Kim Palmer-Boris Gar.: nR EC E t VEA)':
CALIFORNIA FORM 700 STATEMENT OF ECONOMIC INTERESTS CITY OF ROSEMEAD
FMR PouTCAL PRACTICES commissin.4
A PUBLIC DOCUMENT COVER PAGE ".1A1- I :i 2017
Please type or pnnt in ink
NAME OF FILER (LAST) (FIRST) CATV r11 It 6' , Ic!
RV'
Palmer-Boris Kim
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
City of Rosemead
Division, Board, Department, District,if applicable Your Position
Parks 8 Recreation Department Recreation Supervisor
A If filing for multiple positions, list below or on an attachment. (Do not use acronyms)
Agency. Position:
2. Jurisdiction of Office (Check at/east one box)
o Stale ❑Judge or Court Commissioner(Statewide Jurisdiction)
❑Multi-County ❑County of
0 Chy of Rosemead ❑Other
3. Type of Statement (Check at least one box)
O Annual: The period covered is January 1,2016,through i] Leaving Office: Date Lett—J___/
December 31,2016. (Check one)
or-
The period covered is J_J ,through 0 The period covered is January 1,2016,through the date of
December 31,2016. leaving office.
-or•
❑ Assuming Office: Date assumed—JJ 0 The period covered is___/_ ,through
the date of leaving office.
LI Candidate: Election year and office sought, if different than Part 1:
I4. Schedule Summary (must complete) Total number of pages including this cover page:
Schedules attached
O Schedule A-I -Investments-schedule attached o Schedule C-Income, Loans, 8 Business Positrons-schedule attached
❑ Schedule A-2-Investments-schedule attached ❑Schedule 0-Income-Gigs-schedule attached
1 ❑ Schedule B-Real Property-schedule attached i]Schedule E-Income-Gifts-Travel Payments-schedule attached
-Or•
xZ None - No reportable interests on any schedule
5. Verification
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Roofless or Agency Address Recommended.Pudic Dao,meMJ
8838 E Valley Blvd Rosemead Ca 91770
DAYTIME TELEPHONE NUMBER E-MAIL ADDRESS
( 626 ) 569-2250 kboris@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 s true and correct.
Date Signed 03/09/2017 Signature 6, L:,,
(mmM,doy lea) (delle°HoucYysynod Rahman,.hourfiling offcRR
FPPC Form 700(2016/2017)
FPPC Advice Email:advice@fppc.ca.gov
FPPC Toll-Free Helpline:866/275-3772 www.fppc.ca.gov