700 Statement of Economic InterestCALIFORNIA 1 1 STATEMENT OF ECONOMIC INTEREST (jfrrat;��;7t� �t
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DOCUMENTA PUBLIC COVER PAGE 2016
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NAME OF FILER (LAST) (FIRST) (, ( , %� I (MjOp� )(� 1/ CLERK Ij
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1. Office, Agency, or Court
Agency Name (Do not use acronyms)
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Division, Board, 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 /I ❑ County of
tA City of C :'&/ J? P r–f l Y"J �a ❑ Other
3. Type of Statement (Check at least one box)
❑ Annual: The period covered is January 1, 2015, through ❑ Leaving Office: Date Left / I
-or-
December 31, 2015. (Check one)
The period covered is through O The period covered is January 1, 2015, through the date of
December 31, 2015. -or- leaving office.
❑ Assuming Office: Date assumed 1 O The period_ covered is —_J— I through
the date of leaving office.
[� Candidate: Election year 0�?O / �LO— and office sought, if different than Part 1:
5. Verification
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business or Agency Address Recommended - Public Document)
DAYTIME TELEPHONE NUMBER E-MAIL ADDRESS
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1 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.
1 certify under penalty of perjury under the laws of the State of California that the
with your (ling official.)
FPPC Form 700 (2015/2016)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov