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DECEIVED "A STATEMENT OF ECONOMIC INTERESTS Agency Name City of Riverside Division, Board, Department, District, if applicable Your Position Cultural Heritage Board Board member n r I . 0S, i 4 fo� itions. list below or on an attachment. Agency Position: 2. Jurisdiction of Office (Check at least one box) ❑ State ❑ Multi-County M City of Riverside F Judge or Court Commissioner (Statewide Jurisdiction) ❑ County of ❑ Other — 3. Type of Statement (Check at least one box) [R] Annual: The period covered is January 1, 2011, through ❑ Leavin Office• n i F+ December 31, 2011. -or- 05 03 , 2011 December 31, 2011. ❑ Assuming Office: Date assumed F_� Candidate: Election Year J e ------ J_ (Check One) I 'lie ) p er iod jod covered is January 1, 2011, through the date of ,D leaving office. 0 The period covered is through the date of leaving office. Office sought, if different than Part 1: 4. Schedule Summary Check iq;plicible SwIledules or 'Voile. Total number of pages including this cover page ❑ Schedule A-1 - 1'iVe5t1r`0 - schedule attached ❑ Schedule C - Income, Loai7s, & PWiness Positions - schedule attached Schedule A-2 - 1 - schedule atta-hen' _'Chedule D - sd attached ❑ Schedule B - Real Property schedule attached ❑ Schedule E - Incc),wo - Gifts - Travel Payments - schedule attached , or- None - No reportable interests on any schedule 5. Verification MA, NG ADDRESS STREET CITY STATE ZIP CODE Ravao��5 orA qm y Atld,"r,' , R&et TELEPHONE NUMBER Riverside E -MAIL CA 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 I certify under penalty of perjury under the laws of the State of California that the foreqoina is true and rarriaM Date Signed , 03/28/12 Signature (n."w"Y ddy, Y%� FPPC Toll-Free Helpline: 866/275-3772 www.,fppc.ca--.go-v,