Daniel Lopez.
STATEMENT OF ECONOMIC INTERESTS
Date Received
COVER PAGE
k .
A Public Document
Please type or print in ink
NAME (LAST)
(FIRST) (MIDDLE)
CITY E U Cr -i UMBER
U
L0,QC 2
'Do --1J i C(_
(6 )37/ qC,?
MAILING ADDRESS STREET CITY STATE ZIP CODE
OPTIONAL: FAX I E -MAIL ADDRESS
(May use business address)
90 2 q
fi �22Grr Sj 1?6SI L
1 . Office, Agency, or Court
Name of Office, Agency, or Court::
n C) r Ro g C7 eF`1 )
Division, Board, District, if applicable:
Your Position:
Po®
rT /A/Uy/eU r e 44 /5
�+ If filing for multiple positions, list additional agency(ies)/
position(s): (Attach aseparate sheet if necessary.)
Agency:
Position:
2. Jurisdiction of Office (check at least one box)
❑ State
❑ County of
❑ City of
❑ Multi- County
❑ Other
3. Type of Statement (Check at least one box)
❑ Assuming Office /Initial Dater l ill � �
❑ Annual: The period covered is January 1, 2004,
through December 31, 2004.
-or-
0 The period covered is through
December 31, 2004.
❑ Leaving Office Date Left:
(Check one)
• The period covered is January 1, 2004, through the
dale of leaving office.
-o r-
0 The period covered is __—J, through
the date of leaving office. -
❑ Candidate
4. Schedule Summary
(Check applicable schedules or "No reportable interests.")
— During the reporting period, did you have any reportable
interests to disclose on:
Schedule A -1 ❑ Yes - schedule attached
Investments (less than 10% Ownership)
Schedule A -2 ❑ Yes - schedule attached
Investments (10% or greater Ownership)
Schedule B ❑ Yes.- schedule attached
Real Property
Schedule C ❑ Yes - schedule attached
Income, Loans, & Business Positions (income Other than Gifts and
Travel Payments)
Schedule D (Eliminated - report loans on Schedule C)
Schedule E ❑ Yes - schedule attached
Income - Gifts
Schedule F ❑ Yes - schedule attached -
Income - Travel Payments
-or-
r ❑ No reportable interests on any schedule
Total number of pages
completed including this cover page:
5. Verification
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 herein and in any attached schedules
is true and complete.
I certify under penalty of perjury under the laws of the State
of California that the foregoing is true and correct.
Date Signed
iTl nth, day, year)
Signature.
(File the originally signe enaenllaieMVur fling official.)
FPPC Form 700 (200412005)
FPPC Toll -Free Helpline: 866 /ASK -FPPC