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STATEMENT OF ECONOMIC INTERESTS <br />nt <br />- <br />A <br />: <br />I <br />a <br />CALIFORNIA <br />q <br />L <br />' <br />FAIR <br />POLITICAL <br />COVER PAGE <br /> <br />F,-3 1 9 20,10 <br />Please type or print in ink. <br />A P21b11C DOC?d17ZEYlt <br /> <br />NAME (LAST) <br />(FIRST) (MIDDLE) <br />DAYTIME TELEPHONE NUMBER <br />MAILING ADDRESS STREET <br />(Business Address Acce table <br />CITY YSTAT ZIP <br />CODE <br />OPTIONAL: E-MAIL ADDRESS <br />1. Office, Agency, or Court <br />Name of Office, Agency, or Court: <br />Division, Board, District, if applicable: 'r <br />Your Position: <br />i <br />► If filing for multiple positions, list additional agency(ies)I <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 />XQ City of <br />❑ Multi-County <br />❑ Other <br />13. Type of Statement (Check at least one box) <br />❑ Assuming Office/initial Date: I <br />] Annual: The period covered is January 1, 2009, <br />through December 31, 2009. <br />-or- <br />0 The period covered is JI , through <br />December 31, 2009. <br />❑ Leaving Office Date Left: -J I <br />(Check one) <br />O The period covered is January 1, 2009, through the <br />date of leaving office. <br />-or- <br />0 The period covered isI , through <br />the date of leaving office. <br />❑ Candidate Election Year: <br />4. Schedule Summary <br />► Total number of pages <br />including this cover page: <br />l <br />v` <br />► Check applicable schedules or "No reportable <br />interests." <br />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 (10% or Greater ownership) <br />Schedule B ❑ Yes - schedule attached <br />Real Property <br />Schedule C ❑ Yes - schedule attached <br />Income, Loans, & Business 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 />5. Verification <br />I 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 />/ t <br />Date Signed <br />FPPC Form 700 (2009/2010) <br />FPPC Toll-Free Helpline: 8661ASK-FPPC www.fppc.ca.gov <br />