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CALIF ORNIA • - 1 1 STATEMENT OF ECONOMIC INTE ESTS' ' orecraruse 0 = I
PUBLI FAIR POLITICAL PRACTICES COMMISSION I
DOCUMENT COVER PAGE L -_A I
Please type or print in ink. Y aii
NAME OF FILER (LAST) (FIRST( (MIDDLE - - - --
1. Office, Agency, or Court
Agency Name
C i� �9 o Pr7Se
Division, Board, qepartment, District, if applicable Your Position t
► If filing for multiple positions, list below or on an attachment.
Agency: Position:
2. Jurisdiction of Office (Check at least one box)
❑ State ❑ Judge (Statewide Jurisdiction)
❑ Multi-County El County of
City of '9q-5 e f , a 4 ❑ Other
3. Type of Statement (Check at least one box)
Annual: The period covered is January 1, 2010, through December 31,
2010. -or-
The period covered is __J J_, through December 31
2010.
❑ Leaving Office: Date Left
(Check one)
O The period covered is January 1, 2010, through the date of
leaving office.
❑ Assuming Office: Date - -- O The period covered is ___J __J_, through the date
of leaving office.
❑ Candidate: Election Year Office sought, if different than Part 1:
4. Schedule Summary
Check applicable schedules or "None." ► Total number of pages including this cover page:
❑ Schedule A -1 - Investments — schedule attached ❑ Schedule C - Income, Loans, & Business Positions — schedule attached
❑ Schedule A -2 - Investments — schedule attached Schedule D - Income — Gifts — schedule attached
El Schedule B - Real Property — schedule attached Schedule E - Income — Gins — Travel Payments — schedule attached
-or-
❑ None - No reportable interests on any schedule
5. Verification
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business or Agency Address Recommended - Punic Document)
993 IR F. t e I V' - Lz�v1 9177 ` v
DAYTIME TELEPHONE NUMBER I E- MAILADDRESS
I have used all reasonable diligence in preparing this statement. I have reviewed this statement and to the best of my knowledge the infdrmation contained
herein and in any attached schedules is true and complete. I acknowledge this is a public document.
I certify under penalty of, perjury under the laws of the State of California that the foregqjK is true ;rrtj cprrecL ` ry
Date Signed Signature
(mmlh, Day, year) (FA the 4 4 1 y signetl sFafeme aslh your fihbg orfidalJ
b
I
I
FPPC Forrn 700 (2 0 1 012 011)
FPPC Toll -Free Helpline: 8661275.3772 www.fippc.ca.gov
SCHEDULE D
Income — Gifts
► NAME OF SOURCE
ADDRESS (Business A mss Acceptable)
J3040 9csevvoad Ala -c-
���Set G
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm /dd /yy) VALUE DESCRIPTION OF GIFTS)
5 L ! 0 d D - 2 h -s 't(cke xs
Vi
$
��— $
► NAME OF SOURCE
ADDRESS (B siness Address Acceptable)
ZZ0o lMa�e 5'r 12�'�sc CA
BUSINESS ACTIVITY, IF ANY, OF SO RCE
c
Lt we V� �3 Dl n vier
DATE m /dd /yy) VALUE DESCRIPTION OF GIFT(S)
$ 70ou C�fv�riYw �3i�)S
$
$
► NAME OF SOURCE
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF
DATE (mm /ddtyy) VALUE
/�— $
— / —/ $
Comments:
DESCRIPTION OF GIFT(S)
► NAME OF SOURCE
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm /ddtyy) VALUE DESCRIPTION OF GIFT(S)
��— $
$
��— $
► NAME OF SOURCE
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm /ddtyy) VALUE DESCRIPTION OF GIFT(S)
��— $
��— $
$
► NAME OF SOURCE
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/dd/yy) VALUE
$
_ / —/— $
DESCRIPTION OF GIFT(S)
FPPC Form 700 (201012011) Sch. D
FPPC Toll -Free Helpline: 8661275 -3772 v w .fppc.ca.gov
SCHEDULE E
Income — Gifts
Travel Payments, Advances,
and Reimbursements
• Reminder — you must mark the gift or income box.
• You are not required to report income from government agencies.
• You may mark the box 501(c)(3) for a travel payment received from a nonprofit 501(c)(3)
organization. When the payment is a gift it is
reportable but is not subject to the $420 gift limit.
► NAME OF SOURCE
RQSeut,t + Assorwcha„
I- NAME OF SOURCE
ADDRESS (Business Address Acceptable)
ADDRESS (Business Address Acceptable)
9'3 9 q > . "r &3c , . V_i&yeed
CITY AND STATE
f ysei I& ; 0A
CITY AND STATE
BUSINESS ACTIVITY, IF ANY, OF SOURCE '� 501 (c)(3)
BUSINESS ACTIVITY, IF ANY, OF SOURCE ❑ 501 (c)(3)
P romote, ✓C4e�t1$ccliTJ-1vgPer ePonrawher
l A i;tV14t.;ft V\ clst kles 5!; fi-fun tr{u'�S
DATE(S): AMT: s
(M applicable)
(I/ applicable)
TYPE OF PAYMENT: (must check one) )Q Gift ❑ Income
TYPE OF PAYMENT: (must check one) ❑ Gift ❑ Income
{J 1 frC,
DESCRIPTION: n/d l'fl j rt', del l,u rgr;,r- w,t� -� r
DESCRIPTION:
clnsl�3 d-r, K��lu✓I Talwel� (�is+zrei
r
► NAME OF SOURCE
► NAME OF SOURCE
ADDRESS (Business Address Acceptable)
ADDRESS (Business Address Acceptable)
CITY AND STATE
CITY AND STATE
BUSINESS ACTIVITY, IF ANY, OF SOURCE ❑ 501 (c)(3)
BUSINESS ACTIVITY, IF ANY, OF SOURCE ❑ 501 (c)(3)
DATE(S): __J __J_ - __J --- J_ AMT. $
DATE(S): - _ /__1_ AMT: $
(If applcable)
(I / applicable)
TYPE OF PAYMENT: (must check one) ❑ Gift ❑ Income
TYPE OF PAYMENT: (must check one) ❑ Gift ❑ Income
DESCRIPTION:
DESCRIPTION:
Comments:
FPPC Form 700 (201012011) Sch. E
FPPC Toll -Free Helpline: 8661275 -3772 w Jppe.ca.gov