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• ' • ' STATEMENT OF ECONOMIC INTERESTS
COMMISSION FAIR POLITICAL PRACTICES JUL 2 9.2014
DOCUMENT A PUBLIC COVER PAGE
CITY CLERK
Please type or print in ink.
CITY OF SEAL BEACH
NAME OF FILER _ _ (LAST) (FIRST) (MIDDLE)
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
C (-ry CovNcc L
Division, Board, Department, District, if applicable Your Position
l S+r 1'C+ -5- /fit EM SEE-
► 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 ❑Judge or Court Commissioner(Statewide Jurisdiction)
❑Multi-County ❑County of
City of �9bA).— 12)EACfi ❑Other
3. Type of Statement (Check at least one box)
❑ Annual: The period covered is January 1, 2013, through ❑ Leaving Office: Date Left
December 31, 2013. (Check one)
-or-
The period covered is I I through O The period covered is January 1, 2013, through the date of
December 31, 2013. leaving office.
❑ Assuming Office: Date assumed I 1 O The period covered is I through
the date of leaving office.
no"candidate: Election year and office sought, if different than Part 1:
4. Schedule Summary /
Check applicable schedules or"None." ► Total number of pages including this cover page:
❑ Schedule A-1 -Investments–schedule attached ❑ Schedule C-Income, Loans, &Business Positions–schedule attached
❑ Schedule A-2-Investments–schedule attached ❑ Schedule D- Income– Gifts–schedule attached
❑ Schedule B- Real Property–schedule attached ❑ Schedule E- Income– Gifts– Travel Payments–schedule attached
�/ -or-
FV None-No reportable interests on any schedule
5. Verification
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business or Agency Address Recommended-Public Document)
DAYTIME TELEPHONE NUMBER E-MAIL ADDRESS(OPTIONAL)
c ) r ny\e a.h dry, com
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 t
Date Signed ` Signature
(month,dal year)
FPPC Form 700(2013/2014)
FPPC Advice Email:advice @fppc.ca.gov
FPPC Toll-Free Helpline:866/275-3772 www.fppc.ca.gov