2003 (2)STATEMENT OF ECONOMIC INTER
COVER PAGE
RACE IVIWI®¢ny
CITY OF ROSEMEAD
L) k_1 1 v 2003
Please type or print in ink A Public DLICU Ment
r
NAME (LAST) (FIRST). (MIDDLE) (NUMBER
.MAILING ADDRESS STREET CITY ZIP CODE OPTIONAL: FAX / E -MAIL ADDRESS
(May be business address)
136 7 S/ /cfa,4-v.7 /e 9J 3 �2-
1 . Office, Agency or Court
Name:
/ '�v G/ lZas Pvh��tG�
Division, Board, District, if applicable:
Position:
) U 14 N l G
If filing for multiple positions, list additional agency(ies)/
position(s): (Attach a separate sheet if necessary.)
Agency:
Position:
2. Jurisdiction of Office (Check at least one box)
❑ State
❑ County of
Xcity of 12 en 5 ° Qe f
❑ Multi- County
❑ Other
3. Type of Statement (Check at least one box)
❑ Assuming Office /Initial Date:
❑ Annual: The period covered is January 1, 2002,
through December 31, 2002.
-or-
0 The period covered is through
December 31. 2002.
�J Leaving Office Date Left: _11 � .? / 0 33
(Check one) -
O The period covered is January 1, 2002, through
the date of leaving office.
-or-
0 The period covered is _I _J_, through
the date of leaving office.
❑ Candidate
4. Schedule Summary
(Check applicable schedules or "No reportable interests. ")
-+ During the reporting period, did you have any reportable
interests to disclose on:
Schedule A -1 ❑ Yes - schedule attached
Investments (Less than 10 % Ownership)
Schedule A -2 ❑ Yes - schedule attached
Investments (10% or greater ownership)
Schedule B ❑ Yes - schedule attached
Real Property
Schedule C ❑ Yes - schedule attached
Income & Business Positions (inoome other than Loess, Gihs, and Travail
Schedule D ❑ Yes - schedule attached
Income - Loans -
Schedule E ❑ Yes - schedule attached
Income - Gilts -
Schedule F ❑ Yes - schedule attached
Income - Travel Payments
-or-
.. ® No reportable interests on any schedule
Total number of pages completed including this
cover page:
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.
1 certify under penalty of perjury under the laws of the
State of California that the foregoing is true and correct.
Date Signed /0-/"/ 0 3
(month, day, year)
Signatu�f / /�Y.CX%G�
(File the originally signed slaleo�,` with your filing Dt icial.)
FPPC Form 700 (200212003)