Polly LowSTATEMENT OF ECONOMIC
COVER PAGE
Please type or print in ink.
NAME OF FILER (LAST) (FIRST)
Low Polly
1. Office, Agency, or Court
d 2 IJ12
l CLIP OFFJCE
BY
Agency Name
City of Rosemead
Division, Board, Department, District, if applicable Your Position
Council Member
► If fling for multiple positions, list below or on an attachment.
Agency:
Position:
2. Jurisdiction of Office (Check at least one box)
❑ Stale
❑ Multi-County
❑X City of Rosemead
❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ County of
❑ Other —
3. Type of Statement (Check at least one box)
❑X Annual: The period covered is January 1, 2011, through _ ❑ Leaving Office: Date Left I
December 31. 2011. (Check one)
-or-
The period covered is
December 31, 2011.
❑ Assuming Office: Date assumed
❑ Candidate: Election Year
O The period covered is —
the date of leaving office.
Office sought, if different than Pad 1:
through
4. Schedule Summary
Check applicable schedules or "None."
❑ Schedule A -1 - Investments - schedule attached
❑ Schedule A -2 - Investments - schedule attached
❑ Schedule B - Real Property - schedule attached
❑ Schedule C - Income, Loans, & Business Positions - schedule attached
F' Schedule D - Income - Gifts - schedule attached
❑ Schedule E - Income - Gifts - Travel Payments - schedule attached
.or
❑ None - No reportable interests on any schedule
5. Veri
MAILING ADDRESS STREET CT": - STATE ZIP CODE
(Business crAgency Address Recommended - Public Document)
1039 La Presa Avenue Rosemead CA 91770
( 626 ) 573 -5549
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 acknowledge this is a public document.
I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date Signed 3113112 Signature ( /
(monlh, day, fear) rHM 'aeyssnedslalem 1rAh purging afba!)
through O The period covered is January 1, 2011, through the date of
leaving office.
► Total number of pages including this cover page: 2-
FPPC Form 700 (2011/2012)
FPPC Toll -Free Helpline: 866 /275 -3772 vvww.fppc.ca.gov
SCHEDULE D
Income — Gifts
► NAME OF SOURCE
�lvL/l..c , yU'rwr�El2nS � S di2�bl� , �
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE -
DATE (mm /ddtyy) VALUE DESCRIPTION OF GIFT(S)
J —l — $
► NAME OF [SOURCE y�
ADDRESS (Business Addres Acceplab /e) gIP n
ova /? 5 , Uo s� • 4:� kz.
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm /ddtyy) VALUE DESCRIPTION OF GIFT(S)
► NAME OF SOURCE
ADDRESS (Business Address Acceptable) -
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm /dd /yy) VALUE
$
/J $
� J— $
DESCRIPTION OF GIFT(S)
Comments:
► NAME OF SOURCE
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm /ddyy) VALUE
��— $
��— $
DESCRIPTION OF GIFT(S)
► NAME OF SOURCE
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm /ddtyy) VALUE
$
$
__J __J— $
DESCRIPTION OF GIFT(S)
► NAME OF SOURCE
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm /ddtyy) VALUE
$
$
DESCRIPTION OF GIFT(S)
FPPC Forrn 700 (201112012) Sch. D
FPPC Toll -Free Helpline: 866 1275 -3772 w .fppc.ca.gov
alrTzLs o
CALIF ORNIA 1 1 STATEMENT OF ECONOMIC INTERESTS em�a USn
FAIR POLITICAL PRACTICES COMMISSION
i j
f , �?7iJ
.P ...
COVER PAGE f _
Please type or print in ink.
foS�'C01AFICIi
NAME OF FILER (LAST)
(FIRST)
Low
Polly
1. Office, Agency, or Court
❑ Schedule A -2 - Investments - schedule attached
Agency Name
❑ Schedule B - Real Property - schedule attached
C of Rosemead Community Development Commission
Commissioner
Division, Board, Department, District, if applicable
Your Position
► If filing for multiple positions, list below or on an attachment
5. Veri
Agency:
Position:
2. Jurisdiction Of Office (Check at least one box)
(Business cr Agency Address Recanmended - Public Document)
❑ State
❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ Multi - County
❑ County of
0 City of Rosemead
❑ Other
3. Type of Statement (Check at least one box)
❑ Annual: The period covered is January 1, 2011, through
_ ❑X Leaving Office: Date Left _01 ( 2012
December 31, 2011.
(Check one)
.pr.
The period covered is I I
through O The period covered is January 1, 2011, through the date of
December 31, 2011.
leaving office.
❑ Assuming Office: Date assumed
O The period covered is — I through
the date of leaving office.
❑ Candidate: Election Year
Office sought, it different than Part 1:
4. Schedule Summary
,
Check applicable schedules or "None."
► Total number of pages including this cover page.
❑ Schedule A -1 - Investments - schedule attached
❑ Schedule C - Income, Loans, & Business Positions - schedule attached
❑ Schedule A -2 - Investments - schedule attached
Schedule D - Income - Gifts - schedule attached
❑ Schedule B - Real Property - schedule attached
Schedule E - Income - Gifts - Travel Payments - schedule attached
-or-
El None -
No reportable interests on any schedule
5. Veri
MAILING ADDRESS STREET
CITY STATE ZIP CODE
(Business cr Agency Address Recanmended - Public Document)
-_
1039 La Presa Avenue
Rosemead CA 91770
DAYTIME TELEPHONE NUMBER
EMAIL ADDRESS (OPTIONAL)
( 626 ) 573 -5549
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 acknowledge this is a public document.
I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date Signed 3113112 Signature
(mnnlh, day, yea') ifi unisfigirallysignedslafament amt your Ring wrdet)
FPPC Form 700 (2 01112 0 1 2)
FPPC Toll -Free Helpline: 8661275 -3772 www.fppc.ca.gov
SCHEDULE D
Income — Gifts
► NAME OF SOURCE
15tkc ,
ADDRESS (Business Address Acceptable)
L A Cot 9�v7/
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm /dd /yy) VALUE DESCRIPTION OF GIFT(S)
$
� J— $
► NAME OF SOURCE
ADDRRE Ad ss Acceptable)) �l
O O j r7 7, UG.el ,, _6"C s'l1. F- �21GvL�'I / /7/
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm /dd /yy)
_L/201 / /
��—
� J—
VALUE DESCRIPTION OF GIFT(S)
$
$
► NAME OF SOURCE
ADDRESS (Business
Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/dd /yy)
VALUE DESCRIPTION OF GIFT(S)
$
Comments:
► NAME OF SOURCE
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm /dd /yy) VALUE DESCRIPTION OF GIFT(S)
$
$
� J— $
► NAME OF SOURCE
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm /dd /yy) VALUE DESCRIPTION OF GIFT(S)
--J ---/— $
—J —J— $
► NAME OF SOURCE
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mnVddlyy) VALUE DESCRIPTION OF GIFT(S)
$
$
FPPC Form 700 (2011/2012) Sch. D
FPPC Toll - Free Helpline: 866275 -3772 vd _ fppc.ca.gov
MAYOR:
Steven Ly
MAYOR PRO TEM:
Sandra Armenta
COUNCIL MEMBERS:
William Alarcon
Margaret Clark
Polly Low
April 2, 2012
Secretary of State
Political Reform Division
1500 1I Street, Room 495
Sacramento, CA 95814
To Whom It May Concern:
City of ftsemead
8838 E. VALLEY BOULEVARD P.0 BOX399
ROSEMEAD, CALIFORNIA 91770
TELEPHONE (626) 569 -2100
FAX (626) 307 -9218
Enclosed, are original 700 Statement of Economic Interest for filer Polly Low If there are
any questions, please feel free to contact the office of the City Clerk at (626)569 -2177.
Thank You.
Sincerely,
Ericka Hernandez
Assistant to the City Clerk
700 Statements Enclosed: Polly Low— Council Member
Polly Low - Commissioner