2003 (37)CALIFORNIAFORM 700
FAIR POLITICAL PRACTICES COMMISSION
Please type or print in ink
COVER PAGE
A Public Document
, z E C Eniv eived
! CITY OF ROSE E p
2004
NAME (LAST)
(FIRST)
(MIDDLE)
- _ — _DAN:FIN Te La77 6NE'A MBER
i BA Pro
C '(Z M NE
C
310 2-r I W
MAILING ADDRESS STREET
(May be business a
1 6 - I �t' a E.
- CITY
VJ L L A. F L— j
STATE ZIP CODE
�aS EH EAO 0
OPTIONAL: FAX / E -MAIL ADDRESS
e4r'IPI I on /
91770 W H C
t
V
1 . Office, Agency or Court
Name of Office, Agency or Court:
112-4FV -16 CDMMr 5S1 0, "j
Division, Board, District, if applicable:
Your Position:
Tit41- "Kfc CofAM I SS110A_ z
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)
❑ Stale
❑ County of
U city of R-Ost= H r✓ A R
_ ❑ Multi -County
❑ Other
3. Type of Statement (Check at least one bOOoK
[j Assuming Office /Initial Date:��
❑ Annual: The period covered is January 1, 2003,
through December 31, 2003.
-or-
0 The period covered is _J___J through
December 31, 2003.
❑ Leaving Office Dale Left: —J �—
(Check one)
• The period covered is January 1, 2003, through
the date of leaving office. _
-o r-
• The period covered is _J___J through
the dale of leaving office.
Candidate
STATEMENT OF ECONOMIC INT
4. Schedule Summary
(Check applicable schedules or 'We reportable inferests.'J
During the reporting period, did you have any reportable
interests to disclose on:
.Schedule A -1 ❑ Yes - schedule attached
Investments (Less inan to% ownenoty)
Schedule A -2 ❑ Yes - schedule attached
Investments (to% or greater Ownerstipl
Schedule B ❑ Yes - schedule attached
Real Property
Schedule C ❑ Yes - schedule attached
Income B Business Positions gnome other man Loans, Gins, ano Trowel
Schedule D ❑ Yes - schedule attached
Income - Loans
Schedule E ❑ Yes - schedule attached
Income - Gifts
_ Schedule F ❑ Yes - schedule attached
Income — Travel. Payments
-or-
.r No reportable interests on any schedule
Total number of pages
completed including this cover page:
5. Verification
1 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
Signature 0
(File Its o in II signed statement with your
FPPC Form 700 (200312004)
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