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RECEIVED <br />STATEMENT OF ECONOMIC INTERESTS <br />COVER PAGE <br />City of Riverside <br />City Clerk's Office <br />Please type or print in ink. <br />NAME OF FILER (LAST) (FIRST) (MIDDLE) <br />Za ki Omar M. <br />1. O ffice, Agency, or Court <br />Agency Name <br />C ity of Riverside <br />Division, Board, Department, District, if applicable Your Position <br />Planning Commission Commissioner <br />P. If filing for multiple positions, list below or on an attachment <br />Agency: <br />Position: <br />2. Jurisdiction of Office (Check at least one box) <br />❑ State <br />❑ Multi- County <br />C City of Riverside <br />❑ Judge or Court Commissioner (Statewide Jurisdiction) <br />❑ County of <br />❑ Other <br />3. Type of Statement (Check at least one box) <br />❑ Annual: The period covered is January 1, 2011, through ❑ Leaving Office: Date Left I I <br />December 31, 2011. (Check one) <br />- or- <br />The period covered is t _ , through G The period covered is January 1, 2011, through the date of <br />December 31, 2011. leaving office. <br />Assuming Office: Date assumed �3 01 i 2012 __. G The period covered is I I through <br />the date of leaving office. <br />Candidate: Election Year 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 ❑ Schedule C - Income, Loans, & Business Positions - schedule attached <br />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 />El None - No reportable interests on any schedule <br />5. V <br />MAILING ADDRESS STREET CITY STATE ZIP CODE <br />(Business of Apency Adaress Recommended Public. Document) <br />Riverside CA _ <br />DAYTIME TELEPHONE NUMBER I E -MAIL ADDRESS (OPTIONAL) <br />I have used all reasonable diligence in preparing this statement. I have reviewed this he information contained <br />herein and in any attached schedules is true and complete. I acknowledge this is a <br />I certify under penalty of perjury under the laws of the State of California that <br />Date Signed Signature <br />imnnth, day, yoacl riling otrin -az) <br />FPPC Form 700 (201112012) <br />FPPC Toll -Free Helpline: 8661275 -3772 www.fppc.ca.gov <br />