Kim BorisSTATEMENT OF ECONOMIC INTERESTS Date Received
OOlalel Use Received
COVER PAGE
Please type or print in ink
NAME OF FILER (LAST) (FIRST) (MIDDLE)
Palmer -Boris Kimberly L
1. Office, Agency, or Court.,
Agency Name
City of Rosemead
Division, Board, Department, District, if appricable Your Position
Parks & Recreation Department Recreation Supervisor
► If fling for multiple positions, list below or on an attachment
Agency:
Position:
2. Jurisdiction of Office (check at feast one box)
❑ State ❑ Judge (Statewide Jurisdiction)
❑ Multi-county
® City of Rosemead
3. Type of Statement (check at tease one box)
® Annual: The period covered is January 1, 2010, through December 31,
2010. - or-
The period covered is ��� through December 31,
2010.
❑ Assuming Office: Date
❑ Candidate: Election Year
® County of Los AN(
❑ other
❑ Laving Office: Date
(Check ore)
O The period covered is January 1, 2010, through the date of
leaving office.
O The period covered is --J --J_ through the date
of leaving office.
Office sought, If different than Part 1:
4. Schedule Summary
Check applicable schedules or "None."
► Total number of pages including this cover page:
❑ Schedule A -1 - Investments — schedule attached ❑ Schedule C - Income, Loans, & Business Positrons — schedule attached
❑ Schedule A-2 - Investments — schedule attached ❑ Schedule D - Income — Gilts — schedule attached
❑ Schedule B - Real Properly— schedule arched ❑ Schedule E - Income — Gifts — Travel Payments — schedule attached
-or-
El None - No reportable interests on any schedule
5. Verification
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Bolls m ftemyAddras Recommended - Public Ooxu p
8838 E Valley Blvd Rosemead Ca 91770
DAYTIME TELEPHONE NUMBER EMAIL ADDRESS
( 626 ) 569 -2250 1 kborisOcitvofrosemead.om
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 acknowledge this is a public document.
I certify under penalty of perjury under the laws of the State of California that the foregoing its true and correct.
Date Signed 3/15/11 Signature
vwne, day yeah I Fib the o art• svmd sbram rd wrdh yom bag official)
FPPC Form 700 (2 01 012 011)
FPPC Toll -Free Helpline: 866/276.3772 www.fppc.ca.gov