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Piease type or print in ink, <br />NAME OF FILER (LAST) (FIRST) <br />O� — (MiDDL <br />IN <br />1. Office, Agency, or Court <br />M <br />Agency Name <br />Division, Board, Department, District, if applicab[e Your Position <br />r If filing for multiple positions, list below or on an attachment. <br />Agency: <br />Dah <br />STATEMENT OF ECONOMIC INTERESTS f <br />Position: <br />Z.. Jurisdiction Of Office (Check at least one box) <br />❑ State <br />❑ Judge (Statewide Jurisdiction) <br />El Multi-County ❑ County of • RrCity of R 1 ❑ Other — <br />3. Type of Statement (Check at least one box) <br />❑ Annuah The period covered is January 1, 2010, through December 31, <br />2010, <br />The period covered is ----- through December 31, <br />2414. <br />1:1 Assuming Office: Date <br />Candidate: Election Year _X21 ZL- <br />9 <br />El Leaving Office: Date Left J ------ J_ <br />(Chock one) <br />0 The period covered is January 1, 2010, through the date of <br />leaving office, <br />0 The period covered is <br />of leaving office. <br />Office sought, it different than Part 1: <br />through the date <br />6chedule Summary <br />Check applicable schedules or "'None." <br />5. Verification <br />MAILING ADDRESS STREET <br />(Business or Agency Address Recommended - Public <br />CITY <br />STATE ZIP <br />I nave used all reasonable diligence in preparing this statement. l 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 />l certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. <br />Date Signed ti <br />(month, day, , tar) <br />® Total number of pages including this cover pager <br />FPPC Form 700 (201012011) <br />FPPC Toll-Free Helpline: 866t275-3772 www.fppc.ca.gov <br />