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:; $ R <br />STATEMENT OF ECONOMIC INTERESTS eia�s ived <br />COVER PAGE MAR 10 2017 <br />Please type or print in ink f3ity of R,'i e si <br />NAME OF FILER (LAST) — (FIRST) <br />1. Office, Agency, or Court <br />Agency Name (Do not use acronyms) <br />CA -�v C� u Inc: - <br />Division, Board, Department, Distric , if applicable Your Position <br />W 0-4- A, G Cc AAe' <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 />Position: <br />❑ State ❑ Judge or Court Commissioner (Statewide Jurisdiction) <br />❑ Multi- County ❑ County of <br />® City of 'V\weA'szdP ❑ Other — <br />3. Type of Statement (Check at least one box) <br />❑ Annual: The period covered is January 1, 2016, through ❑ Leaving Office: Date Left I I <br />December 31, 2016. (Check one) <br />-or- <br />The period covered is <br />December 31, 2016. <br />❑ Assuming Office: Date assumed <br />through O The period covered is January 1, 2016, through the date of <br />leaving office. <br />.or- <br />0 The period covered is I through <br />the date of leaving office. <br />Candidate: Election year eo 111– 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 ❑ 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 />None - No reoortable interests on anv schedule <br />5. Verification <br />MAILING ADDRESS STREET CITY STATE ZIP CODE <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 th <br />Date Signed ®� tic) i 9O R <br />(month, day, year) <br />FPPC Advice Email: advice @fppc.ca.gov <br />FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov <br />