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700 STATEMENT OF ECONOMIC INTERESTS Ps+mrlePIROSFMFAP
FAIR POLITICAL
eITICALPRACIICFSCCIMMiSSION
A PUBLIC DOCUMENT COVER PAGE
Please type or print in ink.
1ITV 1
`I FRMS IIOFICE
MANE OF FILER (UST) (FIRST) - citRALE)
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1. Office, Agency, or Court
Agency Name (Do not use acronyms)
Division,Board, Department,Distract,if applicable Your Position
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I If filing for multiple positions,list below or on an attachment. (Do not use acronyms)
Agency: Position:
2. Jurisdiction of Office (Check at least one box)
State ❑Judge or Court Commissioner(Statewide Jurisdiction)
❑Multi-CountyI ❑County of
(].City of ZOSehr Pag1 ❑Other
3. Type of Statement (Check at least one box)
Q Annual: The period covered is January 1,2016,through ❑ Leaving Office: Date Left_JJ
December 31,2016. (Check one)
-or 0 Theperiod covered is January1, 2016,through the date of
The penia,covered is_JJ ,through g
D.,..,...6.. 31,2016. leaving office.
-or-
Assuming Office: Date assumed —J 0 The period covered is —J ,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 D-Income-Gifts-schedule attached
❑ Schedule B-Real Property-schedule attached E 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
(Bumpess or Agency Adores Recommended-Public Document)
93(6 . vD 3lva . R°seAe d CA
DAYTIME TELEPHONE NUMBER EMAIL ADORLSSL
(62C ) sGel— 2(u( Can\0Q Cih.,of rosemeRrit o
I have used all reasonable diligence in preparing this statement. I have reviewed this statement and to the best of my knowledge the informafien 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.
Dale Signed ZC\ ll� Signature
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FPPC Form 700(2016/2017)
FPPC Advice Email:advice@fppc.a.gov
FPPC Toll-Free Helpline:866/275-3772 www.fppc.ca.gov