2003 (22)STATEMENT OF ECONOMIC
Please type or print In ink
COVER PAGE
A Public Document
I
NAME (LAST) (FIRST) (MIDDLE) OAYTIMETELEPHONE NUMBER
Mrat -j�nr� U(i f(OA17 9, r7
ay be business address)
4 N Wil�a�� A
1 . Office, Agency or Court
Name of Office, Agency or Court:
-T { ca c'm'hiX10KA
Division, Board, District, if applicable:
Your Position:
C'ym mr <'Si
�+ 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 ?\C)— Ory1
❑ Multi -County
❑ Other
3. Type of Statement (Check at least one box)
❑ Assuming Office /Initial Date:--J--]—
Annual: The period covered is January 1, 2003,
,through December 31, 2003.
-or-
0 The period covered is I through
December 31, 2003.
❑ Leaving Office Dale Left: —J--J
(Check one)
• The period covered is January 1, 2003, through
the date of leaving office.
-o r-
0 The period covered is through
the date of leaving office.
❑ Candidate
STATE ZIP CODE
� T�ete Received
IT? OF ROSEMEAD
MAR 9 2004 I
o(MO
OPTIONAL: FAX / E -MAIL ADDRESS I
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 - ❑ Yes - schedule attached
investments (Lees than io owaersmp)
Schedule A -2 ❑ Yes - schedule attached
Investments (10% or greater oanersnip)
Schedule B ❑ Yes - schedule attached
Real Property
Schedule C ❑ Yes - schedule attached _
Income B Business Positions rim. aner man Laans, aRS, ans T.m)
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
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.
1 certify under penalty of perjury under the laws of the State
of California that the foregoing is true and correct.
Date Signed 3 I - � o4 Q
Signature
FPPC Form 700 (2 00 312 0 0 4)
FPPC Toll -Free Helpline: 866 /ASK -FPPC
SCHEDULE E
Income — Gifts
> NAME OF SOURCE
Q,ricw\ Womo�ala\ aeon
ADDRESS 1_
BUSINESS ACTIVITY, IF ANY, OF SOURCE 012833
DATE (mm/dd /yy) VALUE DESCRIPTI OF GIFT(S)
,J o3 $
��— $
> NAME OF SOURCE
KCilar� WOW J\ - 1 -��11� L"AL � 6
ADDRESS
�i �>2 N. lAV6M e,1 AUQ- eCAr� A
BUSINESS ACTIVITY, IF ANY, OF SOURCE CA
[Alf, LtaD,UQ, p(tYl tt {'TUN S-W�J '
DATE (mm/dd /yy) WJ WE DESCRIPTION OF GIFT(S)
(� Io / 6 a 00 Co WOCK arv,2,
$
> NAME OF SOURCE
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/dd /yy) VALUE DESCRIPTION OF GIFT(S)
--J --J_ $
--J --J $
$
Comments:
Name `' �_ L
ban I��yGI�JrI
> NAME OF SOURCE
ADDRESS
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm /dd/yy)
VALUE
J J
$
ADDRESS
��—
$ -
DATE (mm /dd /yy)
��
$
$
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)
$
$
FPPC Form 700 (200312004) Sch. E
FPPC Tall -Free Helpline: 866 /ASK -FPPC