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EC <br /> 4 , 'ft, <br /> r--iv <br /> CALIFORNIA FORm 700 ' -, STATEMENT OF ECONOMIC INTE., STS FEg `.'-t.`J`�of `. <br /> FAIR POLITICAL PRACTICES COMMISSION <br /> ` PUBLIC DOCUMENT COVER PAGE City of Rivej- ,ide <br /> Please type or print in ink. City Clerk'_ ' ,f ice <br /> NAME OF FILER (LAST) (FIRST) (MIDDLE) <br /> ❑u.SWne$ <br /> 1. Office, Agency, or Court <br /> Agency Name <br /> Division, Board, Department, District, if applicable Your Position <br /> f Iv ► el ��,.bl '1C.- LI L <br /> ers m L l'l ) K1e S Pow-a mernbe-r <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 (Vey-,s1 Z ❑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—J_J <br /> -or- <br /> December 31,2012. (Check one) <br /> The period covered is I 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 1 O The period covered is_J_ 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: <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 /> (Busine <br /> )'vefs)Je CA gala l <br /> DAYTI E-MAIL ADDRESS(OPTIONAL) <br /> (9 <br /> I have ment. 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 th <br /> Date Signed �� � Signature <br /> (month,day,year) <br /> 00(2012/2013) <br /> ce@fppc.ca.gov <br /> FPPC Toll-Free Helpline:866/275-3772 www.fppc.ca.gov <br />