Robert BreenC &J Vc�eD
STATEMENT OF ECONOMIC INTEREST c(TY OF � -SIW yaD
COVER PAGE MAR Q 3 2005
Please type or print in ink A Public Document CITY CLERK'S OFFICE
NAME - (LAST) (FIRST) (MIDDLE) DAYTIME TELEPHONE NUMBER
MAILING ADDRESS - STREET CITY STATE ZIP CODE OPTIONAL: FAX / E-MAIL ADDRESS
(May use business address)
1afI) AlxK:3taht
1 . Office, Agency, or Court
Name of Office, Agency, or Court:
e(T ter- R -M17,- K
Division, Board, District, if applicable:
Your Position:
PLk N)Pe- E' alc g�c8 I`�
.. If filing for multiple positions, list additional agency(ies)/
position(s): (Attach a separate sheet if necessary.
Agency:
Position:
2. Jurisdiction of Office (Check at least one box)
❑ State
❑ County of
City of Q 25E C Ab
❑ Multi- County
❑ Other
3. Type of Statement (Check at least one box)
❑ Assuming Office /Initial Date:
❑ 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
date of leaving office.
-or-
O The period covered is —J_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 (to% or greater Ownership)
Schedule B ❑ Yes — schedule attached
Real Property
Schedule C ❑ Yes — schedule attached
Income, Loans, & Business Positions (Income Other than G1fis 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-
. ❑ 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 ky, Q1 - 3 a
(month, day, year)
Signature
(File re originally signed smiemenl with your filing Maui.)
FPPC Form 700 (200412005)
FPPC Toll -Free Helpline: 666 /ASK -FPPC