Robert BreenDate Received
STATEMENT OF ECONOMIC INT5 J6 S,�IHBI IODATPIu
FAIR POLITICAL PR ACTICO COMMISSIONiiiiiiii COVER PAGE £OV I dVW
DUPLICATE A Public Document
Please type or print in ink - OV31IGSOH AO A-LI0
NAME (LAST). (FIRST) - '� (MIDDLE) .a7 t d9131�A :_ PHONE NUMBER
qjbprirr AL-L- x Ali 'OLD-,
' M411 INR nnnRFSS STREET CITY ZIP CODE OPTIONAL: FAX / E -MAIL ADDRESS
923 M111�sffo4w�" �T, e�SE rt� f�1� `1
1 . Office, Agency or Court
Name:
C (T-Y -or Division, Board, District, if applicable:
Position'
F> OJAI IAI I S -2 1OnaEp,
-+ 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 , KQ3�a�
❑ Multi- County
❑ Other
3. 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 !Less man tn% ownarshlp)
Schedule A -2 ❑ Yes - schedule attached
Investments (tot m gd,war Ownarahip)
Schedule B ❑ Yes - schedule attached
Real Property
Schedule C ❑ Yes - schedule attached
Income & Business Positions rmsoma Omer man roans. Oms, and lna.1)
Schedule D ❑ Yes - schedule attached
Income - Loans
Schedule E ❑ Yes - schedule attached
_ Income - Gifts
Schedule F ❑ Yes - schedule attached
Income - Travel Payments
-or-
.. f�] No reportable interests on any schedule
Total number of pages completed including this
cover page:
❑ Assuming Office /Initial Date: ___/ ---- J_
❑ Annual: The period covered is January 1, 2D02,
through December 31, 2002.
-or-
0 The period covered is —J� —, through
December 31 2002.
❑ Leaving Office Date Left: _l am
(Check one)
0 The period covered is January 1, 2002, through
the date of leaving office.
-or-
0 The period covered is through
the date 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.
I certify under penalty of perjury under the laws of the
State of California that the foregoing is true and correct.
Date Signed
(m day, year))
Signature
(File the originally signed statement with your filing official.)
FPPC Form 700 (200212003)
.tee uvi..u..e. uaate c¢_FPPC