Margaret Clarkr
r
Please type or print in ink.
STATEMENT OF ECONOMIC
COVER PAGE
al U se 012
nnmc yr nLrn rynoy Tnney .— �,_
C LAKk
1. Office, Agency, or Court
Agency Name -
Ctf j cf- - NUQJQM evt-1— C0Myy1l5St0V\
Division, Board, Department, District, if applicable Your Position -
► If filing for multiple positions, list below or on an attachment.
Agency:
Position:
2. Jurisdiction Of Office (Check at least one box)
❑ State
❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ Multi- County
El County of
'P\ 1
IgCity of 0 S 2 4t'l;Lcr_6\
❑ Other
3. Type of Statement (Check at least one box)
❑ Annual: The period covered is January 1, 2011, through
❑X Leaving Office: Date Lett 01 1 31 1 2012
December 31, 2011.
(Check one)
.
The period covered is _��
, through O The period covered is January 1, 2011, through the dale of
December 31, 2011.
leaving office.
❑ Assuming Office: Date assumed __J__J
O The period covered is through
the date of leaving office.
❑ Candidate: Election Year Office sought, if 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
N 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. Verification
MAILING ADDRESS STREET
CITY STATE ZIP CODE
(Busmss or Agency Address Recommended - Public Document)
Data Signed - f - / 2. Signature (Ro 4�^ -c- - 6 -1
(mma,, day, yea) l miginallysigned statement ailh ywrffing orraial)
FPPC Form 700 (2 0 1112 0 1 2)
FPPC Toll -Free Helpline: 8661275 -3772 www.fppc.ca.gov
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.
SCHEDULE C
Income, Loans, & Business
Positions
(Other than Gifts and Travel Payments)
NAME OF SOURCE OF INCOME
8 161t [ -- ijt0 Ush
ADDRESS (Business Address Accept ble)
ACTIVITY, IF AtbdV, OF SOURCE
YOUR BUSINESS POSITION
GROSS INCOME RECEIVED
Eg $500 - $1,000 ❑ $1,001 - $10,000
❑ $10,001 - $100,000 ❑ OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
❑ Salary I&Spousejs or registered domestic partner's income
❑ Loan repayment ❑ Partnership
❑ Sale of
(Real properly car, boar, etc.)
❑ Commission or []Rental Income, list each source of $10,Wo or more
❑ Other
( Descdbe)
NAME OF SOURCE OF INCOME
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOUR BUSINESS POSITION
GROSS INCOME RECEIVED
❑ $500 - $1,000 ❑ $1,001 - $10,000
❑ $10,001 - $100,000 ❑ OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
❑ Salary ❑ Spouse's or registered domestic partner's income
❑ Loan repayment ❑ Partnership
❑ Sale of
(Rear p-operty, car, boat, etc)
❑ Commission or ❑ Rental Income, list each source of $70,000 or more
❑ Other
( Descibe)
LOANS 111 2. • OR OUTSTANDING DURING THE REPORTING PERIOD
You are not required to report loans from commercial lending institutions, or any indebtedness created as part of a
retail installment or credit card transaction, made in the lender's regular course of business on terms available to
members of the public without regard to your official status. Personal loans and loans received not in a lender's
regular course of business must be disclosed as follows:
NAME OF LENDER"
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF LENDER
INTEREST RATE TERM (MonthsNears)
% ❑ None
SECURITY FOR LOAN
❑ None ❑ Personal residence
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500 - $1,000
❑ $1,001 - $10,000
❑ $10,001 - $100,000
❑ OVER $100,000
Comments:
❑ Real Property
Street address
❑ Guarantor
❑ Other
(Describe)
FPPC Form 700 (2011/2012) Sch. C
FPPC Toll -Free Helpline: 866/275 -3772 w .fppc.ca.gov
SCHEDULE D
Income — Gifts
► NAME OF SOURCE /+
L, - Qoatlornl: 6bes
ADD SS(Business Address Acceptable)
Tlfoo k Sind- - SxranrP { CA' 2sl j f
BUSINESS ACTIVITY, IF ANY, OF SOURCE y/
X7.1 / C/1 U 'rdY' G'rl S Cyne.( l (,tl r hP5 1 r 5
DATE (mmPotl ) VALUE D�E OF GIFT(S)
__�j fl $ 30.00 f 3kkgst, LwvLck
1 ?, 11 $ Zz°(1 �k l LVaticl
► NAME OF SOURCE
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm /dd/y) VALUE DESCRIPTION OF GIFT(S)
J am— $
__J __J— $
► NAME OF SOURCE
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/ddtyy) 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)
► NAME OF SOURCE
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm /ddtyy) VALUE DESCRIPTION OF GIFT(S)
__J __J_ $
��— $
► NAME OF SOURCE
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm /dd /yy) VALUE
� J— $
$
$
DESCRIPTION OF GIFT(S)
FPPC Form 700 (2011/2012) Sch. D
FPPC Toll -Free Helpline: 866 1275 -3772 w .fppc.ca.gov
MAYOR:
Steven Ly
MAYOR PRO TEM:
Sandra Armenta
COUNCIL MEMBERS:
William Alarcon
Margaret Clark
Polly Low
March 29, 2012
Attn: Elaine Anderson
Secretary of State
Political Reform Division
1500 11 Street, Room 495
Sacramento, CA 95814
Dear Mrs. Anderson:
City of 1psemead
8838 E. VALLEY BOULEVARD P.O BOX 399
ROSEMEAD, CALIFORNIA 91770
TELEPHONE (626) 569 -2100
FAX (626) 307 -9218
It has come to our attention that the City of Riverside received back a couple of original
Statement of Economic Interest forms which did not need to be file with FPPC. However,
within their returned 700 forms, one of our filers' original form was mistakenly returned
to the City of Riverside. They indicated that they mailed the form to the City of
Rosemead and I am faxing a copy to avoid late charges, in case you do not receive our
filers' original form 700 before the April 2 nd deadline.
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
Attachment: Margaret Clark Redevelopment leaving office statement
03/29/2012 14:02 FAX
4350
919163220883
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TRANSMISSION OR
TX /RX NO
DESTINATION TEL #
DESTINATION ID
ST. TIME
TIME USE
PAGES SENT
RESULT
03/29 14:00
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OK
IM 001
MAYOR:
Steven Ly
MAYOR PRO TEM:
Sondra Annenta
COUNCIL MEMBERS:
William Alarcon
Margaret Clark
Polly Low
March 29, 2012
Attn: Elaine Anderson
Secretary of State
Political Reform Division
1500 l l Street, Room 495
Sacramento, CA 95814
Dear Mrs. Anderson:
City of &semead
8838 E. VALLEY BOULEVARD P.O BOX 399
ROSEMEAD, CALIFORNIA 91770
TELEPHONE (626) 569 -2100
FAX (626)
It has come to our attention that the City of Riverside received back a couple of original
Statement of Economic Interest forms which did not need to be file with FPPC. However,
within their returned 700 forms, one of our filers' original form was mistakenly returned
to the City of Riverside. They indicated that they mailed the form to the City of
Rosemead and I am faxing a copy to avoid late charges, in case you do not receive our
filers' original form 700 before the April 2 nd deadline.
If there are any questions, please feel free to contact the office of the City Clerk at
(626)569 -2177. Thank You.
Sincerely,
#c
Ericka Hernandez
Assistant to the City Clerk
STATEMENT OF ECONOMIC
COVER PAGE
Please type or pdnt in ink.
NAME OF FILER
C,(,a,rK
- 1. Office, Agency, o Court
Agency Name
Cif I/ OF I�c 5 t?nle - 6
Division` Board, Department, District if
P. If filing for multiple positions, list below or on an attachment.
Agency.
Position:
2. Jurisdiction of Office (Check at least one box)
❑ Stale ❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ Multi -County ❑ County of
21 CIty of ^ C e IM e r ( ❑ Other —
3. Type of Statement (Check at least one box)
Annual: The period covered is January 1, 2011, through
December 31, 2011.
.or-
The period covered is __J___J
December 31, 2011.
❑ Assuming Office: Date assumed
❑ Candidate: Election Year
❑ Leaving Office: Date Left - -J
(Check one)
through O The period covered is January 1, 2011, through the date of
leaving office.
_ O The period covered is through
the date of leaving office.
Office sought, if 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 Positrons- 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. Verification
MAILING ADDRESS STREET CITY STATE ZIP CODE
(euslness a Agency Address Recommended - Publk DOCUMN)
(6VI) 8 33—
CA
(7
I have used all reasonable diligence in preparing this statement. I have reviewed this statement and to the best of rdy knowledge the information contained
herein and in any attached schedules is true and complete. I acknowledge this is a public document.
1 certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date Signed - 3 � - Signature ; �
/mantle, day year) (Rome orajurallysignedsblemeM W )ourOng OW814
CITY C .EIR rS v DICE
BY
FPPC Form 700 (201112012)
FPPC Toll -Free Helpline: 8661275 -3772 www.fppc.ca.gov
SCHEDULE C
Income, Loans, & Business
Positions
(Other than Gifts and Travel Payments)
NAME OF SOURCE OF INCOME
Q+ble Fes(( wS11 i T c
ADDRESS (Business Address Accept ble)
J I Lt' VZ J
BUSINESS ACTIVITY, IF AI , OF
YOUR BUSINESS POSITION
GROSS INCOME RECEIVED
® $500 - $1,000 ❑ $1,001 - $10,000
❑ $10,001 - $100,000 ❑ OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
❑ Salary g Spouses or registered domestic partners income
❑ Loan repayment ❑ Partnership
❑ Sale of
(Real mpeny, car boe, etc.)
❑ Commission or ❑ Rental Income, list each source of $10,000 or more
❑ Other
NAME OF SOURCE OF INCOME
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOUR BUSINESS POSITION
GROSS INCOME RECEIVED
❑ $500 - $1,000 ❑ $1,001 - $10,000
❑ $10,001 - $100,000 ❑ OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
❑ Salary ❑ Spouses or registered domestic partners income
❑ Loan repayment ❑ partnership
❑ Sale or
(Rod p Parry, car, boa, etc)
❑ Commission or ❑ Rental Income, list each source of $10,000 or amore
❑ Other
LOANS 2. D OR OUTSTANDING DURING THE REPORTING PERIOD
You are not required to report loans from commercial lending institutions, or any indebtedness created as part of a
retail installment or credit card transaction, made in the lender's regular course of business on terms available to
members of the public without regard to your official status. Personal loans and loans received not in a lender's
regular course of business must be disclosed as follows:
NAME OF LENDER"
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF LENDER
INTEREST RATE TERM (Months/Yeam)
% ❑ None
SECURITY FOR LOAN
❑ None ❑ Personal residence
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500 - $1,000
❑ $1,001 - $10,000
❑ $10,001 - $100,000
❑ OVER $100,000
Comments:
❑ Real Property
Street address
❑ Guarantor
❑ Other
(Describe)
FPPC Form 700 (2011/2012) Sch. C
FPPC Toll -Free Helpline: 866 1275 -3772 v✓rvw.fppc.ca.gov
SCHEDULE D
Income — Gifts
► NAME OF SOUpRCEE (I�� /
hrlVgu.e o1" ailkYl11a CPL'S
ADD SS (Business Address Acceptable)
1yoo K 5h- cf EecrameA Ch g5eJ
BUSINESS ACTIVITY, IF ANY, OF SOURCE ��JJ (A ��,
r'IYTVOUAfU t Cl }y - PS ct"k Mil teG I daylts
DATE (mm/dd ) VALUE DESCRIPTION OF GIFT(S)
� J II � 30. o D } f 31c�s - F L
1 7/ I1 $ 2 ( �k.Fsf Lu�ti�l
► NAME OF SOURCE
ADDRESS (Business Address Acceptab /e)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm /dd /yy) VALUE
$
__J __J_ $
DESCRIPTION OF GIFT(S)
► NAME OF SOURCE
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm /dd /yy) VALUE
$
$
Comments:
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)
► 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 /dd /yy) VALUE
��— $
��— $
DESCRIPTION OF GIFT(S)
FPPC Form 700 (2011/2012) Sch. D
FPPC Toll -Free Helpline: 866/275 -3772 vyvyw.fppc.ca.gov