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2003 (33)STATEMENT OF ECONOMIC INTEREST Received CALIFORNIA FORm 1 1 E C L FAIR POLITICAL PRACTICES COMMISSION CITY OF ROSEMEAD COVER PAGE MAR 2 2 2004 Please type or print In ink A Public Document - NAME (LAST) (FIRST) - (MIDDLE) - — � B R Scott Daniel 3. 1 525 ,974 -8371 21P CODE OPTIONAL: FAX I E -MAIL ADDRESS 400 North Citrus Avenue Covina CA 91723 1 . Office, Agency or Court Name of Office, Agency or Court: City of Rosemead (LA County) Fire Division, Board, District, if applicable: Fire Department Your Position: A ssistant Fire Chief If filing for multiple positions, list additional agency(ies)I posilion(s): (Attach a separate sheet if necessary.) Agency: Position: 2. Jurisdiction of Office (Check at least one box) ❑ Stale Ej County of Los A ngeles ❑ City of p Multi- County ❑ Other 3. Type of Statement (Check at least one box) ❑ Assuming Office /Initial 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) • The period covered is January 1, 2003, through the date of leaving office. -or- O The period covered is J_ / through the date of leaving office. ❑ Candi 4. Schedule Summary (Check applicable schedules or "No reportable inferests.'J — During the reporting period, did you have any reportable interests to disclose on: Schedule A -1 ❑ Yes - schedule attached Investments (Leaman to %o.nerr„q Schedule A -2 ❑ Yes - schedule attached Investments rro %orgmarer pj Schedule B ❑ Yes - schedule attached Real Property Schedule C ❑ Yes - schedule attached Income B Business Positions Imcmna oe,er man L ©� ®n :. a,m travail 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: 1 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. I certify under penalty of perjury underthe laws of the State of California that the foregoing is true and correct. February 26, 2004 Date Signe Imo t day, year) Signature Pile the originally signed statement with your filing oaicel.) FPPC Form 700 (200312004) FPPC Toll -Free Helpline: e661ASK -FPPC