2003 (45)Date Received
STATEMENT OF ECONOMIC INTERES 9 tl ae
CALIFORNIAFO�m 7'0 FAIR POLTIMAL PFI�CTICES COMMISSID 9 COVER PAGE CITY OF ROSEMEAD
A Public Document
2003
Please type or print in ink
NAME (MIDDLE) (FIRST) (MIDDLE) S_ �— II T L -; MBER
CL- Ty D /--,- R 2 E(_ DA" cc� 443
K 2 473
MAILING ADDRESS STREET _ CITY ZIP CODE OPTIONAL: FAX / E -MAIL ADDRESS
(May be business adtlress)
4 4 43 2056 LA. (77
1 . Office, Agency or Court
Name:
C t'T'T
Division, Board, District, if applicable:
PCgi h trtt r (4 Cr,ti-cl -L I'S Storrr
Position:
Cc It- -nC tS'5 (OH
�+ 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 2.C?5 e_mF,°a,
❑ Multi- County
❑ Other
3. Type of Statement (Check at least one box)
Assuming Office /Initial Date: loa / 03
❑ 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: __J
(Check one)
• The period covered is January 1, 2002, through
the date of leaving office.
-or-
• The period covered is through
the date of leaving office.
❑ Candidate
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 -1 Z - schedule attached
investments (Les, than 10% Owne,sh,p
Schedule A -2 ❑ Yes - schedule attached
Investments (fo% or areal., ownership)
Schedule B /Yes - schedule attached
Real Property
Schedule C ❑ Yes - schedule attached
Income & Business Positions (locame Omer than Loans, Gifts, 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 - tgoo-
( onth, day, year)
Signature
(File the originally signed statement with your filing official.)
FPPC Form 700 (200212003)
FPPC Toll -Free Heloline: 866 1ASK -FPPC
SCHEDULE A -1 '
Investments
Name
Stocks, Bonds, and Other Interests O/anaeL
(Ownership Interest is Less Than 10 %)
Do not attach brokerage or financial statements.
> NAME OF BUSINESS ENTITY
11, T7CEL
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
FAIR MARKET VALUE
❑ $2,000 - $10,000 ❑ $10,001 - $100,000
❑ $100,00l - $1,000,000 ❑ Over $1,000,000
[s NATU E OF INVESTMENT ! (� ✓
tock 66 s<LA,L£� C z. 4®
❑ Other
IF APPLICABLE, LIST DATE:
— _J__J 02 _J___J 02
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
❑ $1o,001 - $1oo,000
❑ Over $1,000,000
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
IF APPLICABLE, LIST DATE:
D2
ACQUIRED DISPOSED
Comments:
tc');c
> NAME OF BUSINESS ENTITY.
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
FAIR MARKET VALUE
❑ S2,000 - $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
> NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
FAIR MARKET VALUE
❑ $2,000 - $10,000
❑ $100,001 - $1,000,000
❑ $10,001 - $100,000
❑ Over $1,000,000
NATURE OF INVESTMENT
❑ Stock
❑ Other
IF APPLICABLE, LIST DATE:
ACQUIRED DISPOSED
> NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
FAIR MARKET VALUE
❑ $2,000 - S10,000
❑ $100,001 - $1,000,000
NATURE OF INVESTMENT
❑ Stock
❑ Other
❑ $10,001 - $100,000
❑ Over $1,000,000
( Descibe)
IF APPLICABLE, LIST DATE.
/ 02 _J--j 02
ACQUIRED DISPOSED
FPPC Form 700 (200212003) Sch. A -1
SCHEDULE B
Interests in Real Property
> STREET ADDRESS OR PRECISE LOCATION
x-4 C (A A_c.'�_ '7 u'E
CITY
iZOSEMt-7'� -O CGS. 71-00
FAIR MARKET VALUE
IF APPLICABLE, LIST DATE:
❑ $2,000 - $10,000
❑ $10,001 - $100,o0o
02
00,001 - $1,000,000
ACQUIRED - DISPOSED
❑ Over $1,000,000
NATURE OF INTEREST
❑ Rental Property 21 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: If 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
- 6" i' t"I�_ 0 Ar+E1L i Cta.
ADDRESS
BUSINESS ACTIVITY OF LENDER
P c-0S 'T/+ -F t- La 2 T Ctn C r OF
INTEREST RATE TERM (Months /Years)
3/
❑None "0
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500 - $1,000 ❑ $1,001 - $10,000
110,001 - $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 - $100,000 �� 02 -/ 02
ACQUIRED DISPOSED
71 $100,001 - $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 - $4e9 ❑ $500 - $1,000 ❑ $1,001 - $10,000
❑ $10,001 -. s100,000 - ❑ OVER $100,000 -
SOURCES OF RENTAL INCOME: If 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 - $i0,000
❑ $10,001 - $100,000 ❑ OVER $100,000
❑ Guarantor, it applicable
FPPC Form 700 (2002/2003) Sch. B
FPPC Toll -Free Helpline: 866 /ASK -FPPC