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Polly Lown COVER PAGE MAR 3,,p 1 . Office, Agency, or Court Name of Office, Agency, or Court Rosemead City Council Division, Board, District, if applicable: Your Position: City Council Member • 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 © City of Rosemead ❑ Multi -County ❑ Other © Assuming Office/Initial STATEMENT OF ECONOMIC (Check at least one box) Date: _ _3j 27 / 0 ❑X Annual: The period covered is January 1, 2007, through December 31, 2007. -or- 0 The period covered is — 27 r 07 , through December 31. 2007. ❑ Leaving Office Date Left: J —J (Check one) O The period covered is January 1, 2007, through the date of leaving office. -or- 0 The period covered is J_J through the date of leaving office. ❑ Candidate 4. Schedule Summary —Total number of pages including this cover page: 2 '• Check applicable schedules or "No reportable Interests." I have disclosed interests on one or more of the attached schedules: Schedule A -1 ❑ Yes – schedule attached Investments (Less then 10% Ownership) Schedule A -2 ❑ Yes – schedule attached Investments (to% w 9raeter ownarahip) Schedule B ❑ Yes – schedule attached Reel Property Schedule C ❑ Yes – schedule attached Income, Loans, & Buslness Positions (In=re other wren Gem and Twal Payments) Schedule D Q Yes – schedule attached Income — Gift Schedule E ❑'Yes – schedule attached Income – Trevel Payments -or- E] No reportable interests on any schedule 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 AmGl 2r3o� (manth, day, year) Signature FPPC Form 700 (200712008) FPPC Toll -Free Helpline: 866 /ASK -FPPC A Public Document Please t or print in ink. CITY CLERK'S OFF NAME (LAST) (FIRST) (MIDDLE) DAYTI Low Polly ( 626) 573 5549 MAILING ADDRESS STREET CITY STATE ZIP CODE OPTIONAL: FAX I E -MAIL ADDRESS (May use business address) 1039 La Press Ave Rosemead CA 91770 1 . Office, Agency, or Court Name of Office, Agency, or Court Rosemead City Council Division, Board, District, if applicable: Your Position: City Council Member • 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 © City of Rosemead ❑ Multi -County ❑ Other © Assuming Office/Initial STATEMENT OF ECONOMIC (Check at least one box) Date: _ _3j 27 / 0 ❑X Annual: The period covered is January 1, 2007, through December 31, 2007. -or- 0 The period covered is — 27 r 07 , through December 31. 2007. ❑ Leaving Office Date Left: J —J (Check one) O The period covered is January 1, 2007, through the date of leaving office. -or- 0 The period covered is J_J through the date of leaving office. ❑ Candidate 4. Schedule Summary —Total number of pages including this cover page: 2 '• Check applicable schedules or "No reportable Interests." I have disclosed interests on one or more of the attached schedules: Schedule A -1 ❑ Yes – schedule attached Investments (Less then 10% Ownership) Schedule A -2 ❑ Yes – schedule attached Investments (to% w 9raeter ownarahip) Schedule B ❑ Yes – schedule attached Reel Property Schedule C ❑ Yes – schedule attached Income, Loans, & Buslness Positions (In=re other wren Gem and Twal Payments) Schedule D Q Yes – schedule attached Income — Gift Schedule E ❑'Yes – schedule attached Income – Trevel Payments -or- E] No reportable interests on any schedule 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 AmGl 2r3o� (manth, day, year) Signature FPPC Form 700 (200712008) FPPC Toll -Free Helpline: 866 /ASK -FPPC SCHEDULE D Income — Gifts > NAME OF SOURCE Young's Market Company ADDRESS 2164 N. Batavia St, Orange CA 92865 BUSINESS ACTIVITY, IF ANY, OF SOURCE Social Event DATE (mm /dd/yy) VALUE DESCRIPTION OF GIFT(S) 4j 21 / 07 $ 80 Dinner JJ— $ JJ— $ > NAME OF SOURCE ADDRESS BUSINESS ACTIVITY, IF ANY, OF SOURCE DATE (mm /dd/yy) VALUE DESCRIPTION OF GIFT(S) J J $ JJ $ JJ— $ > NAME OF SOURCE ADDRESS BUSINESS ACTIVITY, IF ANY, OF SOURCE DATE (mm /ddryy) VALUE JJ $ — /J— $ --J--J— $ DESCRIPTION OF GIFT(S) Comments: > NAME OF SOURCE ADDRESS BUSINESS ACTIVITY, IF ANY. OF SOURCE DATE (mmidd/yy) VALUE J J $ JJ— $ --J--J— $ > NAME OF SOURCE ADDRESS DESCRIPTION OF GIFT(S) BUSINESS ACTIVITY, IF ANY, OF SOURCE DATE (mm /dd/yy) VALUE JJ $ J S DESCRIPTION OF GIFT(S) > NAME OF SOURCE ADDRESS BUSINESS ACTIVITY, IF ANY, OF SOURCE DATE(mm /dd /yy) VALUE DESCRIPTION OF GIFT(S) JJ— $ JJ— $ FPPC Form 700 (200712008) Sch. D FPPC Toll -Free Helpline: 866 /ASK -FPPC