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STATEMENT OF ECONOMIC INTERESTS� atef�*cevd <br />COVER PAGE <br />Please type or print in ink. °'" <br />NAME OF FILER (LAST) <br />(FIRST) (MIDDLE} <br />1. Office, Agency, or Court ' <br />Agency Name Name // Q s� <br />- � l" I r7 <br />Division, Board, Department, "bistrict, if applicable <br />Your Position <br />► 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 />❑ State ❑ Judge (Statewide Jurisdiction) <br />❑ Multi- County ❑ County of <br />f <br />❑ City of t 4ji-5 ❑Other <br />3. Type of Statement (Check at least one box) <br />'Annual: The period covered is January 1, 2010, through December 31, ❑ Leaving Office: Date Left 1. 1� <br />2010. -or- (Check one) <br />The period covered is _ -J 1, through December 31, O The period covered is January 1, 2010, through the date of <br />2010. leaving office. <br />❑ Assuming Office: Date —.1 O The period covered is J I , through the date <br />of leaving office. <br />❑ Candidate: Election Year <br />Office sought, if different than Part 1: <br />4. Schedule Summary <br />Check applicable schedules or "None." ► Total number of pages including this cover page: <br />❑ Schedule A -1 - Investments - schedule attached L] Schedule C - Income, Loans, & Business Positions - schedule attached <br />F1 Schedule A -2 - Investments - schedule attached ❑ Schedule D - Income - Gifts - schedule attached <br />❑ Schedule B - Real Property - schedule attached ❑ Schedule E - Income - Gifts -- Travel Payments - schedule attached <br />-or- <br />>9, None - No reportable interests on any schedule <br />5. Verification <br />MAILING ADDRESS STREET CITY <br />(Business orAgency A <br />DAYTIME TELEPHONE NUMBER C MA{ <br />I have used all reasonable diiigence in preparing this statement. I have revlowed MIS s a emen an o <br />herein and in any attached schedules is true and complete. I acknowledge thls is a public document. <br />I certify under penalty of perjury under the laws of the State of California that the <br />Date Signed u _ '1 <br />(month, day, year) <br />ZIP <br />my knowledge the Information contalned <br />Ill Form 700 (2 0 1 012 01 1) <br />FPPC Toll -Free Helpline: 8661275 -3772 www.fppe,ca.gov <br />