Henneberry 700 - LeavingCALIFORNIA FORM 700
AIR POLITICA'. PRACTICES COMMISSION
A PUBLIC DOCUMENT
Please type or print in ink.
NAME OF FILER ST)
4riot Pt A. 11
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
A ti/t ?(4 r‘ 11-41 To,
f
STATEMENT OF ECONOMIC INTERi
TY'
AUG 0 1 2016
e ,
,1
COVER PAGE
Division, Board, Department, District, if applicable
CH -jcL)A
CITY CL '57; OFFIC1i
Ike b<- /2-1/
Your Position
o- 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)
[j] State
lE] Multi-County
111 City of /4%
3. Type of Statement (Check at least one box)
Li Annual: The period covered is January 1, 2015, through
December 31, 2015.
-or-
The period covered is _/_/
December 31, 2015.
0 Assuming Office: Date assumed
Li Candidate: Election year
, through
Position'
[1] Judge or Court Commissioner (Statewide Jurisdiction)
CI County of
111 Other
02/Leaving Office: Date Left
(Check one)
o 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 1:
4. Schedule Summary (must complete) Total number of pages including this cover page:
Schedules attached
-or-
Li Schedule A-1 - Investments — schedule attached
Li Schedule A-2 - Investments — schedule attached
11] Schedule B - Real Property — schedule attached
None - No reportable interests on any schedule
11 Schedule C - Income, Loans, & Business Positions — schedule attached
I] Schedule D - Income — Gifts — schedule attached
El Schedule E - Income — Gifts — Travel Payments — schedule attached
5. Verification
MAILING ADDRESS STREET
(Business or Agency Address FF,ecommendect Public Document)
(
(5-0 )
CITY
E-MAIL ADDRESS
heffe 424
STAT
I have used all reasonable diligence in preparing this statement. I have reviewed this statement and to the best
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
Date Signed
el— (60
(month, day, year)
Signature
E ZIP CODE
a st itJ
f my knowledge theinformation contained
correct.
(
)
orm 700 (2015/2016)
FPPC Advice EiFaI advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov