Wayne Co - Annual JED
CALIFORNIA FORM 700 STATEMENT OF ECONOMIC INTERESTS 'Date InitiatWFl�tl l�Rceived
Official Use Only
FAIR POLITICAL PRACTICES COMMISSION COVER PAGE `" 4 2019
Please type or print in ink. A PUBLIC DOCUMENT CITY CLERK'S QFFIC>n
Sal?
NAME OF FILER (LAST) (FIRST) (MIDDLE)
/Px/
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
DZ- 56-"Ge'4-j
Division, Board, Department, Di ' t, if applicable7A(744;2..e. „4„0,c.,.,, Your Posit'
► 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)
❑ Iti-Countymyu
❑County of
City of ❑Other
3. a of Statement (Check at least one box)
Annual: The period covered is January 1, 2018, through ❑ Leaving Office: Date Left_____I_ I
December 31, 2018. (Check one circle.)
-or-
The period covered is—J_____/ ,through 0 The period covered is January 1, 2018, through the date of
December 31, 2018. -or-leaving office.
❑ Assuming Office: Date assumed_J__J 0 The period covered is______/—J ,through
the date of leaving office.
❑ Candidate: Date of Election and office sought, if different than Part 1:
4. Schedule Summary (must complete) ► Total number of pages including this cover page: 1
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 El Schedule E-Income-Gifts-Travel Payments-schedule attached
-or- id / one - No reportable interests on any schedule
5. Verification
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business or Agency Address Recommended-Public Document)
6'i3e t . Al ��v� Mouctii CA- 6111-10
DAYTIME TELEPHONE NUMBER EMAIL ADDRESSu. a
rDri
I have used all reasonable diligence in preparing this statement. I have reviewed this statement and to the best of my knowledge the inforr ation contained
herein and in any attached schedules is true and complete. I acknowledge this is a public document.
I certify under penalty of pe 'ury un er the laws of the State of California that the foregoing is true and correct.
Signature O I D ( Si 27,,,,,...2ZDate Signed D 9
(month,da,yea (File the originally signed paper statement with your filing official.)
FPPC Form 700(2018/2019)
FPPC Advice Email:advice@fppc.ca.gov
FPPC Toll-Free Helpline:866/275-3772 www.fppc.ca.gov
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