Daniel LopezCALIFORNIA FORM 700
FAIR POLITICAL'PRACTIGES CeMMISSIOIN
Please type or print in ink
STATEMENT OF ECONOMIC
COVER PAGE
A Public Document
NAME - (LAST)
GC){ z
MAILING ADDRESS - STREET
(May be business address) -
�Pag y 64(meTT
(FIRST).. - (MIDDLE)
A I
Date Received
Use only
CITY OFROSEMEAD
MAR 1 6 2004
(VJXCO)J //-
CITY STATE ZIP CODE OPTIONAL: FAX / E -MAIL
5i &arc d-oq g1770
1 . Office, Agency or Court
Name of Office, Agency or Court: -
a � , /:?, 0J-� Aose)nogo
Division, Board, District, if applicable:
Your Po i � tio " n: �
�U�N/Ui�tl` Lc
�+ 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 feast one box)
❑ State - -
❑ County of
[City of / � Q
OS &� &Ao
❑ Multi -County
❑ Other
3. Type of Statement (Check at least one box)
❑ Assuming Office /Initial Date: 1 I-L5- -
❑ 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: __J ___J—
(Check one)
• The period covered is January 1, 2003, through
the date of leaving office. - -
-or-
0 The period covered is through
the dale of leaving office.
❑ Candidate
4. Schedule Summary
(Check applicable schedules or "No reportable Interests.'
r During the reporting period, did you have any reportable
interests to disclose on:
Schedule A -1 ❑ Yes - schedule attached
Investments (Lass man lox oae amr)
Schedule A -2 ❑ Yes - schedule attached
Investments (to %orgrealerowneralp)
Schedule B ❑ Yes - schedule attached
Real Property
Schedule C ❑ Yes - schedule attached
Income 8 Business Positions (mcame omerman Leans, Gift, and Trawv)
Schedule D ❑ Yes - schedule attached
Income - Loans
Schedule E ❑ Yes - schedule attached
Income - Gifts
Schedule F ❑ - Yes - schedule attached
Income - Travel Payments
-o r-
.,. KNo 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. 1 have reviewed this statement and to the best of
my knowledge the information contained herein and in any
attached schedules is true and complete.
1 certify under penalty of perjury under the laws of the State
of California that the foregoing is true and correct.
Date Signed
_ - ( et y, year)
Signature / _ �
- -
IFlle the originally signed s)al ent w M YV W, oRicial.)
FPPC Form 700 (200312004)
FPPC Toll -Free Helpline: 866 /ASK -FPPC