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RECEIVED <br /> I , f1å <br /> COVER FORm7OO STATEMENT OF ECONOMIC INTERESTS <br /> FAIR POLITICAL PRACTICES COMMISSION ADafe PIR) 012-Z la <br /> A PUBLIC DOCUMENT <br /> COVER PAGE City of Riverside <br /> Please type or print in ink. City Clerk's Office <br /> NAME OF FILER (LAST) (FIRST) (MIDDLE) <br /> 1. Office, Agency, or Court <br /> Agency Name <br /> 2. 6 <br /> Division, 1394rd, Department, District, if applicable Your Position <br /> Po- 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 /> F-1 State ❑Judge or Court Commissioner(Statewide Jurisdiction) <br /> r_1 Multi-County ❑County of <br /> 1116ity,of ❑Other <br /> 3. Type of Statement (Check at least one box) <br /> F-1 Annual: The period covered is January 1, 2012,through ❑ Leaving Office: Date Left <br /> -or- December 31,2012. (Check one) <br /> The period covered is 1. through 0 The period covered is January 1,2012,through the date of <br /> December 31, 2012. leaving office. <br /> ❑ Assuming Office: Date assumed 1, 0 The period covered is through <br /> the date of leaving office. <br /> ❑ Candidate: Election year and 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 /> 3?'--Schedule A-1 -Investments—schedule attached [Z?I!rchedule 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 /> ❑ None- No reportable interests on any schedule <br /> 5. Verification <br /> MAILING ADDRESS STREET CITY STATE ZIP CODE <br /> (Business or Agency Address Recommended-Pu6tic Document) <br /> hl� <br /> I have used all reasonable diligence in preparing this statement. I have review ge 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 t <br /> Date Signed /�3 SJignat <br /> (month,day,year) h your filing otficiaL) <br /> FPPC Form 700(2012/2013) <br /> FPPC Advice Email:advice@fppe.ca.gov <br /> FPPC Toll-Free Helpline:866/275-3772 www,fppc.ca.gov <br />