Jay ImperialSTATEMENT OF ECONOMIC INTERESTS
A Public Document
COVER PAGE
Please type or print In ink
Date Received
a! 'el use (bury
NAME (LAST) (FIRST) (Middle) DA`rrlME TELEPHONE NUMBER
Jay T. Imperial ( )
MAILING ADDRESS STREET CITY ZIP CODE OPTIONAL: FAX E -MAIL ADDRESS
(May be business address)
8755 East Ralph Street, Rosemead, CA, 91770
1. Full Name of Office Sought or Held,
Agency or Court:
County Sanitation Districts No(s). 15
of Los Angeles County
Division, Board, District, if applicable:
Board of Directors
Position: -
Director - Rosemead
y If filing for multiple positions, list additional agency(ies)/
position(s): (Attach a separate sheet if necessary.)
Agency:
Position Title:
2. Jurisdiction of Office (Check one box)
❑ State
❑ County of_
❑ City of
❑ Multi- County _
® Other Aeex
3. Type of Statement (Check at least one box)
❑ Assuming Office /Initial Date: / /
® Annual: The period covered is January 1, 2001, through
December 31, 2001.
.or-
0 The period covered is
December 31, 2001.
❑ Leaving Office Date Left: / /
(Check one)
Q The period covered is January 1, 2001, through
the date of leaving office.
-or-
0 The period covered is
the date of leaving office.
❑ Candidate
4. Schedule Summary
(Check applicable schedules or "No reportable interests.")
li During the reporting period, did you have any reportable interests to
disclose on:
Schedule A -1
❑
Yes - schedule attached
Investments (Less
than 10
% Ownership)
Schedule A -2
❑
Yes - schedule attached
Investments (Greaterthan 10 % Ownership)
Schedule B
❑
Yes - schedule attached
Real Property
Schedule C
❑
Yes - schedule attached
Income & Business Positions (Income Other 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-
y ® 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 :/ L� ?O
(rmm flay, yea
Signature
(F' the originally signed sta with fur filing official.)
FPPC Form 700 (2 0 0112 0 0 21
FPPC Toll -Free Helpline: 866 ASK -FPP
Date Received
STATEMENT OF ECONOMIC INTEREA-ISU6�IVEDa,useons
CALIFORNIA FORM 70(1 t,ITY OF ROSEMEAD
! II(�I A Public Document
Please •type or print in ink C" L I C AT L . COVER PAGE BAR 0 �i 2002
U
NAME (LAST) )FIRST) (MIDDLE) I I y PHONE NUMBER
Jay T. Imperial ( )
MAILING ADDRESS STREET CITY ZIP CODE OPTIONAL: FAX I E -MAIL ADDRESS
(May be business address)
8755 E. Ralph Street, Rosemead, CA 91770
1. Full Name of Office Sought or Held,
Agency or Court:
City of Rosemead
Division, Board, District, if applicable:.
Position:
Councilmember
If filing for multiple positions, list additional agency(ies)/
position(s): (Attach a separate sheet if necessary.)
Agency:
Position Title:
2. Jurisdiction of Office (Check one box)
❑State
❑ County of
[][City of Rogainead
❑ Multi- County
r 1 .Im
3. Type of Statement (Check at least one box)
❑ Assuming Office /Initial Date:
® Annual: The period covered is January 1, 2001,
through December 31, 2001.
-or-
0 The period covered is _lam —, through
December 31, 2001.
❑ Leaving Office Date Left: __J___J-
(Check one)
0 The period covered is January 1, 2001, through
the date of leaving office.
-or-
0 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
❑ Yes – schedule attached
Investments (Lass than
10% ownership)
Schedule A -2
❑ Yes – schedule attached
Investments (Greater than 10 %d ownership)
Schedule B
❑ Yes – schedule attached
Real Property
_
Schedule C
❑ Yes - schedule attached
Income & Business Positions (Income other man Loan,. Gills, and navel
Schedule D
❑ Yes – schedule attached
Income – Loans
Schedule E ❑ Yes – schedule attached
Income – Gilts
Schedule .❑ 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 March 6, 2002
( year)
Signatur414' signed stale nl with your filing official.)
FPPC Form 700 (200112002)
FPPC Toll -Free Helpline: B66 /ASK -FPPC