Daysi annualPlease type or print in ink.
STATEMENT OF ECONOMIC INTERESTS
COVER PAGE
A PUBLIC DOCUMENT
1. Office, Agency, or Court
Name (Do not use acronyms)
District, if applicable
(MIDDLE)
► 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
Position:
RECEIVED
CITY OF ROSEMF�ID
Date Initial Filing Receive
Filing 10'e ft 2023
CITY CLERK'S OFFICE
BY.
❑ Judge, Retired Judge, Pro Tem Judge, or Court Commissioner
(Statewide Jurisdiction)
❑ Multi -county ❑ County of
City of tDsf'Y ac: ❑ Other
3. Type of Statement (cheek at least one box)
Annual: The period covered is January 1, 2022, through
December 31, 2022.
-or.
The period covered is ---J--J
December 31, 2022.
❑ Assuming Office: Date assumed
❑ Candidate: Date of Election
❑ Leaving Office: Date Left --J--J
(Check one circle.)
through ❑ The period covered is January 1, 2022, through the date of
leaving office.
.or -
E] The period covered is I I through
the date of leaving office,
and office sought, if different than Part 1:
Schedule Summary (required) ► 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- IXI None - No reportable interests on anv schedule
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business w AgencyAddress Recommended - PuOgc Dwument)
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I have used all reasonable diligence in preparing this statement. I have reviewed this statement and to the best of my k edge the information contained i
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
FPPC Form 700 - Cover Page (2022/2023)
advicegfppn.ca.gov - 966-275-3T/2 - v+ww.fppc.w.gov
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