Merced OrtizSTATEMENT OF ECONOMIC INTERE c I
CEIV R eceived
1 ' OSe Only.
COVER PAGE CITY OF ROSEMEAD
' I MAR 1,Q 2003
Please type or print in ink 4 l - I J CAT A Public Docu77 ent
/ f 1 r_
NAME (LAST) (FIRST) (MIDDLE) E� O = NUMBER
Z F
MAILING ADDF1 SS STREET CITY ZIP CODE OPTIONAL: FAX / E -MAIL ADDRESS
(May be business address) - - - -
3q,0'/ Al", ,e,:l`c, /ll01W -e - h'®s Gr7zr
1 . Office, Agency or Court
Name:
Division, Board, District, if applicable:
Position:
` 155 /Gore
l - J
If filing for multiple positions, list additional agency(ies)/
position(s): (Attach a separate sheet if necessary.)
Agency:
- Position:
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
10 %0nnemhip)
Schedule A -2
❑ Yes - schedule attached
Investments (lo% or greater 0.narshi0)
Schedule B
❑ Yes - schedule attached
Real Property -
Schedule C
❑ Yes - schedule attached
Income & Business Positions (Income Other than Loans. Gills, and Travel)
Schedule D
❑ Yes - schedule attached
Income - Loans
2. Jurisdiction of Office (check at /east one box)
❑ State
❑ County of
[eClty of / 65 ti° !mot'/
❑ Multi- County
❑ Other -
3. Type of Statement (Check at least one box)
❑ Assuming Office /Initial Date: __J __J
[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 __J
(Check one)
O The period covered is January 1, 2002, through
the date of leaving office.
-or-
0 The period covered is through,
the date of leaving office.
❑ Candidate
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 �`f - 03 -
(month d ay , year)
year)
Signature A_�- W /r. , � , ��� r
(File the originally signed t1`al Y
enl your filing official.)
FPPC Form 700 (200212003)