700 Gosselin (Vacation Rental Compliance) - 2019 from 01/01 to 12/31STATEMENT OF ECONOMIC INTERESTS Date Initial Filing Received
Filing Offictal Use Only
COVER PAGE
Please type or print in ink. A PUBLIC DOCUMENT
NAME OF FILER (LAST) (FIRST) (MIDDLE)
0 Sf o V A/
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
/
Division, Board, Department, District, if applicable Your Position
P. If filing for multiple positions, list below or on an attachment. (Do not use acronyms)
Agency:
2. Jurisdiction of Office (Check at least one box)
❑ State
❑ Multi -County
❑ City of —
3. Type of Statement (Check at least one box)
Annual: The period covered is January 1, 2019, through
December 31, 2019.
.or -
The period covered is I I through
December 31, 2019.
❑ Assuming office: Date assumed
❑ Candidate: Date of Election
Position:
❑ Judge, Retired Judge, Pro Tern Judge, or Court Commissioner
(Statewide Jurisdiction)
❑ County of
❑ Other _
❑ Leaving office: Date Left —J_ I
(Check one circle.)
O The period covered is January 1, 2019, through the date of
-or- leaving office.
O The period covered is — I through
the date of leaving office.
and office sought, if different than Part 1:
4. Schedule Summary (must complete) ► Total number of pages including this cover page: '&-_
Schedules attached
❑ Schedule A-1 - Investments — schedule attached
❑ Schedule A-2 - Investments — schedule attached
❑ Schedule B - Real Property — schedule attached
-or- ❑ None - No reportable interests on any schedule
❑ Schedule C - Income, Loans, & Business Positions — schedule attached
❑ Schedule D - Income — Gifts — schedule attached
❑ Schedule E - Income — Gifts — Travel Payments — schedule attached
5. Verification
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business or Agency Address Recommended - Public Document)
DAYTIME TELEPHONE NUMBER EMAIL ADDRESS
10 ) 7Y'� 5 7 y� v�c,q 10"�ILo.,. C'r.+y+ w'l+�-..+ A i+vo -G cam.
I have used all reasonable diligence in preparing this statement. I have reviewed this statement and to the best of my knowledge the inf6rmation 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
Date Signed ti 2 0 2 v Signature
(m nth, day, year) ile the originally signed pa 'Wh your filing orficial.)
Clear Page Print FPPCForm 700- Cover Page (2019/2020)
advice@fppc.ca.gov • 866-275.3772 • www.fppc.ca.gov
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