Statement of Economic Interest
CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
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Date Received
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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)
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CITY
1. Office, Agency, or Court
Nam of Office, Agency, or Court:
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DiviSiO~ 80 rd, District, if appl cable:
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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
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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