Jay ImperialSTATEMENT OF ECONOMIC INTERESTS'
COVER PAGE
Please type or print in ink A Public Document
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JUN �.•
CITY C LERK'S OFF
NAME (LAST) (FIRST) (MIDDLE) DAYTIME TELEPHONE NUMBER
_T e-«L� icq T. gy3 ��gy
MAILING ADDRESS STREET Clity STATE ZIP CODE OPTIONAL: FAX / E -MAIL ADDRESS
(May use business address) �7 ss dress) l0N9iL -1S_'44;) GA-- 81770
1 . Office, Agency, or Court
Name of Office, Agency, or Court: I
C 0unC;Jvv14A I �Ose n egl U -I
Division, Board, District, if applicable:
Your Position:
C I mo
�+ 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
N city of :�osf m e a
- ❑ Multi- County
❑ Other
3. Type of Statement (Check at least one box)
❑ Assuming Office /Initial Date: __J__J—
ffi Annual: The period covered is January 1, 2005,
through December 31, 2005.
-or-
Q The period covered is through
December 31. 2005.
❑ Leaving Office Date Left:
(Check one)
• The period covered is January 1, 2005, through
the date of leaving office..
-or-
• The period covered is ___J_ _J_, through
the date of leaving office.
❑ Candidate
4. Schedule Summary
Total number of pages
including this cover page:
.� 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 than 10% Ownership)
Schedule A -2 ❑ Yes - schedule attached
Investments (10% m greater Ownership) -
Schedule B ❑ Yes - schedule attached
Real Property
Schedule C ❑ Yes - schedule attached
Income, Loans, & Business Positions (Innome Other than Gies
and Travel Payments)
Schedule D ❑ Yes - schedule attached
Income - Gifts
Schedule E ❑ Yes - schedule attached
income - Travel Payments
-or-
[ 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.
I certify under penalty of perjury underthe laws of the State
of California that the foregoing is true and correct.
Date Signed y 2,�k `P
/ (month, day, year)
FPPC Form 700 (200512006)
FPPC Toll -Free Helpline: 866 /ASK -FPPC