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Please type or print in ink. <br />NAME OF FILER <br />(LAST) <br />1. Office, A or Court <br />!L�� <br />Agency Name L,/ ,..t <br />Division, Board_qepartrpent, District, <br />m If filing for multiple posi(ioVs, Ust below or on an attachment. <br />3. Type Statement (Check at least one bo, <br />An -c a r - iod covered is January 1, 201 <br />201 2�0 1 <br />(C) <br />The period covered is <br />2010, <br />El Assuming Office: Date <br />❑ Candidate: Election Year <br />through December 31, ❑ Leaving Office: Date Left <br />(Check one) <br />through December 31, 0 The period covered is January 1, 2010, through the date of <br />leaving office. <br />0 The period covered is 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 />F Schedule A-2 - investments — schedule attached <br />❑ Schedule B - Real Property — schedule attached <br />P- Total number of pages including this cover page: — <br />[--] Schedule C - Income, Loans, & Business Positions — schedule attached <br />E] <br />Schedule D - income — Gifts — schedule attached <br />El Schedule E - Income — Gifts — Travel Payments — schedule attached <br />None - No reportable interests on any schedule <br />5. Verification <br />MAILING ADDRLSS STREET CITY STATE ZIP CODE <br />(Business or Agency Address R --mm - <br />I have used all reasonable diligence in preparing this statement. I have reWITRIMM <br />herein and in any attached schedules is true and complete. I acknowledge this is a public <br />I certify under penalty If perju under the laws of the State of California that the for <br />Date Signed I Tt Signature <br />a(rant , day, y ear, �- <br />R E 0 5. 1 V8b <br />JAN 19 2011 <br />Riverside <br />FPIPC Form 700 (201012011) <br />FPPC Toll-Free Helpline: 8661275-3772 wwrw.fppc,ca.gov <br />