Phong Ly - Assuming CALIFORNIA FORM Date Initigi cy1; .4PeQed
700 STATEMENT OF ECONOMIC INTLriESTS CyPoYflhe(G18e MEAD
FAIR POLITICAL PRACTICES COMMISSION
A PUBLIC DOCUMENT COVER PAGE
Please type or print in ink CITY CI_EH S OFFICE
NAME OF FILER (LAST) (FIRST) 1 LiMIDDLE)
1. Office, Agency, or Court _
Agency Name (Do not use acronfms)
Division,
Board, Department, District,if applicable Your Position
( Cry)c CC3✓'rN1ZSrrvl. _. ( 6144ribs)c4ity-
. If filing for multiple positions, list below or on an attachment, (Do not use acronyms)
Agency: _. - _ Position: _
2. Jurisdiction of Office (Check at feast one box)
❑State ❑Judge or Court Commissioner(Statewide Jurisdiction)
Multi-County - __ ❑County of
2)Clty of h'os6N)Li'l 1) LI Other
3. Type of Statement (Check at least one box)
Annual: The period covered is January 1, 2016,through ❑ Leaving Office: Date Left
December 31, 2016. (Check one)
or-
The period covered is through 0 The period covered is January 1, 2016, through the date of
December 31, 2016. leaving office.
-or-
Assuming Office: Date assumed (-% %2!1�y 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, &Business Positions-schedule attached
Schedule A-2-Investments-schedule attached L_•••Schedule D- Income-Gilts-schedule attached
❑ Schedule B• Real Properly-schedule attached ❑Schedule E -income- Gifts- Travel Payments-schedule attached
-or- z —
NOne - No reportable interests on any schedule
5. Verification
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business or Agency Addiss Recommended-Puns Oocumeni) r� /�
h?6Z AYJtiELUC _ I- . hcSe (A� CM q17-;/b)
DAYTIME TELEPHONE NUMBER EMIL ADDRESS
( CR6 ) 61o 4
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.
Date Signed (1/45'/ ( Signature
www.day,year) (File the o ginally signed gatemen!wan your flung olfic'e)!
FPPC Form 700(2016/2017)
FPPC Advice Email:advice@fppc.ca.gov
FPPC Toll-Free Helpline:866/275-3772 www.fppc.ca.gov