Wayne Co _ 'AA°Date Ini } C i(;�g�AD
CALIFORNIA FORM 700 STATEMENT OF ECONOMIC INTERESTS
FAIR POLITICAL PRACTICES COMMISSION
A PUBLIC DOCUMENT COVER PAGE
Please type or print in ink CITY CLE K'S OFFICE
NAME OF FILER LAST) /t (FIRSii�/
01
1. Office, Agency, or Court
Agency Name (Do not use acronyms) 7
� 77 Cr 1—rS FLe C.rA- i)
Division, Board,//o(a�,�Department,D✓�� .r/�lDisCtrict,,if applicable Your
Your Po (-----/ r—
pteit a c m -E / y Ei✓.i�a ot) �"NfmRlfr+erNj
. If filing Ifor multiple positions,list below or on/an attachment. (Do not use acronyms)
Agency: Position:
2. Jurisdiction of Office (Check at least one box)
❑State E Judge or Court Commissioner(Statewide Jurisdiction)
❑Multi-County / ❑County of
El city of .b5 f rfig,JP D U Other
3. Type of Statement (Check at least one box)
Annual: The period covered is January 1,2016,through
X ❑ Leaving Office: Date Left__/_____/December 31,2016. (Check one)
•
The period covered is_/_ , through 0 The period covered is January 1,2016,through the date of
December 31, 2016. or leaving once.
❑ Assuming Office: Date assumed—JJ 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, &Business Positions-schedule attached
❑ Schedule A-2-Investments-schedule attached ❑Schedule 0-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 ,iViola „p 0 /As tiKc/FII) (-fit 7777D
MAILING ADDRESS STREET CITY STATE ZIP CODE
(BusTess or Agency/duress Retwnmen4oa•Pudic Document)
DAY M LEPHOONNfNY” R �> EMAIIL ADDRESS �i
( , / )/ge Cry �J � o VeSF r iJ C/F�
I Gave 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 perju and the laws of the State of California that the foregoing is true and cow ,L
63 /7 �/ /.
Date Signed Signature
(Month day.Mar) rRk me ong rnlA'sand antenna)r.Mi esu'DM/ofl'afl
FPPC Form 700(2016/2017)
FPPC Advice Email:advice@fppc.ca.gov
FPPC Toll-Free Helpline:866/275-3772 www.fppc.ca.gov