Jerry MotaSTATEMENT OF ECONOMIC INTERESTS R 0 "
CITY OF ROiSEMEAD
COVER PAGE MAR 2 3 2015
Please type or print in ink
NAME OF FILER (LAST) (FIRST) CiT ?N , t ):(I{.S OFF
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
Gity of Rosemead
Division, Board, Department, District, if applicable Your Position
Parks and Recreation
Recreation
► If filing for multiple positions, list below or on an attachment. (Do not use acronyms)
Agency:
Position:
2. Jurisdiction of Office (cheek 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 feast one box)
❑✓ Annual: The period covered is January 1, 2014, through ❑ Leaving Office: Date Left
December 31, 2014. (Check one)
-or-
The period covered is
December 31, 2014,
01 1 01 I 2014 through O The period covered is January 1, 2014, through the dale of
leaving office.
❑ Assuming Office: Date assumed
❑ Candidate: Election year
O The period covered is —
the dale of leaving office.
and office sought, if different than Part 1:
through
Schedule Summary
Check applicable schedules or "None."
❑ Schedule A -1 - Investments - schedule attached
❑ Schedule A -2 - Investments - schedule attached
❑ Schedule 6 - 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.
❑✓ None - No reportable interests on any schedule
5. Verification
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business or Agency Address Recommended- Public Document)
8838 E. Valley Blvd. Rosemead CA 91770
NUMBER
( 626 ) 569 -2160
Total number of pages including this cover page:
E -MAIL ADDRESS
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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 correct.
n
03/19/2015 �L�c 6 tilwwr
Date Signed Signature
(month, day, year) (File the originally signed statement with your filing official )
FPPC Form 700(2014/2015)
FPPC Advice Email: advice @fppc.ca.gov
FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov