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STATEMENT OF ECONOMIC INTEREST <br />Please type or print in ink. k, <br />NAME OF FILER (LAST) (FIRST) IMIDDLE) <br />1. Office, Agency, or Court <br />Agency Name <br />Division, Board, Department, Position <br />P. If filing for multiple positions, list below or on an attachment, <br />Agency: Position: <br />2. Jurisdiction of Office (Check at least one box) <br />L] State ❑ Judge (Statewide Jurisdiction) <br />Assuming Office; Date 0 The period covered is ------ J_ through the date <br />of leaving office. <br />anclidate: Election Year <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 />to 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 />El Schedule E - Income - Gifts - Travel Payments - schedule attached <br />4 -or- <br />None - No reportable interests on any schedule <br />5. Verification <br />MAILING ADDRESS 0 <br />(Business or Agency Address Recommended - Public Document) U1 I Y STATE <br />I acknowledge this is <br />I certify under penalty of perjury under the taws of the State of California that <br />Date Signed <br />6 ��yeq,� <br />FPPC Form 700 (2010/2011) <br />FPPC Toll-Free Helpline: 8661275-3772 www.fppe.ca.gov <br />