Laserfiche WebLink
STATEMENT OF ECONOMIC INTERESTS <br />COVER PAGE <br />Please type or print in ink. <br />NAME OF FILER (LAST) (FIRST) (MIDDLE) <br />\j r <br />1. Office, Agency, or Court <br />Agency Name <br />Division',," Board Department, Dist applicable <br />Your Position <br />_-ICA (A <br />m If filing for multiple positions, list below or on an a achment. <br />Agency: <br />Position: <br />2. Jul-isdiction Of Office (Check at least one box) <br />[-] State <br />❑ Judge (Statewide Jurisdiction) <br />❑ Multi -c my <br />❑ County of <br />C ity of <br />Y �c <br />❑ Other <br />3. Type of Statement (Check at least one box) <br />A Annual: The period covered is January 1, 2010, through <br />December 31, ❑ (Leaving Office: Date Left 1 __j_ <br />201 or- <br />(Check one) <br />The period covered is ____J ------ J_ through December 31, 0 The period covered is January 1, 2010, through the date of <br />201 <br />leaving office. <br />❑ Assuming Office: Date J_ <br />0 The period covered is J ___J_ 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." <br />P* Total number of pages including this cover page: <br />J% Schedule A-1 - investments — schedule attached <br />❑ Schedule C - Income, Loans, & Business Positions — schedule attached <br />Schedule A-2 - Investments — schedule attached <br />❑ Schedule D - Income — Gifts — schedule attached <br />❑ Schedule B - Real Property — 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 <br />(Business or Agency Address Recommended - Public blocum n <br />CITY STATE ZIP CODE <br />I 11HU <br />UAY I I MI-H <br />E -MAIL ADQRESS <br />I have used all reasonable diligence in preparing this statement, I 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 />I certify under penalty of perjury under the laws of the State of California that the f r <br />Date Signed Signature <br />(201012011) <br />FPPC Toll-Free Helpline: 8661275-3772 www.fppc,ca,gov <br />