Fillable CA Form700-09-10 Statemnt Of Enon Intrst%5B1%5D

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CA Form700-09-10 Statemnt Of Enon Intrst%5B1%5D

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Election Year:
► Check applicable schedules or “No reportable
interests.”
I have disclosed interests on one or more of the
attached schedules:
Schedule A-1
Yes – schedule attached
Investments (Less than 10% Ownership)
Schedule A-2
Yes – schedule attached
Investments (10% or Greater Ownership)
Schedule B
Yes – schedule attached
Real Property
Schedule C
Yes – schedule attached
Income, Loans, & Business Positions (Income Other than Gifts
and Travel Payments)
Schedule D
Yes – schedule attached
Income – Gifts
Schedule E
Yes – schedule attached
Income – Gifts – Travel Payments
Leaving Ofce Date Left: / /
(Check one)
The period covered is January 1, 2009, through the
date of leaving ofce.
The period covered is / / , through
the date of leaving ofce.
Annual: The period covered is January 1, 2009,
through December 31, 2009.
The period covered is / / , through
December 31, 2009.
-or-
STATEMENT OF ECONOMIC INTERESTS
COVER PAGE
NAME (LAST) (FIRST) (MIDDLE)
MAILING ADDRESS STREET CITY STATE ZIP CODE
( )
DAYTIME TELEPHONE NUMBER
FPPC Form 700 (2009/2010)
FPPC Toll-Free Helpline: 866/ASK-FPPC www.fppc.ca.gov
4. Schedule Summary
5.Verication
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 certify under penalty of perjury under the laws of the State
of California that the foregoing is true and correct.
Date Signed
(month, day, year)
Signature
3. Type of Statement (Check at least one box)
State
County of
City of
Multi-County
Other
2. Jurisdiction ofOfce(Check at least one box)
Candidate
No reportable interests on any schedule
A Public Document
Assuming Ofce/Initial Date: / /
OPTIONAL: E-MAIL ADDRESS
(Business Address Acceptable)
Date Received
Ofcial Use Only
(File the originally signed statement with your ling ofcial.)
Please type or print in ink.
-or-
-or-
700
FAIR POLITICAL PRACTICES COMMISSION
CALIFORNIA FORM
Name of Ofce, Agency, or Court:
Division, Board, District, if applicable:
Your Position:
► If ling for multiple positions, list additional agency(ies)/
position(s): (Attach a separate sheet if necessary.)
Agency:
Position:
1.Ofce,Agency,orCourt
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CA Form700-09-10 Statemnt Of Enon Intrst%5B1%5D

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Completed 17 February 2020

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