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HECEIVED <br /> ICPCeived <br /> CALIFORNIA FORm 700 STATEMENT OF ECONOMIC INTERESTS AUG <br /> DOCUMENT FAIR POLITICAL PRACTICES COMMISSION <br /> A PUBLIC COVER PAGE City yClerRiverside 4 e <br /> Please type or print in ink. <br /> NAME OF FILER (LAST) (FIRST) (MIDDLE) <br /> 4`�� m-42/ <br /> 1. Office, Agency, or Court <br /> Age cy Name <br /> of R, V-&s1dz, <br /> D' ision,Bo rd,Department, District, if applicable dem Your Position <br /> it-�l'k- n,� 'J� rn ' SS I Mbt-1� <br /> P. 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-Countv ❑County of <br /> City of ❑Other <br /> 3. Type of Statement (Check at least one box) <br /> F-1 p Annual: The period covered is January 1, 2012,through ILl-teaving Office: Date Left `-3 <br /> -or- <br /> December 31, 2012. (Check one) <br /> The period covered is I through he 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—J I through <br /> the date of leaving office. <br /> ❑ Candidate: Election year and office sought, if different than Part 1: <br /> I 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 /> R, . Verificatioril <br /> MAILING ADDRESS STREET CITY STATE ZIP CODE <br /> (Bus <br /> DA <br /> ( <br /> I ha I have re <br /> herein and in any attached schedules is true and complete. I acknowled <br /> I certify under penalty of perjury under the laws of the State of Calif <br /> .Date Signed ° I <br /> (month,day,year) <br />