S)

~..EJ~ $_-=9.=2",.6.:...8 Reception ~.EJ~ $ 196.86 Reception

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

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

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

Northern CA Water Association Klamath Alliance for Resource

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

455 Capitol Mall Ste. 335, Sacramento, CA 95814 P.O. Box 1234, Yreka, CA 96097
BUSINESS ACTIVITY. IF ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE

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

Framed Poster ~.EJ~ $ 339.23 Airfare & Woods Tour

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

$ $

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

Pacific Gas & Electric Barona Band of Mission Indians

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

1415 L SI. Ste. 280, Sacramento, CA 95814 1095 Barona Rd., Lakeside, CA 92040
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)

~~~ $ 209.86 Dinner Dinner

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

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

Comments: ______________________________ ~ ____________________________________________________

FPPC Form 700 (2009/2010) Sch. D

FPPC Toll-Free Helpline: 866/ASK·FPPC www.fppc.ca.gov
 • CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
SCHEDULE D
Name
Income - Gifts
James W. Nielsen

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

California Farm Bureau Speaker of the Assembly

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

2300 River Plaza Dr., Sacramento, CA 95833 777 S. Figueroa Sl. Steo4050,Los Angeles, CA 90017
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)

~_2~_L!~ $
52049 Reception ~06,....!.2... $ 110.00 Leather Portfolio

~~....!.2... $
71.32 Dinner

---1---1_ $

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

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

$ $

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

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

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

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

Comments: ____________________________________________________________________________________

FPPC Form 790 (200912010) Sch. 0

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