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2003 (40)Date Received STATEMENT OF ECONOMIC INTEREST- facialusa0M • 1 1 �IVE® FAIR POLITICAL PRACTICES COMMISSID E �n COVER PAGE CITY OF ROSEMEAD l UP I M 2003 L Public Document Please type or print in ink - NAME (LAS'S - (FIRST) (MIDDLE) f "" t 6hYZME%Td1UMF0W ! lTMEER K CL T D /�. 2 i Z9� DAn tC Z_ C- ) 443 -z 47� MAILING ADDRESS STREET CITY ZIP CODE OPTIONAL: FAX / E -MAIL ADDRESS (May be business address) 4 F_ AR `tom pYE 2 aye fK, EAo, CA - nr 177ci 1 . Office, Agency or Court Name: C tT OF: Division, Board, District, if applicable: P 4 f , ( t ( - ( ,f Gc,rvcrV isStorCr Position: cc rKrLlS5 �+ 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 el of 206 ❑ Multi- County ❑ Other 3. Type of Statement (Check at least one box) Assuming Office /Initial Date: ❑ Annual: The period covered is January 1, 2002, through December 31, 2002. -or- 0 The period covered is through December 31, 2002. ❑ Leaving Office Date Left: (Check one) • The period covered is January 1, 2002, through the date of leaving office. -or- • The period covered is _--J—, through the date of leaving office. ❑ Candidate 4. Schedule Summary (Check applicable schedules or "No reportable interests. ") iii During the - reporting period, did you have any reportable interests to disclose on: Schedule A -1 [Yes - schedule attached Investments (Las +than 10% ownership) - Schedule A -2 ❑ Yes - schedule attached Investments (1o% or greater Ownership) - Schedule B Zes - schedule attached Real Property Schedule C ❑ Yes - schedule attached Income 8 Business Positions (income Omer than Loans, Gins, and Travel) 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 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 3_ri -y3 �� / // (m /� onth, day, year) /� // /� / Signature " � `-�' " ' / (File the originally signed statement with your filing official.) FPPC Form 700 (200212003) FPPC Toll -Free Heloline: 866 /ASK -FPPC SCHEDULE A -1 Investments Stocks, Bonds, and Other Interests (Ownership Interest is Less Than 10 %) Do not attach brokerage or financial statements. > NAME OF BUSINESS ENTITY l� T7eEc- GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE ❑ $2,000 - $10,000 ❑ $10,001 - $100,000 ❑ $100,001 - $1,000,000 ❑ Over $1,000,000 s ATUS a OF IINVCSTMEN PA-£' CJ ❑ Other IF APPLICABLE, LIST DATE: ACQUIRED DISPOSED > NAME OF BUSINESS ENTITY GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE ❑ $2,000 - $10,000 ❑ $10,001 - $1oo,000 ❑ $100,001 - $1,000,000 ❑ Over $1,OD0,000 NATURE OF INVESTMENT ❑ Stock ❑ Other (Describe) IF APPLICABLE, LIST DATE: ACQUIRED DISPOSED > NAME OF BUSINESS ENTITY GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE ❑ $2,000 - $10,000 ❑ $100,001 - $1,000,000 NATURE OF INVESTMENT ❑ Stock ❑ Other ❑ $10,001 - $100,000 ❑ Over $1,000,000 (Describe) IF APPLICABLE, LIST DATE, ACQUIRED DISPOSED Comments: Name oA > NAME OF BUSINESS ENTITY GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE ❑ $2,000 - $10,000 ❑ $10,001 - $1o0,000 ❑ $100,001 - $1,000,000 ❑ Over $1,000,000 NATURE OF INVESTMENT ❑ Stock ❑ Other (Describe) IF APPLICABLE, LIST DATE: _J .. J 02 ACQUIRED DISPOSED > NAME OF BUSINESS ENTITY GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE ❑ $2,000 - $10,000 ❑ $10,001 . $10o,o0o ❑ $100,001 - $1,000,000 ❑ Ov6 $1,000,000 NATURE OF INVESTMENT ❑ Stock ❑ Other IF APPLICABLE, LIST DATE: 02 �_J 02 ACQUIRED DISPOSED > NAME OF BUSINESS ENTITY GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE ❑ $2,000 - $10,000 ❑ $10,001 - $100,000 ❑ $100,001 - $1,000,000 ❑ Over $1,000,000 NATURE OF INVESTMENT ❑ Stock ❑ Other (Describe) IF APPLICABLE, LIST DATE: Dz ACQUIRED DISPOSED FPPC Form 700 (2002/2003) Sch. A -1 SCHEDULE B Interests in Real Property > STREET ADDRESS OR PRECISE LOCATION 4443. C, CITY (2oSCrtc'ea.p C 1. g[ FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 ❑ $10,001 - $100,000 - 02 __J _N2 ACQUIRED - DISPOSED 00,001 - - $1,000,000 - ❑ Over $1,000,000 NATURE OFINTEREST ❑ Rental Property - - Ownership/Deed of Trust ❑ Easement ❑ Leasehold Yrs. remaining Other IF RENTAL PROPERTY, GROSS INCOME RECEIVED ❑ $0 - $499 ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 SOURCES OF RENTAL INCOME: 11 you own a 10% or greater interest, list the name of each tenant that is a single source of income of $10,000 or more. NAME OF LENDER ��L1 I�L OF AM-E /L�CIA ADDRESS BUSINESS ACTIVITY OF LENDER �ao�n TAF M a2zC T a4� INTEREST RATE TERM (Months/Years) 3/ % ❑None 3o XE'L2" HIGHEST BALANCE DURING REPORTING PERIOD ❑ $500 - $1,000 ❑ $1,001 - $10,000 $10,001 - $100,000 ❑ OVER $100,000 ❑ Guarantor, it applicable Comments: > STREET ADDRESS OR PRECISE LOCATION CITY FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 ❑ $10,001 - $100,00a 02 ❑ $100,001 - $1.000,000 ACQUIRED DISPOSED ❑ Over $1,000,000 - - NATURE OFINTEREST ❑ Rental Property ❑ Ownership /Deed of Trust ❑ Easement ❑ Leasehold ❑ Yrs- remaining Other IF RENTAL PROPERTY, GROSS INCOME RECEIVED ❑ $0 - $499 ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 $100,000 ❑ OVER $100,000 SOURCES OF RENTAL INCOME- It you own a 10% or greater interest, list the name of each tenant that is a single source of income of $10,000 or more. NAME OF LENDER ADDRESS BUSINESS ACTIVITY OF LENDER INTEREST RATE TERM (Months /Years) % ❑ None HIGHEST BALANCE DURING REPORTING PERIOD ❑ $500 - $1,000 ❑ $1,001 - $io,000 ❑ $1o,001 - $100,000 ❑ OVER $100,000 ❑ Guarantor, it applicable FPPC Form 700 (200212003) Sch. B FPPC Toll -Free Helpline: 866 /ASK -FPPC