David Montgomery-ScottDate Received
CALIFORNIA • • 1 1 STATEMENT OF ECONOMIC INTERESTS Official Use Only
FAIR POLITICAL PRACTICES COMMISSION
A PUBLIC DOCUMENT COVER PAGE
Please type or print in ink.
NAME OF FILER (LAST) - (FIRST) .'(MIDDLE)
Montgomery-Scott David Gregory
1. Office, Agency, or Court
Agency Name
City of Rosemead
Division, Board, Department, District, if applicable Your Position
Parks and recreation Department Parks and Recreation Director
P. If filing for multiple positions, list below or on an attachment.
Agency:
Positon:
2. Jurisdiction of Office (cheek at least one box)
❑ State
❑ Multi - County
W1 City of Rosemead
❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ County of
❑ Other
3. Type of Statement (Check at least one box)
[VI Annual: The period covered is January 1, 2012, through
December 31, 2012,
-or-
The period covered is
December 31, 2012.
❑ Assuming Office: Date assumed
❑ Candidate: Election year
O The period covered is —
the date of leaving office,
and office sought, if different than Part 1:
through
4. Schedule Summary
Check applicable schedules or "None."
❑ Schedule A -1 - Investments - schedule affached
❑ 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 - Gifts - Travel Payments - schedule attached
-or-
Z None - No reportable interests on any schedule
5. Verification
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business or Agency Address Recordireided - Public Document)
8838 E Vallev Blvd. Rosemead CA 91770
( 626 ) 569 -2160 1 rims @cityofnasdmead.oW,
I have used all reasonable diligence in preparing this statement. I have revieweirea— the est o my knowledge the information contained
herein and in any attached schedules is true and complete. I acknowledge this
I certify under penalty of perjury under the laws of the State of California true
Date Signed 02/19/2013 Sign
❑ Leaving Office: Dale Left
(Check one)
through O The period covered is January 1, 2012, through the date of
leaving office.
► Total number of pages including this cover page: 1
FPPC Form 700 (2012/2013)
FPPC Advice Email: advice @fppc.ca.gov
FPPC Toll -Free Helpline: 8661275 -3772 www.rppc.ca.gov