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CALIFOR <br />NIA FORM 7 <br />0 <br />0 <br />FAIR POLITICA <br />L PRACTICES COM <br />MISSIO <br />N <br />Please type or print in ink. <br />(LAST) <br />ADDRESS STREET <br />STATEMENT OF ECONOMIC INTERESTS <br />COVER PAGE <br />.A Public Document <br />(FIRST) <br />CITY <br />1. Office, Agency, or Court <br />Name of Office, Agency, or Court: <br />Division, Board, District, if applicable: <br />Your Position: <br />o'N <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 of t y v + t <br />❑ Multi-County <br />❑ Other <br />13. 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: I <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 -I I , through <br />the date of leaving office. <br />❑ Candidate Election Year: <br />(MIDDLE) <br />N vl e- <br />STATE ZIP CODE <br />se fficia ;Et3e In <br />DAYTIME TELEPHONE NUMBER <br />ADDRESS <br />4. Schedule Summary <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 ❑ Yes - schedule attached <br />Investments (Less than 10% ownership) <br />Schedule A-2 ❑ Yes - schedule attached <br />Investments (90% or Greater Ownership) <br />Schedule B ❑ Yes - schedule attached <br />Real Property <br />Schedule C es -schedule attached <br />Income, Loans, & 8 iness Positions (income Other than Gifts <br />and Travel Payments) <br />Schedule D ❑ Yes - schedule attached <br />Income Gifts <br />Schedule E ❑ Yes - schedule attached <br />Income - Gifts - Travel Payments <br />-or- <br />No reportable interests on any schedule <br />S. Verification <br />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 />-1 Z) <br />Date Signed <br />Signatu <br />i N."g, y signed statement with your fling official.) <br />FPPC Form 700 (200912010) <br />FPPC Toll-Free Helpline: 8661ASK-FPPC www.fppc.ca.gov <br />