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Assuming Office: Date 0 The period covered is ------ through the date <br />of leaving office. <br />F Candidate: Election Year <br />Office sought, if different than Part 1: <br />5. Verification <br />herein and In any attached schedules Is true and complete, I acknowledge this is <br />I certify under penalty of perjury under the laws of the State of California thz <br />Form 700 (201012011) <br />772 www.fppc,ca.gov <br />P ' AILING ADD . RESS . '' _ STREET CITY STATE ZIP CODE <br />