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2003 (25)STATEMENT OF ECONOMIC INTERE E L' TY OF o°e "ed CALIF ORNIA • CI r R I M - COVER PAGE MAR 1 5 2004 Please type or print in ink A Public Document r ;CITY CLERK Of FIC NAME - (LAST) (FIRST) (MIDDLE) - DAYTIME TELEPHONE NUMBER 041/?e Aeo�'Iwe/ ✓d L . ( J?z g 6224 MAILING ADDRESS STREET CITY STATE ZIP CODE OPTIONAL: FAX i E -MAIL ADDRESS (May be business address) l Cir06.S r0a4A, fCY� ✓261j& y love l'!, 6k 4v Gt 5yav '9/ 1 . Office, Agency or Court Name of Office, Agency or Court: (mil i zy ow lo*Iyead Division, Btiak, District, if applicable: Your Pos n: _ ��++,, C:/ �l 7 2y # ^ 76 Agine?et- �+ If filing for multiple positions, list additional ager 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 ❑ Multi -County ❑ Other Type of Statement (Check at least one box) 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 rLess men to% ownership) Schedule A -2 ❑ Yes - schedule attached Investments flim a greeter ownership) Schedule B ❑ Yes - schedule attached Real Property Schedule C [-Yes - schedule attached Income 8 Business Positions (rncomo omerman Loans, Gins, and Tray i Schedule D ❑ Yes - schedule attached Income - Loans 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: ❑ Assuming Office /Initial Date: _J ___1 [Annual: The period covered is January 1, 2003, through December 31, 2003. -or- 0 The period covered is __JJ through December 31. 2003. ❑ Leaving Office Dale Left: __J—J (Check one) • The period covered is January 1, 2003, through the date of leaving office. - -or- O The period covered is ___J_ /, through the dale of leaving office. ❑ Candidate 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. 1 certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Dale Signed 90 (Mon , day, r) Signat (File the originally signed stale eel with your filing official.) FPPC Form 700 (200312004) FPPC Toll -Free Helpline: 866 /ASK -FPPC SCHEDULE C income & Business Positions (Income Other than Loans, Gifts, and Travel Payments) > NAME OF S RC BUSINESS ACTIVITY, IF ANY, OF SOURCE - G(¢ BUSINESS GROSS INCOME RECEIVED E �$500 - sixo ❑ $1,001 - $10,000 LYJy10,001 - $100,000 ❑ OVER $100,000 CON FOR WHICH INCOME WAS RECEIVED LF Salary E] spouse's income ❑ Loan repayment ❑ Sale of (Prota:rly, coq Dual, e(c) ❑ Commission or ❑ Rental Income, list each source of $10,000 or more ❑ Other (Describe) > NAME OF SOURCE ADDRESS BUSINESS ACTIVITY, IF ANY, OF SOURCE YOUR BUSINESS POSITION GROSS INCOME RECEIVED ❑ $50D $1,000 - ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary - ❑ Spouse's income ❑ Loan repayment ❑ Sale of (Pmparly. car, Dual, etc.) ❑ Commission or ❑ Rental Income, list each source of $10,000 or more ❑ Other (Describe) Comments: > NAME OF SOURCE ADDRESS BUSINESS ACTIVITY, IF ANY, OF SOURCE YOUR BUSINESS POSITION GROSS INCOME RECEIVED ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary ❑ Spouse's income ❑ Loan repayment ❑ Sale of (Property. car, boaq etc.) ❑ Commission or ❑ Rental Income, list each source or 810,000 or more ❑ Other rOescnbe) > NAME OF SOURCE ADDRESS BUSINESS ACTIVITY, IF ANY, OF SOURCE YOUR BUSINESS POSITION GROSS INCOME. RECEIVED ❑ $$00 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary ❑ Spouse's income ❑ Loan repayment ❑ Sala of (Properly, car boat, etc.) ❑ Commission or ❑ Rental Income, list each source or S10,000 or more ❑ Other FPPC Form 700 (200312004) Sch. C FPPC Toll -Free Helpline: 866/ASK-FPPC