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Kim BorisI I Date Received CALIF ORNIA FORM 7 STATEMENT OF ECONOMIC INTERESTIS E -IEL1) iafps[ � F41R POLITiCAL PRACTICES COMMISSION A PUBLIC .. COVER PAGE E '��kr _F'� SCI+, please type or print in ink. — NAME OF FILER (LAST) (FIRST) se; Palmer -Boris Kimb erly L 1. Office, Agency, or Court Agency Name City of Rosemead Division, Board, Department District, if applicable Your Position Parks & Recreation Recreation Supervisor ► If filing for multiple positions, list below or on an attachment. Agency: Position: 2. Jurisdiction of Office (check at least one barn ❑ State ❑ Judge or Court Commissioner (Statewide Jurisdiction) ❑ Multi-County X❑ County of Los Angeles ❑K City of Rosemead ❑ other 3. Type of Statement (check at least one box) © Annual: The period covered is January 1, 2011, through ❑ Leaving Office: Date Left December 31, 2011. (Check one) -or- The period covered is through O The period covered is January 1, 2019, through the date of December 31, 2011. leaving office. ❑ Assuming Office: Date assumed 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 cotter page: ❑ Schedule A -1 - Investments- schedule attached ❑ Schedule C - Income, Loans & Business Posillons - schedule attached ❑ Schedule A -2 - Investments- schedule attached ❑ Schedule D - Income - Gihs- schedule attached ❑ Schedule B - Real Property- schedule attached ❑ Schedule E - Income - Gifts - Travel Payments - schedule attached -or- None - No reportable interests on any schedule 5. Verification MAILING ADDRESS STREET CITY STATE ZIP CODE (Business ffAgw yAdmess Recdnrt "n Pabk Daryrnand Rosemead Ca 91770 DAYTIME TELEPHONE NUMBER E-MAIL ADDRESS (OPTIONAL) ( 626 ) 569 -2250 kbo(s @cityofmsemead.org 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 2/14112 Signatur V) �' (monM, �y yeml h'ie me oriyvrwNysignedaatemen( wahyowahg dfi[re() FPPC Form 700 (2011/2012) FPPC Toll -Free Helpline: 8661275-3772 www.fppc.ca.gov