Holly KnappSTATEMENT OF ECONOMIC
COVER PAGE
Please type or print in ink
NAME (LAST)
(May use business 7
address)
W
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4 2 -3u , l a
(FIRST)
A Public Document
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5W8 r" IV d' -'„O Use Ony
CITY OF ROSE�JEAD
too -Aaii u 7 2005
CITY CLERK'S _1 I .....
PHONE NUMBER
1 . Office, Agency, or Court
Name of Offfire, Agency, or Court:
( �A 4 a & yy,, &A
Division, Board, bistrict, if applicable:
Your Position:
Tt Ti C C� YV11'Yt I SS I U �
• 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 1 ' /� J -
❑ County of l� e A nd)A P
❑ City of R—U SLW U
❑ 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 through
December 31, 2004.
❑ Leaving Office Date Left: _J__J
(Check one)
O The period covered is January 1, 2004, through the
date of leaving office.
-or-
0 The period covered is through
the date of leaving office.
❑ Candidate
OPTIONAL: FAX I E -MAIL ADDRESS
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 (fc% or greater Ownership)
Schedule B ❑ Yes - schedule attached
Real Property
Schedule C lSd Yes - schedule attached
Income, Loans, & Bfisiness Positions (Income Other than Gifts and
Travel Payments)
Schedule D (Eliminated - report loans on Schedule C)
Schedule E j Yes - schedule attached
Income - Gifts
Schedule F ❑ Yes - schedule attached
Income - Travel Payments
-or-
. ❑ No reportable interests on any schedule
Total number of pages
completed including this cover page:
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 Y C4 ,' � r c>-16(j
(month, day, year)
r� I
Signature
(File the originally signed statement with youVitiry official.)
FPPC Form 700 (200412005)
FPPC Toll -Free Helpline: 866/ASK-FPPC
SCHEDULE C
income, Loans* & Business
Positions
(Other than Gifts and Travel Payments)
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOUL
�` I�-tl. ���1�o�as
YOUR BUSINE_S� ���O�yS�ITION
'7'4 -k ly C. C @Nb�YI /�B� YIDf
GROSS INCOME RECEIVED /HIGHEST BALANCE DURING
REPORTING PERIOD, IF LOAN
0$500 - $1,000 ❑ $1,001 - $10,000
❑ $10,001 - $100,000 ❑ OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
Salary ❑ Spouse's income ❑ Loan repayment
❑ Sale of
(Property, car, boat, etc.)
❑ Commission or ❑ Rental Income, list each some of $10,000 or mare
❑ Other
(Descnbe)
❑ LOAN RECEIVED (complete box 2)
I.NAME OF S
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOUR BUSINESS POSITION
GROSS INCOME RECEIVED /HIGHEST BALANCE DURING
REPORTING PERIOD, IF LOAN
❑ $500 - $1,000 ❑ $1,001 - $10,000
❑ $10,001 - $100,000 ❑ OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
❑ Salary ❑ Spouse's income ❑ Loan repayment
❑ Sale of
(Property, car, boat, etc.)
❑ Commission or ❑ Rental Income, list each source of $10,000 or more
❑ Other
(Descnbe)
❑ LOAN RECEIVED (complete box 2)
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOUR BUSINESS POSITION
GROSS INCOME RECEIVED /HIGHEST BALANCE DURING
REPORTING PERIOD, IF LOAN
❑ $500 - $1,000 ❑ $1,001 - $10,000
❑ $10,001 - $100,000 ❑ OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
❑ Salary "❑ Spouse's income ❑ Loan repayment
❑ Sale of
(Property car, boat, etc.)
❑ Commission or ❑ Rental Income, list each source of $10,000 ormore
❑ Other
(Describe)
❑ LOAN RECEIVED (complete box 2)
INTEREST RATE TERM (Months/Years)
% ❑ None
SECURITY FOR LOAN
❑ None ❑ Personal residence
❑ Real Property
❑ Guarantor —
❑ Other
(Descnbe)
* You are not required to report loans from
commercial lending institutions, or any indebtedness
created as part of a retail installment or credit card
transaction, made in the lender's regular course of
business on terms available to members of the
public without regard to your official status.
Comments:
FPPC Form 700 (2004/2005) Sch. C
FPPC Toll -Free Hairline: 866 1ASK -FPPC
SCHEDULE E
Income — Gifts
> NAME OF SOURCE
11 - 1 4�1 &,(,— d
ADDRESS
RS 38
BUSINESS ACTIVITY, IF ANY, OF SOURC
DATE (mm /dd /yy) VALUE DESCRIPTION OF GIFT(S)
��
NAME OF SOURCE
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mmlddlyy) VALUE DESCRIPTION OF GIFTS)
__j --- J $
> NAME OF SOURCE
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mmldd /yy) VALUE
��— $
—J — $
Comments:
DESCRIPTION OF GIFT(S)
> NAME OF SOURCE
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm /dd /yy) VALUE DESCRIPTION OF GIFT(S)
$
$
> NAME OF SOURCE
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm /dd/yy) VALUE DESCRIPTION OF GIFT(S)
$
—JJ $
J am_ $
> NAME OF SOURCE
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm /dd /yy)
VALUE
$
$
_ _J
$
DESCRIPTION OF GIFT(S)
FPPC Form 700 (200412005) Sch. E
FPPC Toll -Free Helpline: 666 /ASK -FPPC