2003 (4)700 STATEMENT OF ECONOMIC INTEREST R E C r�a c�eiwied
' " ' " CITY OF ROSEMEAD
FAIR POLITICAL PRACTICES COMMISSION COVER PAGE MAR 1 v 2004 i
Please type or print in ink A Public Document - , r r QFFI r. J
NAME (LAST) (FIRST) (MIDDLE) " "IIArnUE
rjig, r c ((o ) a 3 Le
MAILING ADDRESS T EET CITY STATE ZIP CODE OPTIONAL: FAX E -MAIL ADDRESS
(May be business address) _
,3(o N. gyrosF �o��l� owl CR- 4/770 6 30 —gd-ly
1 . Office, Agency or Court
Name of Office, Agency or Court:
Division, Board, District, if applicable: -
Your Position:
Ct �, C6 jUA C L I rt e m
.a. 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 1
City of �fRn Sp vV � � �.
❑ Multi -County
❑ Other
3. Type of Statement (Check at least one box)
❑ Assuming Office /Initial Date:
Annual: The period covered is January 1, 2003,
through December. 31, 2003.
-or-
0 The period covered is _J� through
December 31, 2003.
❑ Leaving Office Date Left: —
(Check one)
• The period covered is January 1, 2003, through
the dale of leaving office.
-or-
0 The period covered is _J� through
the dale of leaving office.
❑ Candidate
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 men io% ownership)
Schedule A -2 ❑ Yes - schedule attached
Investments (le% m greater Ownership)
Schedule B ( Yes - schedule attached
Real Property
Schedule C Yes - schedule attached
Income & Business Positions (nmorne omer man Loans, Gins, and Tares)
I
Schedule D ❑ Yes - schedule attached
Income - Loans
Schedule E ❑ Yes - schedule attached
Income - Gilts
Schedule F Ej Yes - schedule attached
Income - Travel Payments.
-or-
E] 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 - lf, ( T
(month, day, year)
Signature ; Q'4 A:Lr
(FAe the orlgl Ily signed swiemeM with your ffling official.)
FPPC Form 700 (200312004)
FPPC Toll -Free Helpline: 866 /ASK -FPPC
SCHEDULE B
Interests in Real Property
> STREET ADDRESS OR PRECISE LOCATION
7' l 6Cwlev�
CITY
&5.�1?yYLVO -A CA 91?76
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
❑ $2,000 - $10,000
- rg $1 0,001- $mo,000 - - �_I 03 _/ / 03
❑ $10,001 .$1,000,000 ACQUIRED DISPOSED
❑ Over $1,000,000 -
- NATURE OF INTEREST
❑ Rental Property ❑ Ownership /Deed of Trust ❑ Easement
❑ Leasehold - -. ❑
Yrs. remaining - Other
IF RENTAL PROPERTY, GROSS INCOME RECEIVED
❑ $0 $499 ❑ $600 - $1,000 K $1,001 - $10.000
❑ $10,001 - $100.000 ❑ OVER $100,000
SOURCES OF RENTAL INCOME: If you own a 10% or greater
interest, list the name of each tenant that is a single source of
Income of $10,000 or more.
NAME OF LENDER
ADDRESS
BUSINESS ACTIVITY: OF LENDER
INTEREST RATE. TERM (MonthslYears)
% ❑ None
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500 - $1,000 ❑ $1,001 - $10,000 -
❑ $10,001 - $100,000 ❑ OVER $100,000
❑ Guarantor, If applicable
Comments:
> STREET ADDRESS OR PRECISE LOCATION
CITY
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
❑ $2,000 - $10,000
❑ $10,001- $100,000 JJ 03 �� 03
❑$10,001- $1,o0o,000 ACQUIRED DISPOSED
❑ Over $1,000,000
NATURE OF INTEREST
❑ Rental Property ❑ Ownership /Deed of Trust ❑ Easement
❑ Leasehold ❑
Yrs. remaining Other
IF RENTAL PROPERTY, GROSS INCOME RECEIVED
❑ $0 - $499 ❑ $500 - $1,000 - ❑ $1,001 - $10,000
❑ $10,001. -. $100,000 -- ❑ OVER $100,000
SOURCES OF RENTAL INCOME: If you own a 10% or greater
interest, list the name of each tenant that is a single source of
income of $10,000 or more.
NAME OF LENDER -
.ADDRESS
BUSINESS ACTIVITY OF LENDER -
INTEREST RATE TERM (Months /Years)
% ❑ None
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500 - $1,000 ❑ $1,001 - $10,000
❑ $10,001 - $100,000 ❑,OVER $100,000
[] Guarantor, If applicable
FPPC Form 700 (200312004) Sch. B
FPPC Toll- Free Helpline: 8661ASK -FPPC
SCHEDULE C
Income & Business Positions
(Income Other than Loans, Gifts, and
Travel Payments)
> NAME OF SOURCE /
Rf le, Fe- flowsLP
ADDRESS I
BUSINESS
BUSINESS POSITION
F G�R 7 OSS INCOME RECEIVED
R1d $500 - $1.000 ❑ $1,001 - $10,000
❑ $10,001 13100,000 ❑ 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 810,000 or more
❑ Other
(Describe)
> NAME OF SOURCE
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOUR - BUSINESS POSITION
GROSS INCOME RECEIVED
❑ $500 - $1,000 ❑ $1,001 - $1o,0o0
❑ $10,001 - $100,000 ❑ OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
❑ Salary ❑ Spouse's income ❑ Loan repayment
❑ Sale of
(Property. car, boal, etc.)
❑ Commission or ❑ Rental Income, list each sconce of 510,000 or more
0
❑ Other
(Describe)
Comments:
> NAME OF SOURCE
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOUR BUSINESS POSITION -
GROSS INCOME RECEIVED
❑ $500 - $1,000 ❑ $1,00l - $VI,000
❑ $10,001 - $100,000 ❑ OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
❑ Salary ❑ Spouse's income ❑ Loan repayment
❑ Sale of
(Properly car, boa(, e1cJ
❑ Commission or ❑ Rental Income, list each source of 510,000 or more
❑ Other
(Describe)
> NAME OF SOURCE
ADDRESS
BUSINESS ACTIVITY, - IF ANY, OF SOURCE
YOUR BUSINESS POSITION
GROSS INCOME RECEIVED
❑ $500 - $1,000 ❑ $1,0oi - $io,00o
❑ s10,00l - $1oo,00o ❑ OVER 5100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
❑ Salary ❑ Spouse's income ❑ Loan repayment
❑ Sale of
(Prnpony, car, boat, etc.)
❑ Commission or ❑ Rental Income, iml each sconce of $10,000 or more
❑ Other
FPPC Form 700 (200312004) Sch. C
FPPC Toil -Free Helnlin, RRR /GRK -root
SCHEDULE F
Income — Gifts
Travel Payments, Advances,
and Reimbursements
• Reminder — you must mark the gift or income box.
• You are not required to report "income" from government agencies.
> NAME OF SOURCE ( rr
I Dlh1i. AF C{ �r FdVTYY G- C(
ADDRE S
lg fiD K Sfre�f
CITY AND STATE
&eCL&�ojjlf�
BUSINESS ACTIVITY, IF ANY, OF SOURCE 1 .
)W5C(Ac /%6 -� 6 ) -rs fold �'I 12i✓ 1"ESIt -NW
DATE(S): _�— / --� —�— AMT 5 g . 7T
QraPWlaable)
TYPE OF PAYMENT: (musk Check one) ❑ Gift K Income
DESCRIPTION: Mf Al PQ & P"', &J 'Ca
0j I n �e Qr Se'b cA�_ 4 a bjef lY✓Gh dt GIB
> NAME OF SOURCE -
> NAME OF SOURCE
ADDRESS
CITY AND STATE
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATEiS$ ___/ .. _ AMT: $
(lrapp)kable)
TYPE OF PAYMENT: (must Check One) ❑ Gift ❑ Income
DESCRIPTION:
> NAME OF SOURCE
ADDRESS
CITY AND STATE
BUSINESS ACTIVITY, IF ANY. OF SOURCE
DATE(S):_J_ J_ -__J_J_ AMT. $
(Inapplicable)
TYPE OF PAYMENT (must Check one) -❑ Gift ❑ Income
DESCRIPTION:
Comments:
ADDRESS
CITY AND STATE
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE(S):_/_J_ -__J___/_ AMT .$
(ttappficable)
TYPE OF PAYMENT: (must Check One) ❑ Gift ❑ Income
DESCRIPTION:
FPPC Form 700 (2 0 0 3120 04) Sch. F
FPPC Toll -Free. Helpline: 866[ASK -FPPC