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CALIFORNIA FORM 700 STATEMENT OF ECONOMIC INTERESTS
FAIR PO ITICAEe RACTICES COMM SSION
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A PUBLIC DOCUMENT COVER PAGE
Please type or pent in ink
NAME OF FILER (LAST) (FIRST) (MIDDLE)
HERNANDEZ ERICKA
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
CITY OF ROSEMEAD
Division, Board, Department.District, if applicable Your Position
DEPUTY CITY CLERK
os 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)
El State ❑Judge or Court Commissioner(Statewide Jurisdiction)
❑Multi-County ❑County of
z City of ROSEMEAD ❑Other
3. Type of Statement (Check at least one box)
Annual: The period covered is January 1, 2015.through ❑ Leaving Office: Date Left
December 31, 2015. (Check one)
or-
The period covered is_1_1 through O The period covered is January 1, 2015-through the date of
December 31, 2015. leaving office.
or-
OB 01 2016 0 The period covered is�� through
❑ Assuming Office: Date assumed�� P g
the date of leaving office.
❑ Candidate: Election year and office sought, if different than Part 1:
4. Schedule Summary (must complete) ► Total number of pages including this cover page: 1
Schedules attached
❑ 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 8-Real Property-schedule attached ❑Schedule E•Income-Gifts-Travel Payments-schedule attached
-or-
_ 0 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 BOULEVARD ROSEMEAD CA 91770
DAYTIME TELEPHONE NUMBER E-MAIL ADDRESS
( 626 ) 569-2100 EHERNANDEZ @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 certity under penalty of perjury under the laws of the State of California that the foregoing is true-and c
Date Signed 11/03/2016 signature
Immfh day year) (F■b the on&ns?y sigma semen 'L your MAng ofIcMl
FPPC Form 700(2015/20161
FPPC Advice Email:advice @fppc.ca.gov
FPPC Toll-Free Helpline:866/275-3772 www.fppc.ca.gov
CALIFORNIA FORM 700 STATEMENT OF ECONOMIC INTERESTS
FAIR POLITICAL PRACTICES COMMISSION
A PUBLIC DOCUMENT COVER PAGE
Please type or print in ink.
NAME Of FILER (LAST) (FIRST) (MIDDLE)
HERNANDEZ ERICKA
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
CITY OF ROSEMEAD
Division, Board, Department. District. if applicable Your Position
DEPUTY CITY CLERK
• 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)
U State U Judge or Court Commissioner(Statewide Jurisdiction)
❑Multi-County U County of
N City of ROSEMEAD U Other
3. Type of Statement (Check at least one box)
O Annual: The period covered is January 1, 2016,through U Leaving Office: Date Left Jam'
December 31, 2016. (Check one)
or-
The period covered is Ol I 2016 ,through 0 The period covered is January 1. 2016,through the date of
December 31. 2016. leaving office.
-ar-
U Assuming Office: Date assumed 0 The period covered is , through
the date of leaving office.
U Candidate: Election year and office sought, if different than Pan 1:
4. Schedule Summary (must complete) ► Total number of pages including this cover page:
Schedules attached
U Schedule A-I - Investments-schedule attached U Schedule C -Income. Loans, &Business Positions-schedule attached
U Schedule A-2-Investments-schedule attached U Schedule D-Income- Gifts-schedule attached
U Schedule B-Real Property-schedule attached U Schedule E-Income- Gifts- Travel Payments-schedule attached
-or-
s 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 BOULEVARD ROSEMEAD CA 91770
DAYTIME TELEPHONE NUMBER E-MAIL ADDRESS
( 626 ) 569-2100 ehernandez@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 correct
Date Signed 03/20/2017 Signature
(murih day year) (Die the onglnallY sired statement wrtli your Med°Rolan
FPPC Form 70012016/2017)
FPPC Advice Email:advice@fppc.ca.gov
FPPC Toll-Free Helpline:866/275-3772 www.fppc.ca.gov