Form 700 Cover Page

Please type or print in ink:

Name of Filer:
Last:
First:
Middle:

1. Office, Agency, or Court

Agency Name (Do not use acronyms):

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

Multi-County: Name of Counties

City of: Name of City

Judge or Court Commissioner (Statewide Jurisdiction)

County of: Name of County

Other: Describe Other

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

Annual Statement: The period covered is January 1, 2017, through
December 31, 2017.

• OR The period covered is:   Date (enter month, day, year) , through December 31, 2017.

Candidate Statement:   Election Year (enter year)  and office sought, if different than Part 1:

Leaving Office Statement:   Date Left (enter month, day, year)

(Check one)

• The period covered is January 1, 2017, through the date of leaving office. OR
• The period covered is   Date (enter month/day/year) , through the date of leaving office.

4. Schedule Summary

Schedule A-1 - Investments - schedule attached

Schedule A-2 - Investments - schedule attached

Schedule B - Real Property - schedule attached

Schedule C - Income, Loans and Business Positions - schedule attached

Schedule D - Income - Gifts - shedule Attached

Schedule E - Income - Gifts - Travel Payments - schedule attached

OR

None - No reportable interests on any schedule

Total number of pages including this cover page:

5. Verification

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

Street:
City:
State:
Zip code:

Daytime telephone number with area code:

E-mail Address (optional):

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 statement with your filing official.)