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COVER PAGE <br />g~ { <br />_ Date Received <br />E R <br />F❑ _ 2010 <br />A Public Document <br />Please type or print in ink. <br />NAME (LAST) <br />(FIRST) (MIDDLE) <br />DAYTIME TELEPHONE NUMBER <br />MAILING ADDRESS STREET <br />CITY STATE ZIP CODE <br />OPTIONAL: E-MAIL ADDRESS <br />(Business Address Accentahle) <br />STATEMENT OF ECONOMIC INTERESTS <br />1. Office, Agency, or Court <br />Name of Office, Agency, or Court: <br />Division, Board, District, if applicable: <br />/~iJ~-'F. 't f~'~:e'~ ~ITi~-' r ` l ~ ~%~i.'f7s'~~' r1' i/ <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 />12. Jurisdiction of Office (Check at mast one box) <br />❑ State <br />❑ County of <br />0 City of <br />❑ Multi-County <br />Other <br />13. Type of Statement (Check at least one box) <br />❑ Assuming Officellnitial Date: <br />Annual: The period covered is January 1, 2009, <br />t this December 31, 2009. <br />-or- <br />0 The period covered is I I , through <br />December 31, 2009. <br />❑ Leaving Office Date Left: _._J. I <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 is , 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 />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 />Date Signed`' <br />Signat <br />(File the originally signed statem t with your filing official.) <br />FPPC Form 700 (200912010) <br />FPPC Toll-Free Flelpline: 8661ASK-FPPC www.fppc.ca.gov <br />