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W=_ <br />Am, r ��, <br />P "I <br />EC E.'1_. 1V H <br />Agency Name <br />Division, Board, Department, District, if applicable <br />Yo,r Position <br />_AC� I - I <br />r If filing for multiple positions, list below or on an attachment. <br />Agency: <br />Position: <br />2. Jurisdiction of Office (Check at least one box) <br />[] State <br />MAILING ADDRESS STREET <br />CITY <br />I have used all reasonable diligence in preparing this statement. I have reviewed <br />herein and in any attached schedules is true and complete. I aclknowlod,� <br />I certify under penalty of perjury under the laws of the State of CalifM <br />Date Signed i � -a <br />(m-th, day year) <br />El Judge (Statewide Jurisdiction) <br />ZIP CODE <br />the information contained <br />FPPC Form 700 (2010 <br />FPPC Toll-Free Helpline: 8661275-3772 www.fppc.ca.qov <br />