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RECQeVED <br />STATEMENT OF ECONOMIC INTERESTS APP _ Use Only <br />Please type or print in ink <br />COVER PAGE <br />A Public Document <br />' 1110 <br />NAME (LAST) (FIRST) (MIDDLE) DAYTIME TELEPHONE NUMBER <br />rl. f ~i F 1 ` t <br />MAILING ADDRESS STREET CITY STATE ZIP CODE OPTIONAL E-MAIL ADDRESS <br />(Business A f~ <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)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 />y of Il Jt 2 s' ~ <br />❑ Multi-County <br />❑ Other <br />13. Type of Statement (Check at least one box) <br />❑ Assuming Office/Initial Date: ~I I <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 />0 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 />r 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 (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 reasonabie 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 />FPPC Form 700 (200912010) <br />FPPC Toll-Free Helpline: 8661ASK-FPPC www.fppc.ca.gov <br />