Wayne Co - Annual CEIVEO
CALIFORNIA FORM 700 STATEMENT OF ECONOMIC INTERES i-a Dat 1iLe�F'ad
Filing Official Use Only
FAIR POLITICAL PRACTICES COMMISSION COVER.PAGE MAR 0 4 2020
Please type or print in ink. A PUBLIC DOCUMENT CITY CLERKS OFFICE
NAME OF FILER (LAST) 6.7 (FIRST) (MIDb1E �
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/1/74191/..."'" .
1. Office, Agency, or Court
Agency Name ( of use acronyms)
� 6 /�� iyR -9 S7977y5a7/e✓. 3,Ute.
Division, Board,Department, rict, if applicable Your Position
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pete SA-Fb
► If filing fol multiple positions, list below or on an attachment. (Do not use acronyms)
Agency: Position:
2. Jurisdiction of Office (Check at least,one box)
.❑State El Judge, Retired Judge, Pro Tem Judge, or Court Commissioner
(Statewide Jurisdiction)
❑Multi-County ��(� ❑County of
X(City of1/piped) 0 Other
3. Txpe of Statement (Check at least one box) •
Annual: The period covered is January 1,2019,through
0 Leaving Office: Date Left-J_/
December 31, 2019. (Check one circle.)
-or-
The period covered is___/_/ , through '0 The period covered is January 1, 2019, through the date of
December 31, 2019. .-or.leaving office.
-❑ Assuming Office: Date assumed. _/—J 0 The period covered is___/_/ , 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:
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
-or- None - No reportableinterests on any schedule� �I
5. Verification /09! (/ fife H6G/f/Mz �i�' r,'77O
MAILING ADDRESS STREETCITYODE
(Business or Agency Address Recommended-Public Document) �,,�/�
,A (/ b S ELYr,51----0 - OR-6
(� ONE -
i(eege EMAIL A�� 7
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• I have used all reasonable diligence in preparing this statement. I have reviewed this statement and to a 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 ofperjuryun r�the
'laws of the State of California that the foregoing is true and cor ct.
Date Signed o/ � wV Signature
(month, ay,year) (File the originally signed paper statement with your tiling official.)
FPPC Form 700-Cover Page(2019/2020)
advice@fppc.ca.gov•866-275-3772•www.fppc.ca.gov
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