Rafel FajardoRECEIVED
CITY OF ROSEMEAD
• I 1 STATEMENT OF ECONOMIC INTERESTS &1„4,1`10
a •
COVER PAGE CRY CLERKS UFpFCE
Please type or print in ink.
BY:
NAME OF FILER (LAST)
(FIRST) (MIDDLE)
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1. Office, Agency, or Court
Agency Name (Do not use acronyms)
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6(1-? OF II ,b
Division, Board, Department, District, H applicable
Your Position
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• If filing for multiple Positions, list below or on an attachment.
(Do not use acronyms)
Agency:
Position
2. Jurisdiction of Office (Check at least one box)
❑ State
❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ Multi- County
❑ County of
City of (ZO
71 Other
3. Type of Statement (Check at least one box)
a Annual: The period covered is January 1, 2013, through
❑ Leaving Office: Date Left It
December 31, 2013.
(Check one)
-or-
The paned covered is ---J--J
,through O The period covered is January 1, 2013, through the date of
December 31, 2013.
leaving office.
❑ Assuming Office: Date assumed ____f ---- J
O The period covered is I through
the date of leaving office.
❑ Candidate: Election year and office sought, if different than Pad 1:
4. Schedule Summary
Check applicable schedules or "None."
► Total number of pages including this cover page:
❑ Schedule A -1 - Investments - schedule attached
Schedule C - Income, Loans, 8 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-
0 None - No mpodable interests on any schedule
5. Verification
MAILING ADDRESS STREET
Cm STATE ZIP CODE
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og38 1. VA IIzs.`7 171 JO 03sc
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DAYTIME TELEPHONE NUMBER
EMAIL ADDRESS (OPTIONAL)
( 6Z6) 569— ZiS(
I
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 pubic document.
I certify under penalty of perjury under the laws of the State of Califome that the foregoing is true and correct
03/ Z 6 // //
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Date Signed
Signat
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FPPC Form 700 (2013/2014)
FPPC Advice Email: advicetafppa.ca.gov
FvpC Toll -Free Nelpline: 866 /275 -3772 www.fp Nc.ca.gov