Michael BurbankCALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
Please type or print in ink
STATEMENT OF ECONOMIC INTERESTS l ab
CITY OF i 'O F 17EAD
COVER PAGE
A Public Document
NAME (LAST)
P, 6,4� C
(FIRST)
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( MIDDLE) '�DA1`FtMEFEL-
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C P- dDNE
MAILING ADDRESS STREET
(May use business address)
.94 3 6
CITY
^
STATE ZIP CODE
OPTIONAL: FAX / E -MAIL ADDRESS
1 . Office, Agency, or Court
Name of Office, Agency, or Court:
Division, Board, District, if applicable:
Your Position: 1
�+ 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 o
❑ City
❑ 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)
O The period covered is January 1, 2004, through the
date of leaving office.
-or-
0 The period covered is through
the date of leaving office.
❑ Candidate
4. Schedule Summary
(Check applicable schedules or "No reportable Interests.')
During the reporting period, did youhave 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
-o r-
rKNo reportable interests on any schedule
Total number of pages l
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
(me do year)
Signat e
(File the on al y gnetl sla I
with your fling official.)
2005
CDCr` Vn 9nn I9nnennn Rl
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