2003 (9)CAUFORW� FORM 700
FAIR POLITICAL PAACTICES COMMISSION �',
Please type or print in ink
STATEMENT OF ECONOMIC
COVER PAGE
A Public Docunu
R E C E I V L L ate Received
14x0 S E M E A U0',aat u,e a y
MAR 1 5 2004
ZI TY CLERK'S O FFICE'
NAME (LAST) (FIRST) (MIDDLE) - DAYTIME TELEPHONE NUMBER
Imperial, Jay T. (626 569 -2100
MAILING ADDRESS STREET - CITY STATE ZIP CODE OPTIONAL: FAX I E -MAIL ADDRESS
(May be business address)
8755 E. Ralph Street, Rosemead, CA 91770
1 . Office, Agency or Court
Name of Office, Agency or Court:
City of Rosemead
Division, Board, District, if applicable:
Your Position:
Councilmember
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
❑x City of n,.,.,.y d
❑ Multi - County
❑ Other
3. Type of Statement (Check at least one box)
❑ Assuming Office /Initial Dale: _J - - -
] Annual: The period covered is January 1, 2003,
through December 31, 2003.
-or-
0 The period covered Is through
December 31, 2003.
❑ Leaving Office Date Left: —J �—
(Check one)
• The period covered is January _1, 2003, through
the dale of leaving office. _
-or-
O The period covered is _J_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 than cox ownership)
Schedule A -2 -- ❑ Yes - schedule attached
Investments pox or uemur ownenoup)
Schedule B ❑ Yes - schedule attached
Real Property -
Schedule C ❑Yes - schedule attached
income & Business Positions pncmne other wan Loans, (A'hs, and TM Y
Schedule D ❑ Yes — schedule attached
Income — Loans
Schedule F. E] Yes — schedule attached
Income — Travel Payments
-or-
Schedule E ❑ Yes- schedule attached
Income - Gilts
. ® 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 15, 2004
h, day, year)
Signature r
k J1h f _ ,M.0y
signed Mal ent with your filing offical)
.
FPPC Form 700 (2003/2004)
FPPC Toll -Free Helpline: 8661ASK -FPPC