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STATEMENT OF ECONOMIC INI CRESTS <br />COVER PAGE <br />Date Received <br />Offielal Use Only <br />Please type or print in ink. <br />A <br />Puhlic Document <br />ry <br />NAME (LAST) <br />(FI <br />) <br />(MIDDLE) <br />DAYTIME TELEP E NUMBER <br />ir <br />, r~ f / /1 ~ /'3 r.~ <br />RS <br />l <br />~ <br />f? <br />~ <br />~ <br />f <br />~ <br />~ <br />~ <br />' <br />L ~ / <br />f ✓ l ( <br />MAILING ADDRESS STREET <br />CITY <br />STATE ZIP CODE <br />OPTIONAL: E-MAIL ADDRESS <br />(Business Address Acce fable <br />f7 <br />1. Office, Agency, or Court <br />Name of Office, Agency, or Court: <br />Division, Board, District, if applicable: <br />Your Position: <br />► If filing for multiple positions, list additional agency(ies)1 <br />position(s): (Attach a separate sheet if necessary.) <br />Agency: <br />Position: <br />2. Jurisdiction of Office (Cheek at least one box) <br />❑ State <br />❑ County of <br />City of 1j~'1 J f I <br />❑ Multi-County <br />❑ Other <br />3. Type of Statement (Check at least one box) <br />❑ Assuming Office/Initial Date: - JJ <br />Annual: The period covered is January 1, 2009, <br />through December 31, 2009. <br />-or- <br />0 The period covered is L -1 through <br />December 31, 2009. <br />❑ Leaving Office Date Left: <br />(Check one) <br />d The period covered is January 1, 2009, through the <br />date of leaving office. <br />-or- <br />0 The period covered is ..J_ I 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 t0% Ownership) <br />Schedule A-2 ❑ Yes - schedule attached <br />Investments (10% or Greater owtrership) <br />Schedule B ❑ Yes - schedule attached <br />Real Property <br />Schedule C ❑ Yes - schedule attached <br />Income, Loans, & Business Positions (Income other than Girls <br />ar7d 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 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 <br />Signatur <br />(f e t 7e o77gfnally signed statement w"J, yo 'illrrg official.) <br />FPPC Farm 700 (200912010) <br />FPPC Tall-Free Helpline: 866IASK-FPPC wrww.fppc.ca.gov <br />