Victor RuizDate Received
STATEMENT OF ECONOMIC INTEREST OH,nW Use Onl
ECENED
COVER PAGE CITY OF ROSEMEAD
Please type or print in ink A Public Document. MAR 2 6 2003
NAME (LAST) _ (FIRST) ( MIDDLE) I �I r t CLEJg fIkI ,T,Et,�P,11dd�JF,�tgMSER
U�Z Y C_4- 11 I � C a rt�fn �9 Vr rf(;
MAILING ADDRESS STREET - CITY ZIP CODE OPTIONAL: FAX / E -MAIL ADDRES
(May be business address)
Cjwa-�7 67
1 . Office, Agency or Court
Name:
Division, Board, District, if applicable:
Position:
�► 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 l
El City of 'use YvIL cl
❑ 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)
0 The period covered is January 1, 2002, through
the date of leaving office.
-or-
0 The period covered is —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 rhan 10% ownership)
Schedule A -2 ❑ Yes , schedule attached
Investments (10% or greater Ownership)
Schedule B ❑ Yes - schedule attached
Real Property -
Schedule C ❑ Yes - schedule attached'
Income 8 Business Positions (income other than Loans, sins, 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
.r ;Zj 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 a 6 _-Y2
on , ay, year)
Signature
the on y signed slat ith your tiling official.)
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