Kim Borris-Palmer RECEIVED
CITY OF ROSEMEAD
CALIFORNIA FORM 700 STATEMENT OF ECONOMIC INTERESTS t":"_ +EB' 2 3 16..:,1
FAIR POLITICAL PRACTICES COMMISSION
A PUBLIC DOCUMENT COVER PAGE CITY CLE 'SOFFICE
BY: P
Please type or print in ink
NAME OF FILER (LAST) (FIRST) (MIDDLE)
Boris-Palmer Kim
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
City of Rosemead
Division, Board, Department, District, if applicable Your Position
Parks and Recreation Recreation Supervisor
• 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
IZ City of Rosemead ❑Other
3. Type of Statement (Check at least one box)
Z Annual: The period covered is January 1, 2015,through ❑ Leaving Office: Date Left
December 31.2015. (Check one)
or•
The period covered is through O The period covered is January 1,2015.through the date of
December 31, 2015. err leaving office.
❑ Assuming Office: Date assumed J J O The period covered is J I through
the date of leaving office.
❑ Candidate: Election year and office sought, if different than Pad 1.
4. Schedule Summary(must complete) ► Total number of pages Including this cover page:—I—
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 B-Real Propery—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
(Shyness or Agency AdtlreSS Recommanaed-Puba Daumene
8838 East.Valley Boulevard Rosemead CA 91770
DAYIME TELEPHONE NUMBER EMAIL ADDRESS
( 626 ) 569-2100
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 /SI/to Signature 04At,9
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FPPC Form 700(2015/2016)
FPPC Advice Email:advicegsfppc.ca.gov
FPPC Toll-Free Helpline:866/275-3772 www.fppc.ca.gov