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STATEMENT OF ECONOMIC INTERESTS eff=iolUse Only
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COVER PAGE
Please type or print in ink. crryf,1 Mf4` a OFFICE
NAME OF FILER (LAST) (FIRST) (MIDD ""�
1. Office, Agency, or Court
► If filing for multiple positions, list below or on an attachment. (Do not use acronyms)
Agency:
2. Jurisdiction of Office (Check at least one box)
❑ State
❑ Multi-Coun
3. Type of Statement (Check at least one box)
❑ Annual: The period covered is January 1, 2016, through
December 31, 2016.
-or-
The period covered is I , through
December 31, 2016.
❑ Assuming Office: Date assumed
❑ Candidate: Election year
Position:
❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ County of
❑ Other
�3
Leaving Office: Date Left JLJp��9
(Check one)
O The period covered is January 1, 2016, through the date of
-or-
leaving office.
O The period covered is —
the date of leaving office.
and office sought, if different than Pad 1:
through
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
0❑,- Schedule A-2 - Investments - schedule attached ❑ Schedule D - Income - Gifts - schedule attached
�
�T Schedule B - Real Property - schedule attached ❑ Schedule E - Income - Gifts - Travel Payments - schedule attached
.or -
7 None - No reportable interests on any schedule
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business or Agency Address Recommended - Public Document)
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 tr and correct.
Date Signed t Signature
(month, day, year) (File ire odginallysigned ststement with your filing omciel.)
FPPC Form 700(2016/2017)
FPPC Advice Email: advice@fppc.ca.gov
FPPCToII-Free Helpline: 866/275-3772 www.fppc.ca.gov