Henry Servin - Annual 2015Please type or print in ink.
NAME OF FILER (LAST)
5E R.YI
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
r.
STATEMENT OF ECONOMIC INTERESTS
(FIRST)
COVER PAGE
C
onraal Use
'nib
(MIDDLE)
Division, Board, Department, District, if applicable l Your Position
Y- If-- 2 /
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
[2'61ty of 14re U
Ir
3. Type of Statement (Check at least one box)
Annual: The period covered is January 1, 2015, through
December 31, 2015.
.or-
The period covered is —J —J
December 31, 2015.
❑ Assuming Office: Date assumed
❑ Candidate: Election year
Position:
❑ Judge or Court Commissioner (Statewide Jurisdiction)
F-1 County of
❑ Other
❑ Leaving Office: Date Left —J I
(Check one)
through O The period covered is January 1, 2015, 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-
VO
- ne - No reportable interests on any schedule
❑ Schedule C - Income, Loans. 8 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 Documenq
o y) X7y65 --D N, .s
have used all reasonable diligence in preparing this statement. I have reviewed this statement and to the best of my kn,
herein and in any attached schedules is true and complete. I acknowledge this is a public document.
I certify under penalty of perjury under t ws of the State of California that the foregoing is true and correct.
Date Signed �� Signature ^ '
(month, day, year) (File the on�ally signedstat�
U/s
contained
--FPPC Form 700 (2015/2016)
FPPC Advice Email: advice @fppc.ca.gov
FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov