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Steven Ly (2)• at'wiJl Received STATEMENT OF ECONOMIC INTERESTS Date Received CALIFORNIA FAIR POLITICAL PRACTICES COMMISSION A PUBLIC DOCUMENT COVER PAGE JAN 3 s 2012 Please type or print in ink f - -- - - - - -- - . NAME OF FILER (LAST) (FIRST) ( -' - `(MIDDLE) - - - '- Ly Steven 1. Office, Agency, or Court Agency Name City of Rosemead Division, Board, Department, District, if applicable Your Position City Council Councilman ► 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 ❑ County of ❑x City of Rosemead ❑ Other 3. Type of Statement (check at least one box) ❑x 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 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: 5 ❑ x Schedule A -1 - Investments - schedule attached ❑x Schedule C - Income, Loans, & Business Positions - schedule attached ❑x Schedule A -2 - Investments- schedule attached ❑x Schedule D - Income - Gifts- 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 /auvness aAgencyAddress Recommended PutIc DmrmerNJ 8388 E Valley Blvd Rosemead CA 91770 DAYTIME TELEPHONE NUMBER E -MAIL ADDRESS (OPTIONAL) ( 626 ) 569 -2100 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. Dale Signed 1/5/2012 Signature Ifiwnh a3y year) a mginalrysigrledstareme r w.rh ywufifirga/rela[J FPPC Form 700 (2 0 1112 0 1 2) FPPC Toll -Free Helpline: 8661275 -3772 www.fppc.ca.gov SCHEDULE A -1 CALIFORNIA FORM700 Investments FAIR POLITICAL PRACTICES COMMISSION Stocks, Bonds, and Other Interests Name (Ownership Interest is Less Than 10 %) Steven Ly Do not attach brokerage or financial statements. ► NAME OF BUSINESS ENTITY Union Pacific Corporation GENERAL DESCRIPTION OF BUSINESS ACTIVITY Commercial Rail Services FAIR MARKET VALUE ❑X $2,000 - $10,000 ❑ $10,001 - $100,000 ❑ $100,001 - $1,000,000 ❑ Over $1.000,000 NATURE OF INVESTMENT Q Stock ❑ Other (Desmbe) ❑ Partnership Q Income Received of $0 - $499 Q Income Received of $500 or More (Report on Schedule C) IF APPLICABLE, LIST DATE: ACQUIRED DISPOSED ► NAME OF BUSINESS ENTITY International Business Machines Inc GENERAL DESCRIPTION OF BUSINESS ACTIVITY Business Technologies and Consulting FAIR MARKET VALUE ❑X $2.000 - $10,000 ❑ $10,001 - $100.000 ❑ $100,001 - $1,000,000 ❑ Over $1,000,000 NATURE OF INVESTMENT Q Stock ❑ Other (Describe) ❑ Partnership O Income Received of $0 - $499 Q Income Received of $500 or More (Report on Schedule C) IF APPLICABLE, LIST DATE: ACQUIRED DISPOSED ► NAME OF BUSINESS ENTITY GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE ❑ $2,000 - $10,000 ❑ $10,001 - $100,000 ❑ $100001 - $1,000,000 ❑ Over $1000,000 NATURE OF INVESTMENT ❑ Stock ❑ Other (Desmbe) ❑ Partnership Q Income Received of $0 - $499 Q Income Received of $500 or More (Report on Schedule C) IF APPLICABLE, LIST DATE: ACQUIRED DISPOSED Comments: 0. Walmart Stores Inc GENERAL DESCRIPTION OF BUSINESS ACTIVITY General Merchandise Stores FAIR MARKET VALUE ❑X $2,000 - $10,000 ❑ $10,001 - $100,000 ❑ $100,00i - $1,000000 ❑ Over $1,000.000 NATURE OF INVESTMENT ❑X Stock ❑ Other (Describe) ❑ Partnership Q Income Received of $0 - $499 Q Income Received of $500 or More (Report on Schedule C) IF APPLICABLE, LIST DATE: ACQUIRED DISPOSED ► NAME OF BUSINESS ENTITY - Quest Diagnostics Inc GENERAL DESCRIPTION OF BUSINESS ACTIVITY Medical Supplies FAIR MARKET VALUE ❑X $2,000 - $10.000 ❑ $10,001 - $100,000 ❑ $100,001 - $1,000,000 ❑ Over $1,000,000 NATURE OF INVESTMENT ❑ X Stock ❑ Other (Describe) ❑ Partnership Q Income Received of $0 - $499 Q Income Received of $500 or More (Report on Schedule C) IF APPLICABLE, LIST DATE: ACQUIRED DISPOSED ► NAME OF BUSINESS ENTITY GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE _ ❑ $2,000 - $10,000 ❑ $10,001 - $100,000 ❑ $100,001 - $1.000,000 ❑ Over $1,000,000 NATURE OF INVESTMENT . ❑ Stock ❑ Other ( Describe) ❑ Partnership Q Income Received of $0 - $499 Q Income Received of $500 or More (Report on Schedule C) IF APPLICABLE, LIST DATE: ACQUIRED DISPOSED FPPC Form 700 (201112012) Sch. A -1 FPPC Toll -Free Helpline: 866 /275 -3772 �Jppaca.gov SCHEDULE A -2 Investments, Income, and Assets of Business Entities /Trusts (Ownership Interest is 10% or Greater) LBL Holding LLC Name Address, (Business Address Acceptable) Check one ❑ Trust, go to 2 © Business Entity, complete the box, then go to 2 GENERAL DESCRIPTION OF BUSINESS ACTIVITY Real Estate Investment and Management FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $0 - $1.999 - ❑ $2,000 - $10.000 ❑ $1 o, 001 - $100,000 ACQUIRED DISPOSED ❑ $100,001 - $1,000,000 ❑X Over $1,000,000 , NATURE OF INVESTMENT 'i❑ Sole Proprietorship ❑ Partnership ❑X LLC Other YOUR BUSINESS POSITION Managing Partner ❑ $o - $499 X❑ $10,001 - $100,600 ❑ $Soo - $1,000 ❑ OVER $100,000 ❑ $1.001 - $10.000 Rental Income from 5631 Aldama St and 3450 E 8th St Los Angeles Check one box.: ❑ INVESTMENT ❑X REAL PROPERTY } LBL Holding LLC Name of Business Entity, if Investment, 2r Assessor's Parcel Number or Street Address of Real Property Real Estate Investment and Management Description of Business Activity 2[ City or Other Precise Location of Real Property FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2.000 - $10,000 ❑ $10,001 - $100,000 ❑ $100,001 - $1,000,000 ACQUIRED DISPOSED ❑X Over $1,000,000 NATURE OF INTEREST ❑ Property Ownership /Deed of Trust, ❑ Stock ❑X Partnership. ❑ Leasehold ❑ Other T. remaining ❑ Check box if additional schedules reporting investments or real property are attached ' Steven Ly San Gabriel Valley Business Journal LLC Name Address (Business Address Acceptable) Check one ❑ Trust, go to 2 ❑X Business Entity, complete the box, then go to 2 GENERAL DESCRIPTION OF BUSINESS ACTIVITY News Publication FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ so-$1,999 ❑ $2,000 - $10,000 ❑X $10,001 - $100,000 ACQUIRED DISPOSED ❑ $100,001 - $1,000,000 ❑ Over $1,000,000 NATURE OF INVESTMENT ❑ Sole Proprietorship ❑ Partnership BUSINESS POSITION Publisher LLC Other ❑ $0 - $499 ` ❑ $10,001 - $100,000 ❑ $500 - $1,000 ❑ OVER $100,000 ❑ s1,00l - $1o,000 Check one box: ❑ INVESTMENT ❑ REAL PROPERTY Name of Business Entity, if Investment, 2r Assessor's Parcel Number or Street Address of Real Property Description of Business Activity Q City or Other Precise Location of Real Property FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 ❑ $10,001 - $100,000 J� 11 JJ 11 ❑ $100,001 - $1,000,000 ACQUIRED DISPOSED ❑' Over $1,000,000 NATURE OFINTEREST ❑ Property Ownership /Deed of Trust ❑ Stock ❑ Partnership ❑ Leasehold ❑ Other Yrs. remaining ❑ Check box h additional schedules reporting investments or real property are attached FPPC Form 700 (2011/2012) Sch. A -2 FPPC Toll -Free Helpline: 866/275 -3772 v✓vAv.fppc.ca.gov SCHEDULE C Income, Loans, & Business Positions (Other than Gifts and Travel Payments) NAME OF SOURCE OF INCOME Regional Chamber of Commerce San Gabriel Valley ADDRESS (Business Address Acceptable) 19720 E Walnut Dr. South, Suite 201, Walnut CA BUSINESS ACTIVITY, IF ANY, OF SOURCE Business Association YOUR BUSINESS POSITION Chief Executive Officer GROSS INCOME RECEIVED ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑X Salary ❑ Spouse's or registered domestic partner's income ❑ Loan repayment ❑ Partnership ❑ Sale of property car, boat, etc) ❑ Commission or ❑ Rental Income, list each source or $10,000 or more ❑ Other Name Steven 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 (Real pmPerty, car, boar, etc) ❑ Commission or ❑ Rental Income, list each source of $10,000 arm" ❑ Other (Describe) 2. LOANS RECEIVED 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 (Gans 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 HIGHEST BALANCE DURING REPORTING PERIOD ❑ $500 - $1,000 ❑ $1,001 - $10.000 ❑ $10,001 - $100,000 ❑ OVER $100,000 Comments: INTEREST RATE TERM (Months /Years) ❑ None SECURITY FOR LOAN ❑ None ❑ Personal residence ❑ Real Property Street address City ❑ Guarantor ❑ Other (Describe) FPPC Form 700 (2011/2012) Sch. C FPPC Tall -Free Helpline: 8661275 -3772 w Jppc.ca.gov SCHEDULE D Income - Gifts ► NAME OF SOURCE , Southern California Edison ADDRESS (Business Address Acceptable) 2244 Walnut Grove Ave, Rosemead CA BUSINESS ACTIVITY, IF ANY, OF SOURCE Energy Producer and Supplier DATE (mm/dd /yy) VALUE DESCRIPTION OF GIFT(S) 08j 17 / 11 $ 405 Tour of Big Creek SCE JJ $ facilities and energy JJ— $ conveyance system ► NAME OF SOURCE ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF SOURCE DATE (mmlddlyy) 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($) $ —JJ S JJ $ Comments: ► NAME OF SOURCE Name Steven Ly ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF SOURCE DATE (mMdd /yy) VALUE DESCRIPTION OF GIFT(S) JJ— $ s JJ— $ ► NAME OF SOURCE ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF SOURCE DATE (mmlddlyy) VALUE DESCRIPTION OF GIFT(S) ��— $ JJ $ $ NAME OF SOURCE ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF SOURCE DATE (mm /dd /yy) VALUE $ J —1 $ JJ_ $ DESCRIPTION OF GIFT(S) FPPC Form 700 (2011/2012) Sch. D FPPC Toll -Free Helpline: 866/275 -3772 vry Jppc.ca.gov