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RNIA FORM STATEMENT OF ECONOMIC INTERES R E C EIVE1 <br />CALIFO 700 ii <br />FAIR i COMMISS 10W I COVER PAGE BAR ~o~o <br />A Public Document aty ai;Z ~ 'R1Lr`rl <br />Please type or print in ink. , <br />City Clerk's office <br />;NAME (LAST) (FIRST) (MIDDLE) <br />DAYTIME TELEPHONE NUMBER <br />LIoV -i~-tp c .L~ <br />MAILING ADDRESS STREET CITY STATE ZIP CODE <br />(Busi r OPTIONAL: E-MAIL ADDRESS <br />1. Office, Agency, or Court <br />Name of Office, Agency, or Court: <br />Division, oard, District, i p c ble: <br />Your Position: <br />► If filing for multiple positions, list additional agency(ies)/ <br />position(s): (Attach a separate sheet if necessary.) <br />Agency: <br />Position: <br />2. Jurisdiction of Office (Check at least one box) <br />❑ State <br />❑ County of <br />City ofr <br />Multi-County <br />0 Other <br />I Type of Statement (Check at least one box) <br />Assuming Office/Initial Date: <br />Annual: The period covered is January 1, 2009, <br />through December 31, 2009. <br />-or- <br />0 The period covered is through <br />December 31, 2009. <br />❑ Leaving Office Date Left: <br />(Check one) <br />Q The period covered is January 1, 2009, through the <br />date of leaving office. <br />-or- <br />0 The period covered is 1_ 1 through <br />the date of leaving office. <br />❑ Candidate Election Year: <br />4. Schedule Summery <br />► Total number of pages <br />including this cover page: <br />► Check applicable schedules or "No reportable <br />interests." <br />I have disclosed interests on one or more of the <br />attached schedules: <br />Schedule A-1 D- res _ schedule attached <br />Investments (Less than 70% cwnemhip) <br />Schedule A-2 ❑ Yes schedule attached <br />Investments (10% or Greater ownership) <br />Schedule 8 ❑ Yes - schedule attached <br />Real Property <br />Schedule C <br />❑ Yes - schedule attached <br />Income, Loans, & <br />Business Positions <br />(Income Other than Gigs <br />and Travel Payments) <br />Schedule D <br />ET' es schedule attached <br />Income - Gifts <br />Schedule E 9-Yes - schedule attached <br />Income - Gifts - Travel Payments <br />-or- <br />No reportable interests on any schedule <br />5. Verification <br />1 have used all reasonable diligence in preparing this <br />statement. I have reviewed this statement and to the best <br />of my knowledge the information contained herein and in any <br />attached schedules is true and complete. <br />I certify under penalty of perjury under the laws of the State <br />of California that the foregoing is true and correct. <br />Bate Signed <br />r, <br />