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2003 (18)STATEMENT OF ECONOMIC INTERES E C ED1t1�LiNed OR •' ITY OF RO���I`/�� FAIR POLITICAL PRACTICES COMMISSION COVER PAGE MAR 1 ( 2004 Please type or print in ink A Public Document CITY CLERK'S OFFICF NAME (LAST) (FIRST) (MIDDLE) DAYTIME TELEPHONE NUMBER RUKAVINA KENNETH ( 562 ) 908 -6200 MAILING ADDRESS STREET CITY STATE ZIP CODE OPTIONAL: FAX I E -MAIL ADDRESS (May be business address) 13191 CROSSROADS PKWY N. #405 INDUSTRY CA 91746 krukavina @willdan.com 1 . Office, Agency or Court Name of Office, Agency or Court: CITY OF ROSEMEAD Division, Board, District, if applicable: Your Position: CONSULTANT r 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 © City of ROSEMEAD ❑ Multi- County ❑ Other 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 through December 31, 2003. ❑ Leaving Office Date Left: (Check one) O The period covered is January 1, 2003, through the date of leaving office. -or- 0 The period covered is __J__J through the date 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 (Less man m% ownership) Schedule A -2 ❑ Yes — schedule attached Investments (ia% argnater Ownership) Schedule B ❑ Yes — schedule attached Real Property Schedule C ❑X Yes — schedule attached Income & Business Positions (income ocher man Loans, Gifts, and T..d Schedule D ❑ Yes — schedule attached Income — Loans Schedule E ❑ 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: 2 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 17, 2004 ( Signature ( ile the originally signetl statement with your fling official.) FPPC Form 700 (200312004) FPPC Toll -Free Helpline: 8661ASK -FPPC SCHEDULE C Income & Business Positions (Income Other than Loans, Gifts, and Travel Payments) > NAME OF SOURCE KENNETH RUKAVINA ADDRESS 13191 CROSSROADS PKWY N. #405 91746 BUSINESS ACTIVITY, IF ANY, OF SOURCE YOUR BUSINESS POSITION CONSULTANT GROSS INCOME RECEIVED ❑ $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 (Describe) > NAME OF SOURCE ADDRESS BUSINESS ACTIVITY, IF ANY, OF SOURCE YOUR BUSINESS POSITION GROSS INCOME RECEIVED ❑ $500 - $1,0oo ❑ $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 Comments: > NAME OF SOURCE Name KENNETH RUKAVINA ADDRESS BUSINESS ACTIVITY, IF ANY, OF SOURCE YOUR BUSINESS POSITION GROSS INCOME RECEIVED ❑ $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 (Properly, car, boat, etc.) ❑ Commission or ❑ Rental Income, list each source of $10,000 ormore ❑ Other (Describe) > NAME OF SOURCE ADDRESS BUSINESS ACTIVITY, IF ANY, OF SOURCE YOUR BUSINESS POSITION GROSS INCOME RECEIVED ❑ $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 FPPC Form 700 (200312004) Sch. C FPPC Toll -Free Helpline: 866/ASK -FPPC