Margaret Clark RECEIVED
CITY OF ROSCMEAD
CALIFORNIA FORM 700 STATEMENT OF ECONOMIC INTERESTS Date kN gl ihogRpeeived
FAI R POLITICAL HAC TICLS cos MISSION
A PUBLIC DOCUMENT COVER PAGE CITY CLERKS OFFICE
Please type or print in ink RY'
NAME OF FILER (LAST) (FIRST) (MIDDLE)
Clark Margaret
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
City of Rosemead
Division, Board,Department, District, if applicable Your Position
City Council Council Member
► 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
E7 City of City of Rosemead ❑Other
3. Type of Statement (Check at least one box)
O Annual: The period covered is January 1, 2015,through E Leaving Office: Date Left
December 31,2015. (Check one)
or-
The period covered is JJ through 0 The period covered is January 1,2015, trough the date of
December 31,2015. or leaving office.
❑ Assuming Office: Date assumed 0 The period covered is J J trough
the date of leaving office.
O Candidate: Election year and office sought, if different than Part 1:
4. t�l ,;I t u° i0.Ci ■ Total number of pages including this cover page:,
Schedules attached
❑ Schedule A-I •Investments-schedule attached gj Schedule C•Income,Loans, 8 Business Positions-schedule attached
❑ Schedule A•2•Investments-schedule attached 2 Schedule D-Income-Gifts-schedule attached
❑ Schedule B•Real Property-schedule attached E Schedule E•Income-Gifts-Travel Payments-schedule attached
-Or-
o None- No reportable interests on any schedule
5. Verification
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Susmess or Agency Address Recommended-PoMiC Daumont)
8838 East Valley Boulevard Rosemead CA 91770
DAYTIME TELEPHONE NUMBER E-MAIL ADDRESS
( 626 ) 569-2100 ciarke eesc.@ ycck)cc . corm
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 3`to/2-0E6 Signature '�234--4F-4-L//�/An O d EZA-Ld--
( h GM YAM fHJ he owinagy signed MAO'S mlh your 51m official)
FPPC Form 700(2015/2016)
FPPC Advice Email:advice @fppc.ca.gov
FPPC Toll-Free Helpline:866/275-3772 www.fppc.ca.gov
SCHEDULE C CALIFORNIA FORM 700
Income, Loans, & Business
Positions Name
(Other than Gifts and Travel Payments) Margaret Clark
1. INCOME RECEIVED t NCOME RAJEq'EC
NAME OF SOURCE OF INCOME NAME OF SOURCE OF INCOME
Bible Fellowship, Inc
ADDRESS(Business Address Acuepfable) ADDRESS(Business Address Acceptable)
3149 Verdugo Rd. Los Angeles, CA 90065
BUSINESS ACTIVITY.IF ANY,OF SOURCE BUSINESS ACTMTY,IF ANY.OF SOURCE
YOUR BUSINESS POSITION YOUR BUSINESS POSITION
GROSS INCOME RECEIVED GROSS INCOME RECEIVED
❑E50a-Et000 ®s1,o01 -$10,000 ❑ssoo-$1,000 ❑$toot-sio,o00
❑sic om -$100000 ❑OVER$1 oop00 ❑510.001 -$100,WO ❑OVER$100000
CONSIDERATION FOR WHICH INCOME NAS RECEIVED CONSIDERATION FOR WHICH INCOME WAS RECEIVED
❑Salary ®Spouse's or registered domestic paMees income ❑Salary ❑Spouse's or registered domestic pMner's income
(For self-employed use Schedule A-L) (F self-employed use
❑Partnership(Less than 10%ownership. For 10%or greater use ❑Partnership(Less than 10%ownership.For 10%or greater use
Schedule A-2.) Schedule A-2.)
❑Sale of El Sale or
Reel paper ca Ott etc) Peal PcoCdr. .boa,etc)
❑ Loan repayment ❑ Loan repayment
❑ COne'Naiona ❑ Renal Income.ram ammo mr$igma or mare ❑ Commisslon or ❑ Rental Income,dR eam source or st0,wo a more
Pewee) (tae)
❑Other ❑War
(p (pampa/
ampa!
* You are not required to report loans from commercial lending institutions,or any indebtedness created as part of a
retail installment or credit card transaction,made in the lender's regular course of business on terms available to
members of the public without regard to your official status. Personal loans and loans received not in a lender's
regular course of business must be disclosed as follows:
NAME OF LENDER' INTEREST RATE TERM(ionhsfears)
% ❑None
ADDRESS(Business Address Acceptable)
SECURITY FOR LOAN
BUSINESS ACTIVITY, IF ANY,OF LENDER ❑None 0 Personal residence
❑Real Property 54M a6beas
HIGHEST BALANCE DURING REPORTING PERIOD
❑$500-S1,ODD Ply
❑stool -$10,000 ❑GuareMar
❑510,001 -5100,000
❑OVER$100,000 ❑ Pawnee)
Comments:
FPPC Form 700(2015/2016)Sch.C
FPPC Advice Email:advlce@fppc.Ca.gav
FPPC Toll-Free Helpline:866/275-3772 www.fppc.ca.gov
CALIFORNIA FORM 700
SCHEDULE D
Income — Gifts Name
Margaret Clark
I. NAME OF SOURCE(Not an Acronym) NAME OF SOURCE(Not an Acronym)
Burke, Williams&Sorenson LLP
ADDRESS(Business Address Acceptable) ADDRESS(Business Address Acceptable)
444 S. Flower St. Los Angeles, Ca
BUSINESS ACTIVITY,IF ANY,OF SOURCE BUSINESS ACTIVITY.IF AN OF SOURCE
Legal firm
DATE(mMEtllyy) VALUE DESCRIPTION OF GIFT(S) DATE(rmwtldlyy) VALUE DESCRIPTION OF GIFT(S)
OS) 14 15 $ 155.76 dinner at Contract Citie _1--1
10 ( 01 l $15 127.25 dinner-League of Citie —1J_ $
_J_ J $ $
• NAME OF SOURCE(Not an Acronym) IF NAME OF SOURCE(Not an Acronym)
Si Chuan No. 1 Restaurant
ADDRESS(Business Address Acceptable) ADDRESS(Business Address Acceptable)
8772 Valley Blvd. Rosemead, Ca 91770
BUSINESS ACTIVITY,IF ANY,OF SOURCE BUSINESS ACTIVITY,IF ANY,OF SOURCE
grand opening ribbon cutting
DATE(mmMdtyy) VALUE DESCRIPTION OF GIFT(S) DATE(mnlddlyy) VALUE DESCRIPTION OF GIFT(S)
12 ) 12 ( 15 100.00 Gift coupon-restaurant
$ _1J •
__J_J— • _J_/— $
J� $ JJ— $
• NAME OF SOURCE(Not an Acronym) le NAME OF SOURCE(Not an Anonym)
League of California Cities
ADDRESS(Business Address Acceptable) ADDRESS(Busines Adiess Acceptable)
1400 K Street, Sacramento, CA 95814
BUSINESS ACTIVITY,IF ANY,OF SOURCE BUSINESS ACTMTY,IF ANY,OF SOURCE
Advocacy for cities and their residents
DATE(mMddtyy) VALUE DESCRIPTION OF GIFT(S) DATE(mNddlyy) VALUE DESCRIPTION OF GIFT(S)
Ot 16 ) 15 28.88 Lunch Jam_ •
10 ( 15 33.33 Lunch
• —1J a
30 15 36.00 Lunch y
Comments:
FPPC Form 700(2015/2016)Sch.D
FPPC Advice Email:advice @fppc,ca.gov
FPPC Toll-Free Nelpline:866/275-3772 www.fppc•ca.gav