Nancy ValderamaCAt1FORMAFORM 760
FAIR POLITICAL PRACTICES COMMISSION ',.
Please type or print in Ink
NAME (LAST)
MAILING ADDRESS STREET
(May use business address)
STATEMENT OF ECONOMIC INTERESTSI
CITY OF RO ° C 4 FAO
COVER PAGE
BAR, 3 ® 2005
A Public Document
(FIRST) (MIDDLE)
CITY
3 r F- I/ #LI e Y &V b
&21e) 569--
OPTIONAL: FAX I E -MAIL ADDRE:
s - 6 - H e;l b 7 - 7a
1 . Office, Agency, or Court
Name of Office, Agency, or Court:
Division, Board, District, if applicable:
Your Position:
c /TY Lc E &K
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 T
City of
❑ Multi- County
❑ Other
3. Type of Statement (check at least one box)
❑ Assuming Office /Initial Date: --- J ___J_
Annual: The period covered is January 1, 2004,
C through December 31, 2004.
-or-
0 The period covered is —J— through
December 31, 2004.
❑ Leaving Office Date Left: ---J ---J—
(Check one)
Q 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 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 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
..1X9 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.
Oi Y tJz/5
Date Signed .3 ,
(month, thay. year)
Signature
�(Ithe originally signetl statement with your fling olTCial.)
FPPC Form 706 (2004rzuua).
FPPC Toll -Free HelPIme: 866 /ASK -FPPC
CALIFORNIAFORNI ,77
$AIRYDLtTICAL�PRACTICES �OMMIS$IDN,
Please type or print in ink
NAME (LAST)
i c pa e Received
STATEMENT OF ECONOMIC INTERESTS r or eai� o ty
COVER PAGE
A Public Document
(FIRS') (MIDDLE)
Ili
(1720 569 --117
OPTIONAL FAX I E -MAIL ADDRE:
(May use business address)
1 . Office, Agency, or Court
Name of Office, Agency, or Court:
Division, Board, District, . if applicable:
Your Position:
c /T c E &K
�+ If filing for multiple positions, list additional agency(ies)/
positiori (Attach a separate sheet if necessary.)
Agency:
Position:
2. Jurisdiction of Office (Check at feast one box)
❑ State
❑ County of a
City of
❑ Multi- county
❑ Other
I 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: ---] --J
(Check one)
0 The period covered is January 1, 2004, through the
date of leaving office.
-or-
0 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'11ave 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 greater Ownership)
Schedule B ❑ Yes - schedule attached
Real Property
Schedule C ❑ Yes - schedule attached
Income, Loans, & Business Positions Income Other than Gres 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-
_X9 No reportable interests on any schedule
Total number of pages /
completed including this cover page:
5. Verification
1 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 underthe laws of the State
of California that the foregoing is true and correct.
Date Signed
(month, ay, year)
Signature uh oar aging oRiclaL)
(File w
e the onginalty signed statement y
FPPC Form /uu ([vo41 1
FPPC Toll -Free Helpline: 866 /ASK -FPPC