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Holly KnappDate Received STATEMENT OF ECONOMIC INTERESTREC , gaff lJ)an, FAIR POLITICAL PRACTICES COMMISSION 1 COVER PAGE CITY OF ROSEMEAD MAR 2 6 2003 Please type or print in Ink A Public Document NAME (LAST) - (FIRST) (MIDDLE) L H6 UMBER o ( L;4 ) 30 � sygj MAIL NG ADDRESS I STREET ITY ZIP CODE OPTIONAL: FAX / E -MAIL ADDRESS (May be business address) - 1 . Office, Agency or Court Name: D ' Division, Board, District, if applicable: Position:U a, CA oy, Yo 614 �+ 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 N [County of LO S Tn "FBI �S [xCity of 114 MJQ ❑ 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- , O The period covered is ��_, through December 31, 2002. ❑ Leaving Office Date Left: (Check one) . O The period covered is January 1, 2002, through the date of leaving office. -or- 0 The period covered is —J_J —, 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 ❑ Yes — schedule attached Investments (Less than ro% ownership) - Schedule A - 2 - �i Yes – schedule attached Investments (10 %or grealer ownership) - Schedule B ❑ Yes – schedule attached Real Property - Schedule C ❑ Yes — schedule attached Income & Business Positions (Ineoma Other than Loans, Gifts, and Travel) Schedule D ❑ Yes – schedule attached Income – Loans - - Schedule E (Yes – schedule attached Income – Gilts 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 (month,'d ,year) Signature FPPC Form 700 (2002/2003) FPPC Toll -Free Helpline: 866 /ASK -FPPC SCHEDULE A -2 Investments, Income, and Assets of Business Entities/Trusts (Ownership Interest is 10% or Greater) Check one ❑ Trust, go to 2 ❑ Business Entity, complete the box, then go to 2 DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 ❑$10,001 $1oo,000 / 02 _f_f ❑ $100,001 - $1,000,000 ACQUIRED DISPOSED ❑ Over $1,000,000 NATURE OF INVESTMENT ❑ Sole Proprietorship ❑ Partnership ❑ Other YOUR BUSINESS POSITION ❑ $0- $499 ❑ $10,0ol - $100,000 $500 - $1,000 ❑ OVER $100,000 $1,001 - $10,000 Check one box: ❑ INVESTMENT - ❑ REAL PROPERTY Name of Business Entity or Street Address or Assessor's Parcel Number of Real Property Description of Business Activity 2 City or Other Precise Location of Real Property FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 ❑ $10,001 - $100,000 _j___J 02 ___J___J 02 ❑ $100,001 - $1,000,000 ACQUIRED DISPOSED ❑ Over $1,000,000 , NATURE OF INTEREST ❑ Property Ownership /Deed of Trust ❑ Stock E] Partnership ❑ Leasehold ❑ Other Yrs. remaining ❑ Check box if additional schedules reporting investments or real property are attached k one ❑ Trust, go to 2 ❑ Business Entity, complete the box, then go to 2 IERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 ❑ $10,00l - $100,000 ❑ $100,001 - $1,000,000 - ACQUIRED DISPOSED ❑ Over $1,000,000 ' NATURE OF INVESTMENT ❑ Sole Proprietorship ❑ Partnership ❑ Other YOUR BUSINESS POSITION ❑ $0 -$4ss - ❑ $1o,00l - $100,000 - ❑ $500 - $1,000 ❑ OVER $100,000 ❑ $1,o01 - $10,00o Check one box: - ❑ INVESTMENT ❑ REAL PROPERTY of business Lnnry Address or Assessors Parcel Number of Real Property uescnpuon or business Acnvlry -or City or Other Precise Location of Real Property FAIR MARKET VALUE IF APPLICABLE, LIST DATE:. ❑ $2,000 - $10,000 ❑ $to,00l - $1oo,000 ❑ $100,001 - $1,000,000 ACQUIRED DISPOSED ❑ Over $1,000,000 . NATURE OF INTEREST ❑ Property Ownership/Deed of Trust ❑ Stock ❑ Partnership ❑ Leasehold ❑ Other Yrs. remaining ❑ Check box if additional schedules reporting investments or real property are attached FPPC Form 700 (200212003) Sch. A -2 FPPC Toll -Free Helpline: 866 /ASK -FPPC SCHEDULE E Income — Gifts > NAME OF SOURCE ( 7 1 )) y p �� 1 ADD RESS l.t - U BUSINESS ACTIVITY, IF ANY, OF SOURCE D NS�C_ R PTIO` ,QF G .,(S) VALUE DATE V �u �I n� P b 6 LL- , t $4 Jr Si $ bbi p ibn 11y > NAME OF SOURCE ADDRESS ACTIVITY, IF ANY, OF SOURCE DESCRIPTION OF GIFT(S) > NAME OF SOURCE ADDRESS BUSINESS ACTIVITY, IF ANY, OF SOURCE DESCRIPTION OF GIFT(S) VALUE DATE $ - -- > NAME OF SOURCE VALUE DATE $ __J—J > NAME OF SOURCE ADDRESS BUSINESS ACTIVITY, IF ANY, OF SOURCE DESCRIPTION OF GIFT(S) VALUE DATE Comments: ADDRESS BUSINESS ACTIVITY, IF ANY, OF SOURCE. DESCRIPTION OF GIFT(S) VALUE DATE > NAME OF SOURCE i ADDRESS BUSINESS ACTIVITY, IF ANY, OF SOURCE DESCRIPTION OF GIFT(S) VALUE DATE S ' FPPC Form 700 (2002/2003) Sch. E FPPC Toll -Free Helpline: 866 /ASK -FPPC