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CALIFORNIA •- 1 1 STATEMENT OF ECONOMIC INTERESTS R EGE IVED <br /> COMMISSION FAIR POLITICAL PRACTICES MAR 232012 <br /> PUBLIC DOCUMENT COVER PAGE <br /> Please type or print in ink. City Of Riverside <br /> NAME OF FILER (LAST) (FIRST) <br /> BERG MARK DAVID <br /> 1. Office, Agency, or Court <br /> Agency Name <br /> CITY OF RIVERSIDE <br /> Division, Board, Department, District, if applicable Your Position <br /> PARKS, RECREATION AND COMMUNITY SERVICES CHAIRMAN <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 or Court Commissioner(Statewide Jurisdiction) <br /> ❑Multi-County ❑County of <br /> ❑x City of RIVERSIDE ❑Other <br /> 3. Type of Statement (Check at Least one box) <br /> x❑ Annual: The period covered is January 1, 2011,through ❑ Leaving Office: Date Left I <br /> December 31, 2011. (Check one) <br /> -or- <br /> The period covered is I I through O The period covered is January 1,2011,through the date of <br /> December 31, 2011. leaving office. <br /> ❑ Assuming Office: Date assumed I 1 O The period covered is 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 /> F-1 None- No reportable interests on any schedule <br /> 5. Verification <br /> MAILING ADDRESS STREET CITY STATE ZIP CODE <br /> (Business or Agency Address Recommended-Public Document) <br /> RIVERSIDE CA <br /> DAYTIME TELEPHONE NUMBER E-MAIL ADDRESS(OPTIONAL) <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 t <br /> Date Signed 3/23/2012 Signature <br /> (month,day,year) (File the adginallysigned statement with your tiling offbal) <br /> FPPC Form 700(201112012) <br /> FPPC Toll-Free Helpline:8661275-3772 www.fppc.ca.gov <br />