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Please type or print in ink. <br />P- If filing for multiple positions, list below or on an attachment <br />Agency: <br />Position: <br />20 Jurisdiction Of Office (Check at least one box) <br />❑ State ❑ Judge (Statewide Jurisdiction) <br />Multi-County <br />, City of <br />0 <br />Assuming Office: Date 0 The period covered is through the date <br />of lcavina office, <br />Candidate: Election Year ........ .... Jp I j, <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 />E Schedule B - Real Property – schedule attached <br />P- Total number of pages including this cover page: —LL— <br />x Schedule C - lacome, Loans, & Business Positions – schedule attached <br />Schedule 0 - Income – Gifts – schedule attached <br />❑ Schedule E - Income – Gifts – Travel Payments – schedule attached <br />.or- <br />❑ None - No reportable interests on any schedule <br />5. Verification <br />MAILING ADDRESS STREET CITY STATE ZIP CODE <br />herein and in any attached schedules is true and complete. I acknowledge this is <br />I certify under penalty of <br />❑ County of <br />❑ Other <br />ry under the laws of the State of California that <br />FPPC Form 700 (201012011) <br />FPPC Toll-Firee Helpline: 8661275-3772 www.fppc.ca.gov <br />