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Please type or print in ink. <br />LA <br />87 <br />R E, <br />, F4 ED <br />J'A N 2 8 7 <br />f <br />NAME OF FILER (LAST) (FIRST) (MIDDLE) <br />I., Off ice, Agency, or Court <br />Agency Name <br />Division, Board, <br />W-Pic / e e* <br />rtment, District, if applicable <br />Your Position <br />o- If filing for multiple positions, list below or on an attachment. <br />19 vy;cd 1� w4w <br />V60 de i <br />Agency: P);, i Position: <br />2. Jurisdiction of Office (Check at least one box) <br />❑ State ❑ Judge (Statewide Jurisdiction) <br />Assuming Office: Date <br />F Candidate: Election Year <br />0 The period covered is J_ through the date <br />of leaving office. <br />Office sought, if different than Part 1: <br />4. Schedule Summary <br />Check applicable schedules or "None," <br />❑ Schedule A-1 - Investments — schedule attached <br />❑ Schedule A-2 - Investments — schedule attached <br />❑ Schedule B - Real Property — schedule attached <br />I* Total number of pages including this cover page: — <br />Schedule C - Income, Loans, & Business Positions — schedule attached <br />Schedule D - Income — Gifts — schedule attached <br />E Schedule E - Income — Gifts — Travel Payments — schedule attached <br />- or - <br />9 - No reportable interests on any schedule <br />5. Verification <br />MAILING ADDRESS STREET <br />011--fl <br />ZIP CODE <br />I have used aV reasonable diligence in preparing this statement. I have reviewed this statement and to the best of my knowledge the information contained <br />herein and in any attached schedules is true and complete. I acknowledge this is a public document. <br />I certify under penalty of perjury under the laws of the State of California that I <br />Date Signed ............. X7 [if Signature <br />(ma day, year) <br />FPIPC Form 700 (2011012011) <br />PPPG Toll-Free Helpflne: 866/275-3772 www.fppc,ca.gov <br />