HomeMy WebLinkAboutEileen Jacobs - Assuming Office 2010
CALIFORNIA FORM 700
FAIR POII1ICAL PRACTICES COMMISSION
Please type or print in ink.
A Public Document
COVER PAGE
~
Date ~ived
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STATEMENT OF ECONOMIC INTERESTS
NAME
(LAST)
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CITY
(FIRST)
MAILING ADDRESS STREET
(Business Address Acceptable)
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1. Office, Agency, or Court
e of Office, Agency, or Court:
QLK~
Division, ard, District, if applicable:
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Your Position:
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~ If filing for multiple positions, list additional agency(ies)1
position(s): (Attach a separate sheet if necessary.)
Agency:
Position:
2. Jurisdiction of Office (Check at least one box)
D State
D County of
~ City of C;; I '-'R I) ~
D Multi-County
D Other
3. T~e of Statement (Check at least one box)
~SSUming Office/Initial Date: ~~-12
D Annual: The period covered is January 1, 2009,
through December 31, 2009.
-or-
a The period covered is -------1-------1_, through
December 31, 2009.
D Leaving Office Date Left: -------1-------1_
(Check one)
a The period covered is January 1, 2009, through the
date of leaving office.
-or-
a The period covered is -------1-------1_, through
the date of leaving office.
D Candidate Election Year:
(MIDDLE)
/':
~U.L\ ~
STATE ZIP CODE
q-ot) ~q.6; - O"LD(p
OPTIONAL: E-MAIL ADDRESS
) en- 0] SO<'D
4. Schedule Summary
~ Total number of pages
including this cover page:
~ Check applicable schedules or "No reportable
interests."
I have disclosed interests on one or more of the
attached schedules:
Schedule A- 1 DYes - schedule attached
Investments (Less than 10% Ownership)
Schedule A-2 DYes - schedule attached
Investments (10% or Greater Ownership)
Schedule B DYes - schedule attached
Real Property
Schedule C DYes - schedule attached
Income, Loans. & Business Positions (Income Other than Gifts
and Travel Payments)
Schedule D DYes - schedule attached
Income - Gifts
Schedule E DYes - schedule attached
Income - Gifts - Travel Payments
-or-
~eportable interests on any schedule
5. Verification
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 certify under penalty of perjury under the laws of the State
of California that the foregoing is true and correct.
Signature
Date Signed
FPPC Form 700 (2009/2010)
FPPC Toll-Free Helpline: 866/ASK.FPPC www.fppc.ca.gov