Laserfiche WebLink
Please type or print in ink. <br />iAML U- HILtH (LAST) (FIRST) (MIDDLE) <br />1. Office, Agency, or Court <br />Agency Name <br />Division, Board, Department, Di;Sfrict, if applicable <br />Your <br />'e, <br />o. If filing for multiple positions, list below or on an attachment, <br />Agency: <br />Position: <br />2. Jurisdiction of Off ice (Check at least one box) <br />State <br />❑ Judge (Statewide Jurisdiction) <br />Mufti- County <br />❑ County of <br />ity of <br />[-] Other <br />3. Type otStatement (Check at least one box) <br />2 The period covered is January 1, 2010, through December 31, 0__Leaving Office: Date Left <br />2010. or- <br />(Check one) <br />The period covered is through December 31, 0 The period covered is January 1, 2010, through the date of <br />2010. <br />leaving office, <br />Ll Assuming Office: Date <br />0 The period covered is through the date <br />of leaving office, <br />P#Vndtdate: Election Year Office sought, if different than Part 1: <br />4. Schedule Summary <br />Check applicable schedules or "None," <br />� Total number of pages including this cover page: <br />Schedule A-1 - Investments - schedule attached <br />❑ Schedule G­ Income, Loans, & Business Positions - schedule attached <br />❑ Schedule A-2 - Investments - schedule attached <br />❑ Schedule D - Income - Gifts - schedule attached <br />❑ Schedule 13 - Real Property - schedule attached <br />❑ Schedule E - Income - Gifts - Travel Payments - schedule attached <br />, or , <br />❑ None - No reportable <br />interests on any schedule <br />Fi Form 700 (201012011) <br />Fii Toll-Free 1 8661275-3772 wwvv.fppc.ca,gov <br />5. Verification <br />MAILING ADDRESS STREET CITY STATE <br />/a,,,. ;­­ ­ A­_.. ­­_ n..,,,,_ - .1 ZIP CODE <br />