Laserfiche WebLink
STATEMENT OF ECONOMIC INTERESTS <br />COVER PAGE <br />Please type or print in ink. A Public Document <br />1 L Date~R"e'C Wddr .a t <br />Official use only <br />(1t r, <br />'J <br />NAME (LAST) <br />(FIRST) (MIDDLE) DAYTIME TELEPHONE NUMBER <br />MAILING ADDRESS STREET <br />CITY STATE ZIP CODE <br />OPTIONAL: E-MAIL ADDRESS <br />(Business Address Acceptable) <br />M <br />1. Office, Agency, or Court <br />~Name of Office, Agency, or Court: C~1C~ ir~~fc~:2 <br />!T'~f41ZYSlc~i~ LJ o~ ~r1.GS r,'h.~ 4Zec,~-~.c_-~"Ic'+--. <br />Division, Board, District, if applicable: <br />Your Position: <br />~,Z'v~~t 1'►`t !rte ~ G 4~L.~ Y~° <br />► If filing for multiple positions, list additional agency(ies)1 <br />position(s): (Attach a separate sheet if necessary.) <br />Agency: .-L~.: <br />Position: <br />2. Jurisdiction of Office (Check at least one box) <br />❑ State <br />.r-I'County of <br />. City of C- <br />❑ Multi-County <br />❑ Other <br />13. Type of Statement (Check at least one box) <br />[_1 Assuming Office/Initial Date: --]--J <br />`Annual: The period covered is January 1, 2009, <br />1 through December 31, 2009. <br />.or- <br />0 The period covered is 1 1. , through <br />December 31, 2009. <br />VN Leaving Office Date Left: ks I I J l 0 <br />(Check one) <br />The period covered is January 1, 2009, through the <br />date of leaving office. <br />-or- <br />0 The period covered isJ , 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 />► 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 ❑ 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 />-o r- <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 />Date Signed b - ~ . - r e, <br />(month, day, year) <br />Signatu <br />FPPC Form 700 (200912010) <br />FPPC Toll-Free Helpiine: 866/ASK-FPPC www.fppc.ca.gov <br />