Jean ScottSTATEMENT OF ECONOMIC
COVER PAGE
Please type or print in ink.
NAME OF FILER (LAST)
Scott
1. Office, Agency, or Court
Jean
(FIRST)
JUL 0 J 2012
Agency Name
City of Rosemead
Division, Board, Department, District, if applicable Your Position
Parks and Recreation Assistant Parks an Recreation D
► If filing for multiple positions, list below or on an attachment.
Agency.
Position:
2. Jurisdiction of Office (Check at least one box)
❑ State
❑ Multi- County
❑x 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, 2011, through Leaving Office: Date Left 06 / 28 / 2012
December 31, 2011. (Check one)
.or. The period covered is through
O The period covered is January 1, 2011, through the dale of
�_� ,
December 31, 2011. leaving office.
❑ Assuming Office: Date assumed —J—/ O The period covered is _J —J , through
the date of leaving office.
❑ Candidate: Election Year
Office sought, if different than Pan 1.
4. Schedule Summary
Check applicable schedules or "None." P. 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 – Gifts – Travel Payments – schedule attached
.or.
❑ None - No reportable interests on any schedule
5. Ve rificatio n
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Bmwn or Agency AddmS Recanmended - Pubic Dwumenl)
8838 E. Valley Boulevard Rosemead CA 91770
DAYTIME TELEPHONE NUMBER E -MAIL ADDRESS (OPTIONAL)
( 626 ) 569 -2220 jeanscott@cityofrosemead.org
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^orrect.
Date Signed 07/02/12 Signature
(.th, day. yWJ
FPPC Form 700 (2011/2012)
FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov
SCHEDULE A -1
Investments
Stocks, Bonds, and Other Interests
(Ownership Interest is Less Than 10 %)
Do not attach brokerage or financial statements.
► NAME OF BUSINESS ENTITY
ICRM -RC
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
Retirement Investment Fund
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
(Dascnoe)
❑ Partnership O Income Received of $0 - $499
Q Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
)_J 11 J - 11
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
(OesaiSe)
❑ Partnership O Income Received of $0 - $499
O Income Received of $500 or More (Repot on Schedule C)
IF APPLICABLE, LIST DATE:
JJ 1 1 J_J - 11
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
O Income Received of $500 or More (Report of Schedulo C)
IF APPLICABLE, LIST DATE:
1 —J - 11 J —J
ACQUIRED DISPOSED
Comments:
CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
..
CAL -PERS
ENTITY
GENERAL DESCRIPTION OF BUSINESS ACTIVITY
California Public Employee Retirement System
FAIR MARKET VALUE
❑ $2,000 - $10,000 ❑ $10,001 - $100,000
X❑ $100,001 - $1,000,000 ❑ Over $1,000,000
NATURE OF INVESTMENT
❑ Stock ❑ Other Unknown Investments
(Desent,e)
❑ Partnership O Income Received of $0 - $499
Q Income Received of $500 or More (Report of Schedule C)
IF APPLICABLE, LIST DATE:
lJ 11 J 11
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
(Desai�e)
❑ Partnership Q Income Received of $0 - $499
Q Income Received of $500 or More (Report on SdM ule C)
IF APPLICABLE, LIST DATE:
JJ 11 J J _ 11
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 $7,000,000
NATURE OF INVESTMENT
❑ Stock ❑ Other
(Descdbe)
❑ Partnership Q Income Received of $0 - $499
Q Income Received of $500 or More (Report of Schedule C)
IF APPLICABLE, LIST DATE:
JJ 11 J 11
ACQUIRED DISPOSED
FPPC Form 700 (2011/2012) Sch. A -1
FPPC Toll -Free Helpline: 866 /275 -3772 vvivw.fppc.ca.gov