 Date Left / /
(Check one)
The period covered is January 1, 2017, through the date of
leaving ofce.
The period covered is / / , through
the date of leaving ofce.
 The period covered is January 1, 2017, through
December 31, 2017.
The period covered is / / , through
December 31, 2017.


FPPC Form 700 (2017/2018)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
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 acknowledge this is a public document.


(month, day, year)
 (Check at least one box)
State
Judge or Court Commissioner (Statewide Jurisdiction)
Multi-County
County of
City of
Other
 (Check at least one box)
 Date of Election and ofce sought, if different than Part 1:
 Date assumed / /
DateInitial FilingReceived
Ofcial Use Only
Please type or print in ink.
700
FAIr POLITICAL PrACTICES COMMISSION
CALIFORNIA FORM
Agency Name (Do not use acronyms)
Division, Board, Department, District, if applicable Your Position

   
MAILING ADDRESS STREET CITY STATE ZIP CODE
()
DAYTIME TELEPHONE NUMBER
E-MAIL ADDRESS
(Business or Agency Address Recommended - Public Document)

(File the originally signed statement with your ling ofcial.)

A PuBLIC DOCuMENT
If ling for multiple positions, list below or on an attachment. (Do not use acronyms)
Agency:
Position:
-or-
-or-
None - No reportable interests on any schedule
 
Schedules attached
 Investments – schedule attached
 Investments – schedule attached
 Real Property – schedule attached
Total number of pages including this cover page:
-or-
 Income, Loans, & Business Positions – schedule attached
 Income Gifts – schedule attached
 Income Gifts Travel Payments – schedule attached
Clear Page
Print