Rafael Fajardo RECEIVED
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CALIFORNIA FORM Date m11191 rwivesd
700 STATEMENT OF ECONOMIC INTERESTS
FAIN P
POLITICAL F COMMISSION
A PUBLIC DOCUMENT COVER PAGE
Please type or print in ink. Cil 1-CLERK'S OFFICE
NAME OF FILER (LAST) (FIRST) B______[1—
Fo�a2Do rv,,li..-C
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
t�JAIIC. Ls) OE\-het rtc.FJT ctTR E3s AJ ECIL
Division, Board. Department, District, iL applicable Your Position
F If filing for multiple positiols, list below or on an attachment. (Do not use acronyms)
tG
Agency.
Position:
2. Jurisdiction of Office (Check at least one box)
❑Stale ❑Judge or Court Commissioner(Statewide Jurisdiction)
❑Multi-County ❑County of
❑City of —._ _ ❑Other
3. Type of Statement (check at least one box)
I Annual: The period covered is January 1,2016, through 0 Leaving Office: Date Left___il/
December 31,2016. (Check one)
or-
The period covered is_lir through O The period covered is January 1, 2016, through the date of
December 31,201E. leaving office.
-or-
❑ Assuming Office: Date assumed 0 The period covered is ,through
the date of leaving office.
❑ Candidate: Election year - and office sought, if different than Part 1.
4. Schedule Summary (must complete) ► Total number of pages including this cover page: -
Schedules attached
❑ Schedule A-1 -Investments-schedule attached ❑Schedule C-Income, Loans, 8 Business Positions-schedule attached
❑ Schedule A-2-Investments-schedule attached ❑Schedule 0-Income-Gifts-schedule attached
❑ Schedule B-Real Property-schedu e attached ❑Schedule E-Income-Gifts-Travel Payments-schedule attached
-or-
2-None - No reportable interests on any schedule
5. Verification
MAILING ADDRESS STREET CIIP STATE ZIP CODE
(Buaress or Agency aad,ess RFcarmeodeo-Fumlr Comment.
15( Lc c Ct (23x0r-/o CA- X1-1 6
DAYTIME TELEPHONE NUMBER E-MAIL ADDRESS
( G2s ) St — zlSI EZ-FAVAz@cicV are.nap oeV
I have used all reasonable diligence in prepaing in's statement I have reviewed this statement and to the best of my knoviedge the information contained
herein and in any attached schedules is true enc 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 tine nd correct.
03/086 7 /
Date Signed _.__ Signature
Tonin day yea+ (File the wMnally signed 9elemmr wth your Ong 0E41
FPPC Form 700(2016/2011)
FPPC Advice Email:advice@fppc.ca.gov
FPPC Toll-Free Helpline:866/275-3772 www.fppc.ca.gov