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RECEIVED <br /> Date Received <br /> CALIF•RNIA FORm I STATEMENT OF ECONOMIC INTERESTS SEF`,0=,,—1013 <br /> DOCUMENT FAIR POLITICAL PRACTICES COMMISSION <br /> A PUBLIC COVER PAGE City of Riverside <br /> Please type or print in ink. <br /> City Clerk's Office <br /> NAME OF FILER (LAST) (FIRST) (MIDDLE) <br /> d� le)�al <br /> 1. Office, Agency, or Court <br /> Age Na e ' <br /> T 1��c/aJ <br /> Di ' ' n, Bo rd,Department, District, if applicable • Your Position <br /> C� 'Y� rz>Gi_ <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 /> 10ity of i vt-� t ❑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 I I <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 /> ØAssuming Office: Date assumed! O The period covered is I I through <br /> j7�... 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 /> ( ) <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 t <br /> I certify under penalty of perjury under the laws of the State of Californi <br /> Date Signed f-2�-/,'; Si'' <br /> (month,day,year) <br /> /2013) <br /> f-P17 Acivice Man: .ca.gov <br /> FPPC Toll-Free Helpline:8661275-3772 www.fppc.ca.gov <br />