Jason Chacon - Leaving RECEIVED
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CALIFORNIA FORM 700 STATEMENT OF ECONOMIC II.._RESTS Official Use Only
FAIR POLITICAL PRACTICES COMMISSION MAR 2 9 2018
A PUBLIC DOCUMENT COVER PAGE CITY CLERK'S OFFICE
Please type or print in ink. BY:
NAME OF FILER (LAST) (FIRST) (MIDDLE)
CNA-CC !J C-
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
C\ oo � r�-cam �-� � rS � (� <�
Division, Boatfi, Department, District, if applicable Your Position
► 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-County ❑County of
City of PO St 1,1" a` ❑Other
3. Type of Statement (Check at least one box)
❑ Annual: The period covered is January 1, 2016,through ni Leaving Office: Date Left 2°11 1
December 31, 2016. (Check one)
-or-
The period covered is J I ,through 0 The period covered is January 1, 2016, through the date of
December 31, 2016. leaving office.
-or-
El Assuming Office: Date assumed l/ 0 The period covered is I ,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 D-Income- Gifts-schedule attached
❑ Schedule B-Real Property-schedule attached ❑Schedule E -Income-Gifts- Travel Payments-schedule attached
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None - No reportable interests on any schedule
5. Verification �'� 6_. U a\1 t-vt q l„I 1 -7 7 d
MAILING ADDRESS STREET CITY t STATE ZIP CODE
(Business or Agency Address Recommended-Public Document)
DAYTIME TELEPHONE NUMBER E-MAIL ADDRESS
( )
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 cor • .
Date Signed .a I Signature
(month,day,year) (File the originally signed statement with your filing official)
FPPC Form 700(2016/2017)
FPPC Advice Email:advice@fppc.ca.gov
FPPC Toll-Free Helpline:866/275-3772 www.fppc.ca.gov