Form 700 Cover Page

Statement Of Economic Interests Cover Page - A Public Document

California Form 700 (2018-2019) Fair Political Practices Commission
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Please type or print in ink:

Name of Filer:

Part 1. Office, Agency, or Court

If filing for multiple positions, list below or on an attachment.

Part 2. Jurisdiction of Office (check at least one box)

Part 3. Type of Statement (Check at least one box)


Check one box


Part 4. Schedule Summary

Check applicable schedules or None.


Part 5. Verification

Mailing address (Business or Agency Address Recommended - Public Document)

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.

I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Signature (Print this page and sign below with ink. Do not type signature)

(File the originally signed paper statement with your filing official.)

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