700 Blum - 2015 from 01/01 - 12/31CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
A PUBLIC DOCUMENT
Please type or print in ink.
STATEMENT OF ECONO A
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COVER PAGE
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NAME OF FILER (LAST) (FIRST)
1. Office, Agency, or Court
Date Initial - Filing Received
fY5cial Use Oniy
(MIDDLE)
Agency) amj (Do not use acronyms)
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Division, Board, Department, District, if applicable Your Position
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► If filing for multiple positions, list below or on an attachment. (Do not use acronyms)
Agency: Position.
2. Jurisdiction of Office (Check at feast one box) _
❑ State 0 Judge or Court Commissioner (Statewide Jurisdiction)
❑ Multi-County��II ❑ County of
3(City of A—.4 Q U/ A/ 7/f ❑ Other
3. Type of Statement (Check at least"one box)
Annual: The period covered is January 1, 2015, through ❑Leaving Office: Date Left —1-1
December 31, 2015. (Check one)
-or-
The period covered is , through
Decei ber 31, 2015.
O Assuming Office: Date assumed
❑ Candidate:' Election year
Q The period covered is January 1, 2015, through the date of
leaving office.
-or-
O The period covered is through
the date of leaving office.
and office sought, if different than Part t
5.'Ver'Ification /7 qv v fr 41 ,(,ee an./7---14 4-- ? 21S3
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business or Agency Address Recommended - Public Document)
DAYTIME TELEPHONE NUMBER
DRESS
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1 have used all reasonable diligence in preparing this statement. I have reviewed this statement and (o the best of my knowledge a 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.
Date Signed (-3
/6'
month, day, year)
Signat
(Rde the originally signed statement with your Mew add)
FPPC Form 700 (2015/2016)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov