Rafael FajardoSTATEMENT OF ECONOMIC I
COVER PAGE
Please type or print in ink.
(LAST)
IZAF1ac �,
1. Offic Agency, or Court
FED G �l 2012
Agency Name
City of Rosemead
Board, Department, District, if applicable Your Position
Associate Civil Engineer
► If filing for multiple positions, list below or on an attachment.
Agency: Position:
2. Jurisdiction of Office (Check at lea one box)
❑X State ❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ Multi- County ❑ County of
❑X City of Rosemead ❑ Other
3. Type of Statement (check at least one box)
Q Annual: The period covered is January 1, 2011, through ❑ Leaving Office: Date Left __J__J
December 31, 2011. (Check one)
- or -
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 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 ❑ 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 — Gilts — Travel Payments — schedule attached
.or-
0 None - No reportable interests on any schedule
5. Verificati
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business or Agency Address Recommended � Public Document)
8838 E. Valley Blvd. Rosemead, CA 91770
( 626 ) 569 -2151
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 co
Date Signed 0 Z ( O e,1 ( 2 Signature
(month, day, year) g
FPPC Form 700 (2011/2012)
FPPC Toll -Free Helpline: 8661275 -3772 www.fppc.ca.gov