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STATEMENT OF ECONOMIC INTERESTS <br />COVER PAGE <br />1. Office, Agency, or Court <br />Name of Office, Agency, or Court: <br />Division, Board, District, if pplicable: <br />Your Position: <br />► If filing for multiple positions, list additional agency(ies)/ <br />position(s): (Attach a separate sheet if necessary.) <br />Agency: <br />Position: <br />2. Jurisdiction of Office (Check of least one box) <br />❑ State <br />❑ County of <br />4 City of <br />❑ Multi-County <br />❑ Other <br />13. Type of Statement (Check at least one box) <br />❑ Assuming Office/initial Date: <br />M Annual: The period covered is January 1, 2009, <br />through December 31, 2009. <br />-or- <br />0 The period covered is I I , through <br />December 31, 2009. <br />❑ Leaving Office Date Left: <br />(Check one) <br />p The period covered is January 1, 2009, through the <br />date of leaving office. <br />-or- <br />C) The period covered is through <br />the date of leaving office. <br />❑ Candidate Election Year: <br />Date Received <br />Officnii Use OMy <br />IRE-C-4-1- 7~ <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 E Yes schedule attached <br />investments (Less than 10% Ownership) <br />Schedule A-2 '`FA Yes - schedule attached <br />investments (10% or Greater Ownership) <br />Schedule B Yes - schedule attached <br />Real Property <br />Schedule C --f5 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 />Signatu <br />(File the originally signed statement with your iRM9 official.) <br />FPPG Form 700 (200912010) <br />FPPG Tall-Free Helpline: 8661ASK-FPPC www.fppc.ca.gov <br />A Public Document _ " 2010 <br />Please type or print in ink. <br />