Rafael Fajardo RECEIVED
CITY n
CALIFORNIA FORM 700 STATEMENT OF ECONOMIC INTERESTS D n .rrr FCC
FAIR FOLII Ian L PREP I lc us Rom MISSION
A PUBLIC DOCUMENT COVER PAGE GMT,
Please type or print in ink.
NAME OF FILER (LAST) (FIRST) (MIDDLE)
Fajardo Rafael
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
City of Rosemead
Division,Board, Department District, if applicable Your Position
Engineering City Engineer
M 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)
O Annual: The period covered Is January 1, 2015,through ❑ Leaving Office: Date Left
December 31, 2015. (Check one)
-ory
Dec period covered is through
0 The period covered is January 1,2015.through the date of
J� ,
December 31, 2015, leaving office.
-or-
❑ Assuming Office: Date assumed J J O The period covered is JJ ,through
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-I-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 Properly-schedule attached ❑Schedule E•Income-Gilts-Travel Payments-schedule attached
-Of-
fg None• No reportable interests on any schedule
5. Verification
MAILING ADDRESS STREET clry STATE LP CODE
(Business or Agency Adtess Recommended-Puttee Document)
8838 East Valley Boulevard Rosemead CA 91770
DAYTIME TELEPHONE NUMBER E-MAIL ADDRESS
( 626 ) 569-2100
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 a o
Date Signed 0zt221iG Signature
(month dry,teen (Fie ire away stunted stafemea MIh your come orua)
FPPC Form 700(2015/2016)
FPPC Advice Email:advice@fppc.ca.gov
FPPC Toll-Free Helpline:866/275.3772 www.fppc.ca.gov