Kim BorisSTATEMENT OF ECONOMIC INTE
Please type or print in ink.
COVER PAGE
A Public Document
MAR 1 1 2010
NAME (LAST)
(FIRST)
(MIDDLE)
Palmer -Boris
Kimberly
L
( 626 ) 569 -2250
MAILING ADDRESS STREET
CITY
STATE
ZIP CODE
OPTIONAL: EMAIL ADDRESS
(Business Address Acceptable)
3936 N. Muscatel Ave
Rosemead
Ca
91770
kboris @cityofrosemead.org
L Office, Agency, or Court
Name of Office, Agency, or Court:
City of Rosemead
Division, Board, District, if applicable:
Parks & Recreation
Your Position:
Recreation Supervisor
► 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 feast one box)
❑ State
❑ County of
% City of Rosemead
❑ Multi- County
❑ other
Type of Statement (Check at feast one box)
❑ Assuming Office/Initial Date: __J - - - J
® Annual: The period covered is January 1, 2009,
through December 31, 2009.
-or-
0 The period covered is 01 / __ 01 1 0 9 , through
December 31. 2009.
❑ Leaving Office Date Left: —J
(Check one)
O The period covered is January 1, 2009, through the
date of leaving office.
-or-
0 The period covered is /_ /_, through
the date of leaving office.
❑ Candidate Election Year:
4. Schedule Summary
P. Total number of pages 1
including this cover page:
► Check applicable schedules or "No reportable
interests."
have disclosed interests on one or more of the
attached schedules:
Schedule A -1 ❑ Yes - schedule attached
Investments (Less than 70% ownership)
Schedule A -2 ❑ Yes - schedule attached
Investments (70% or Greater ownership)
Schedule B ❑ Yes - schedule attached
Real Property
Schedule C ❑ Yes - schedule attached
Income, Loans, & Business Positions (Income other than Gilts
and Travel Payments)
Schedule D ❑ Yes - schedule attached
Income - Gifts
Schedule E ❑ Yes - schedule attached
Income - Gifts - Travel Payments
-or-
® No reportable interests on any schedule
5. Verification
1 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.
Date Signed 3/8/10
_ �o (month, day. year)
Signature � ✓1
mile the aiginely signed sletemanl with your filing official.)
FPPC Form 700 (200912010)
FPPC Toll -Free Helpline: 8661ASK -FPPC www.fppc.ca.gov