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Date Initial Filing Received <br />STATEMENT OF ECONOMIC INTEREST oriraa use Only-, <br />COVER PAGE <br />A ft I <br />Please type or print in ink <br />NAME OF FILER (LAST) (FIRST) ' �- (MIDDLE)x_ .y <br />a . §'ice, <br />1. Office, Agency, or Court <br />Agency Came (Do not use acronyms) <br />District, if <br />Your Position <br />► If filing for multiple positions, list below or on an attachment. (Do not use acronyms) <br />Agency: <br />2. Jurisdiction of Office (check at least one box) <br />❑ State <br />❑ Multi -C <br />`�ity of <br />3. Type of Statement (Check at least one box) <br />❑ Annual: The period covered is January 1, 2016, through <br />December 31, 2016. <br />-or- <br />The period covered is I I through <br />December 31, 2016. <br />gem • <br />❑ Judge or Court Commissioner (Statewide Jurisdiction) <br />❑ County of <br />❑ Other <br />❑ Leaving Office: Date Left <br />(Check one) <br />O The period covered is January 1, 2016, through the date of <br />leaving office. <br />.or- <br />F-1 Assuming Office: Date assumed I I O The period covered is I I through <br />the date of leaving office. <br />Candidate: Election year and office sought, if different than Part 1: <br />4. Schedule Summary (must complete) ► Total number of pages including this cover page: <br />Schedules attached <br />.or- <br />❑ Schedule A -1 - Investments — schedule attached <br />❑ Schedule A -2 - Investments — schedule attached <br />❑ Schedule B - Real Property — schedule attached <br />- No reportable interests on any schedule <br />❑ Schedule C - Income, Loans, & Business Positions — schedule attached <br />❑ Schedule D - Income — Gifts — schedule attached <br />❑ Schedule E - Income — Gifts — Travel Payments — schedule attached <br />Verification <br />MAILING ADDRESS STREET CITY STATE ZIP CODE <br />herein and in any attached schedules is true and complete. I ackn( <br />I certify under penalty of perjury under the laws of the State of <br />the information contained <br />FPPC Form 700 (2016/2017) <br />FPPC Advice Email: advice @fppc.ca.gov <br />FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov <br />