Jerry MotaCALIFORNIAIFORM I i 1 STATEMENT OF ECONOMIC INT REST
DOCUMENT FAIR POLITICAL PRACTICES COMMISSiON
A PUBLIC COVER PAGE FrCt a `
Please type or print in ink.
NAME of FILER (LAST) (FIRST) (MI L -
Mota, Gerardo " "" rlur -
1. Office, Ag or Court
Agency Name
City of R osemead
Division, Board, Department, District, if applicable Your Position
Parks and Recreation Recreation Supervisor
► If filing for multiple positions, list below or on an attachment.
Agency:
Position:
2. Jurisdiction of Office (Check at least one box)
❑ State
❑ Multi- County
City of Rosemead
❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ County of
❑ Other —
3. Type of Statement (Check at least one box)
X1 Annual: The period covered is January 1, 2011, through
December 31, 2011.
-or-
The period covered is I I through
December 31, 2011.
❑ Assuming Office: Date assumed
❑ Candidate: Election Year
❑ Leaving Office: Date Left ---J—J (Check one)
O The period covered is January 1, 2011, through the date of
leaving office.
O The period covered is _
the date of leaving office.
Office sought, if different than Part 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
❑ Schedule D - Income - Gifts - schedule attached
❑ Schedule E - income - Grits - Travel Payments - schedule attached
-or-
Do None - No reportable interests on any schedule
5. Verification
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business or Agency Address Recommended - Public Documem)
8838 E. Valley Blvd. Rosemead CA 91770
626 1 569 -2265
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 02 -09 -12 Signal
(month, day, year) \LfKo the originaM1Ysignedshcemenl with yourfiling official.)
► Total number of pages including this cover page:
FPPC Form 700 (2011/2012)
FPPC Toll -Free Hairline: 8661275 -3772 www.fppc.ca.gov