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RECEIVE <br /> Date Recc�ived <br /> CALIFORNIA FORm 700 STATEMENT OF ECONOMIC IN, CRESTS MAR �f 2�01T, <br /> FAIR -. <br /> A PUBLIC DOCUMENT COVER PAGE City of Riverside <br /> Please type or print in ink. City Clerk's Office <br /> NAME OF FILER (LAST) (FIRST) <br /> (MIDDLE) <br /> 1. Office, Agency, or Court <br /> Agency Name � <br /> 1'l1�%2.ryi K�.. t"Jb4t� �TiljF l�,j <br /> Division, Board, Department, District, if applicable Your Position <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 /> [City of !?—g Al->iAa— ❑Other <br /> 3. Type of Statement (Check at least one box) <br /> Annual: The period covered is January 1, 2012, through ❑ Leaving Office: Date Left <br /> -or- <br /> December 31, 2012. (Check one) <br /> The period covered is 9 through O The period covered is January 1, 2012, through the date of <br /> December 31, 2012. leaving office. <br /> Assuming Office: Date assumed O The period covered is_I 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: 3 <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 /> ❑ None- No reportable interests on any schedule <br /> 5. Verification <br /> MAILING ADDRESS STREET CITY STATE ZIP CODE <br /> (B <br /> Olt ? <br /> rit�'LCS.t� C& g2-9zo3 <br /> DA E-MAIL ADDRESS(OPTIONAL) <br /> ( <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 /> 1 certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. <br /> Date Signed * I t 1 17—.t3 Signature <br /> (month,day,year) (File the originally signed statement with your filing official.) <br /> FPPC Form 700(201212013) <br /> FPPC Advice Email:advicegfppc.ca.gov <br /> FPPC Toll-Free Helpline:8661275-3772 www.fppc.ca.gov <br />