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700 Treen (1-1-12 - 3-1-13)
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CALIFORNIA • ' 1 1 TATa �� <br /> S <br /> _Q, <br /> EMENT OF ECONOMIC IN I r-RESTS MAC 2 12013 <br /> FAIR POLITICAL PRACTICES COMMISSION <br /> PUBLIC DOCUMENT COVER PAGE <br /> Please type or print in ink. �Si�}t��Riverside <br /> C,ity Clerk's Office <br /> NAME OF FILER (LAST) (FIRST) (MIDDLE) <br /> l it 41V @\r Loom i S <br /> 1. Office, Agency, or Court <br /> Agency Name <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 A I V-P—r s i ct ❑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 311 % <br /> December 31, 2012. (Check one) <br /> -or- <br /> The period covered is_ I through O The period covered is January 1, 2012, through the date of <br /> December 31,2012. leaving office. <br /> ❑ Assuming Office: Date assumed I 1 O The period covered is—I_J 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 /> ❑ 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 /> (Business or Agency Address Recommended-Public Document) <br /> l iv`rs:df, (_A ia5'® <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 the foregoing is true and correct. <br /> Date Signed — 9 - '"0 1 3 Signatu <br /> (month,day,year) <br /> FPPC Form 700(2012/2013) <br /> FPPC Advice Email:advice@fppc.ca.gov <br /> FPPC Toll-Free Helpline:866/275-3772 www.fppc.ca.gov <br />
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