State For Official Use Only Division / MSD Fllst Name Management Services Department / /
Person
Mejia Dora Last / Frederick Radcliffe / Janice Lumsden / / /
Position
AGENCY REPORT .C~lifornia Form Date Stamp Secretary / Name Training Officer / Filing Officer / Deputy Secretary of State / Management Services Tille First Name DepartmentlDlvlslon Chief / /
Gift to Agency Report A Public Document 1. Agency Name