Kim Palmer-BorisSTATEMENT OF ECONOMIC
COVER PAGE
Please type or print in ink.
Palmer-Boris
Kim
Date Rece
TERESTS___._.RTn�'_0_
V � ;
1. Office, Agency, or Court i ft: f
Agency Name
City of Rosemead
Division, Board, Department, District, if applicable Your Position
Parks & Recreation Department 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 ❑ Judge or Court Commissioner (Statewide Jurisdiction)
F Multi-County ❑ County of
City of Rosemead ❑ Other
3. Type of Statement (Check at least one box)
W1 Annual: The period covered is January 1, 2012, through ❑ Leaving Office: Date Left
December 31, 2012. (Check one)
-or.
The period covered is
December 31, 2012.
Assuming Office: Date assumed
through 0 The period covered is January 1, 2012, through the date of
leaving office.
0 The period covered is —
the date of leaving office
through
F Can didate: Election year and office sought, if different than Pan 1:
4. Sqhq4q!q Summary
Check applicable schedules or "None." ► Total number of pages including this cover page:
n Schedule A•11 - Investments - schedule attached El Sche C I
1. 1 ncome, Loans, & Business Positions - schedule attached
_Ld I
Investments - schedule attached [I Schedule Q Income - Gifts - schedule attached
❑ Schedule B Real Property - schedule attached B schedule E ; Income - Gifts - Tave P ayments - schedule attached
,or!
Hql@ t No reportable interests on any schedule
5. V erification
MAILING ADDRESS STREET -ZIPCODE
(Business or Agency Address Recorrwiedded - PubUc DxvmenV
8838 E Valley Bovd Rosemead Ca 91770
626 ) 569-2250 kboris@cityofrosemead.org
e -
I have used all reasonable in preparing thisstafeWent. 1 have reviewed this statem and to the best of my k n(
herein and in any attached I . r sched ' . is trut . a and com I I I I I ackn I h is i a p ublic d ocum ant.
certify under penal of perjury ------
penalty ry under the laws of the State of California that the foregoing is true and correct.
Date Signed 02/28/2013 Si nature
(month, day, year) (Rio the 09frogy signoslete.enimth }roar erg affly-0
FPPC Form 700 (2012/2013)
FPPC Advice Email: advice9fppc.ca.gov
FPPC Toll-Free Helpfine: 8661275-3772 w".fppc.ca.gov