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11 <br />STATEMENT OF ECONOMIC INTERESTS : <br />~O*LWORN 1A FO <br />Rm 700 <br />.COMMSSION <br />COVER PAGE lit✓ 2 2010 <br />A Public Document <br />Please tvoe or print in ink. <br />4. <br />NAME (LAST) (FIRST) (MIDDLE) <br />d- .sirs <br />MAILING ADDRESS STREET CITY STATE ZIP CODE OPTIONAL: E-MAIL ADDRESS <br />1. Office, Agency, or Court <br />Agency, or Court: <br />Name of Offi~M&Y+ <br />Division, Board, District, if applicable: <br />4 i 4,1.4-7 I `9 YC~ <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 at least one box) <br />❑ State <br />County of <br />City of <br />❑ Multi-County <br />❑ Other <br />13. Type of Statement (Check at least one box) <br />❑ Assu 'ng Office/Initial Date: .,_I I <br />Annual: The period covered is January 1, 2009, <br />through December 31, 2009. <br />-o r- <br />Q The period covered is I I through <br />December 31, 2009. <br />❑ Leaving Office Date Left: I I <br />(Check one) <br />Q The period covered is January 1, 2009, through the <br />date of leaving office. <br />-or- <br />0 The period covered is _._L-__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 1Q% ownership) <br />Schedule A-2 Yes - schedule attached <br />Investments (10% or Greater ownership) <br />Schedule B LIJ 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 es - 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 />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 />(month, day, year) <br />Signature <br />ia1.} <br />FPPC Form 700 (2009/2010) <br />FPPC Toll-Free Helpline: 866/ASK-FPPC www.fppc.ca.gov <br />~U <br />D r~ [~sOnl <br />