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Rafael Fajardo
Date Received STATEMENT OF ECONOMIC INTERESTS Oftial Use Only COVER PAGE Please type or print in ink. NAME OF FILER (LAST) (FIRST) (MIDDLE) Fajardo Rafael Mar 1. Office, Agency, or Court Agency Name City of Rosemead Division, Board, Department, District, if applicable Your Position Associate Civil Engineer ► If fling 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) © Annual: The period covered is January 1, 2012, through December 31, 2012. -or. The period covered is 12 r 31 2013 r through December 31, 2012. ❑ Assuming Office: Date assumed ❑ Candidate: Election year ❑ Leaving Office: Dale Leff (Check one) O The period covered is January 1, 2012, through the dale of leaving office. O The period covered is — the date of leaving office. and office sought, if different than Pad 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 ► Total number of pages including this cover page: ❑ Schedule C - Income, Loans, & Business Positions - schedule attached ❑ Schedule D - Income - Gifts - schedule attached ❑ Schedule E - Income - Gifts - Travel Payments - schedule attached - or. W1 None - No reportable interests on any schedule 5. Verification MAILING ADDRESS STREET (Business or Agency Address Recommended - PuWro Dwument) P.O. 2984 uaT I imc I eLernurve rvumnerc ( 626 ) 569 -2151 CITY West Covina E -MAIL CA 91793 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 er ct 1 7 Date Sinned 02/25/2013 Signature � (mWlh, day, year) 41h yaarrdint WTxia'.) FPPC Form 700 (2012/2013) FPPC Advice Email: advice@fppc.ca.gov FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov