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• ' • ' STATEMENT OF ECONOMIC INTEREM.1 qq ry OHmral Use Only
FAIR POLITICAL PRACTICES COMMISSION
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• P UBLI C DOCUMENT COVER PAGE
Please type or print in ink.
NAME OF FILER (LAST) (FIRST) (MIppLE)
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1. Office, Agency, or Court r
Board, Department, District, if applicable
Your Position
► If filing for multiple ddsitions, list below or on an attachment.
!Agency:
Position:
2. Jurisdiction of Office (Check at least one box)
❑ State
❑ Multi-County
Cdcity of O& E 01t? &al
❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ County of
❑ Other
3. Type of Statement (Check at least one box)
` LAnnual: The period covered is January 1, 2011, through ❑ Leaving Office: Date Left ___J__J
December 31, 2011. (Check one)
-or- -
The period covered is through O The period covered is January 1, 2011, through the date of
December 31, 2011. leaving office.
Assuming Office: Date assumed 4 i 2IBI Z(> t 2 O The period covered is through
the date of leaving office.
❑ Candidate: Election Year Office sought .if different than Part 1:
4. Schedule Summary
Check applicable schedules or "None." ► Total number of pages including this cover page:
❑ Schedule A -1 - Investments - schedule attached - ❑ Schedule C - Income, Loans, & Business Positions - schedule attached
❑ Schedule A -2 - Investments - schedule attached ❑ Schedule D - Income - Gifts - schedule attached
❑ Schedule B - Real Property - schedule attached ❑ Schedule E - Income - Gifts - Travel Payments - schedule attached
-or-
None - No reportable interests on any schedule
5. Verification '
MAILING ADDRESS STREET CITY STATE ZIP CODE
Date Signed Signature
(may , tlay, yzaz)
FPPC Form 700 (2 01112 0 1 2)
FPPC Toll -Free Helpline: 8661275 -3772 www.fppc.ca.gov
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 acknowledge this is a public document.
I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.