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Statement of Economic Interest CALIFORNIA FORM 700 FAIR POLITICAL PRACTICES COMMISSION ~æ(C;æ~WlE~ Date Received AUG ~,~u'2ð(jlj C¡:S8 am Krn5 CUPERTINO CITY CLERK STATEMENT OF ECONOMIC INTERE COVER PAGE Please type or print in ink A Public Document NAME (lAST) (FIRST) j MAILING ADDRESS STREET (May use business address) 6\~ () t1t& CITY 1. Office, Agency, or Court Nam of Office, Agency, or Court: ¡ ðt DiviSiO~ 80 rd, District, if appl cable: C\t", &M.n0 \ Your P&o~C~( ~\pI .. If filing for multiple positions, list additional agency(ies)/ position(s): (Attach a separate sheet if necessary.) Agency: Position: 2. Jurisdiction of Office (Check at least one box) o State o County of ~ityof l!.~~V'\o o Multi-County o Other 3. Type of Statement (Check at least one box) D Assuming Office/Initial o Date: ---.-1---.-1~ Annual: The period covered is January 1, 2004, through December 31, 2004. -or- o The period covered is ---.J----1_, through December 31, 2004. o Leaving Office Date Left: ---.-1---.-1~ (Check one) o The period covered is January 1, 2004, through the date of leaving office. -or- o The period covered is ~-----1_, through the date of leaving office. ri Candidate DAYTIME TELEPHONE NUMBER 2.R . 5tlQ¡ STATE ( OPTIONAL: FAX / E-MAIL ADDRESS tÅ1r'O '}St>í~ 4. Schedule Summary (Check applicable schedules or "No reportable interests. If) _ During the reporting period, did you have any reportable interests to disclose on: Schedule A-1 0 Yes - schedule attached Investments (Less than 10% Ownership) Schedule A-2 0 Yes - schedule attached Investments (10% or greater Ownership) Schedule 8 Rea' Property o Yes - schedule attached Schedule C 0 Yes - schedule attached Income, Loans, & Business Positions (Income Other than Gifts and TraYel Payments) Schedule D (Eliminated - report loans on Schedule C) Schedule E 0 Yes - schedule attached Income - Gifts Schedule F 0 Yes - schedule attached Income - Travel Payments -or- . ~ reportable interests on any schedule Total number of pages completed including this cover page: 5. Verification I have used all reasonable diligence in preparing this statement. r 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 ofthe State of California that the foregoing is true and correct. Date Signed Av-~~",h~\ Ye7:P~ Signature FPPC Form 700 (2004/2005) FPPC Toll-Free Helpline: 866/ASK-FPPC