Jay Imperialr.ALIFORNIA DRM �00
.S'AIR POLiTICALWRACfICES&OMMISSIDN
Please type or print in ink
NAME (LAST) (FIRST)
(MIDDLE)
Imperial, Jay T. ( 626 56902100
MAILING ADDRESS STREET - CITY- STATE ZIP CODE OPTIONAL: FAX I E -MAIL ADDRESS
(May use business address)
877 E. Ralph Street, Rosemead, CA 91770
1 . Office, Agency, or Court
Name of Office, Agency, or Court:
City of Ros emead
Division, Board, District, if applicable:
Your Position:
Couicilmember
-� If filing for multiple positions, list additional agency(ies)/
position(s): (Attach a separate sheet if necessary.)
Agency:
Position:
2. Jurisdiction of Office (Cheek at least one box)
❑ State
County of
City o f Rosemead
Multi- County
Other
3. Type of Statement (check at least one box)
❑ Assuming Office /Initial Date:
�] Annual: The period covered is January 1, 2004,
through. December 31, 2004.
-or-
0 The period covered is _J_J —, through
December 31, 2004.
F1 Leaving Office Date Left:
(Check one)
0 The period covered is January 1, 2004, through the
date of leaving office. -
-or-
0 The period covered is _J —, through
the date of leaving office.
Candidate
..._.— ._Date-Received
STATEMENT OF ECONOMIC INTEREST'S T 01(x Lusaoely
COVERPAGE i
A Public Document
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 to% Ownership)
Schedule A -2 ❑ Yes - schedule attached
Investments Lio% or greater Ownership)
Schedule B Yes - schedule attached
Real Property
Schedule C ❑ Yes - schedule attached.
Income, Loans, & Business Positions n,c..a Olher Than Gift and
Travel Payments)
Schedule D (Eliminated - report loans on Schedule C)
Schedule E ❑ Yes - schedule attached
Income - Gifts
Schedule F ❑ Yes - schedule attached
Income - Travel Payments
-or-
. n No reportable interests on any schedule
Total number of pages
completed including this cover page: -01-
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 under the laws of the State
of California that the foregoing is true and correct.
Date Signed March 29, 2005
Signature
FPPC Form 700 (200412005)
rnor r_u c-.... w. t.l... PFFIGCK.FPPr.