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NAME (LAST).
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STATEMENT OF ECONOMIC INT
(FIRST)
CITY
COVER PAGE
A Public Document
1 . Office, Agency, or Court
Name of Office, Agency, or Court:
C4 8
Divisi n, Yoard, District, if applicable:
1 D3
)1 /
Your Position:
Po L
�+ If filing for multiple positions, list additional agency(ies)l
position(s): (Attach a separate sheet if necessary.)
Agency:
Position:
2. Jurisdiction of Office (Check at least one box)
❑ State
❑ County of �
City of 61 0 � 6 L64
❑ Multi- County
❑ Other
3. Type of Statement (Check at least one box)
❑ Assuming Office /Initial Dater -- J —
Annual: The period covered is January 1, 2004,
through December 31, 2004.
-or-
0 The period covered is _J.� through
December 31, 2004.
❑ Leaving Office Date Left:
(Check one)
0 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
(MIDDLE)
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CITY 01 pc, M1EAD
A, rl e =raK OFFiff
ZIP. CODE OPTIONAL: FAX I E -MAIL ADDRESS
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 po% or grainer Ownership)
Schedule B ❑ Yes - schedule attached
Real Property
Schedule C ❑ Yes - schedule attached
Income, Loans, & Business Positions (ncomo Omer man Gras 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.
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 pen y of p under the la s of the State
of California that he fo
c,�oi( is�rue correct.
Date Signed
Signature
FPPC Form (uu tzuualcuuo)
FPPC Toll -Free Helpline: 866/ASK