Margaret Clark REnCIEVED
Date Vial riling RecceiDved
CALIFORNIA FORM 700 STATEMENT OF ECONOMIC INTERESTS officsa use 01y
FAIR POLITICAL PRACTICES COMMISSION MAR 06 2017
A PUBLIC DOCUMENT COVER PAGE g7YCLERICE
RY'
Please type or print in ink nn�� ', OFFIC�
NAME OF FILER (LAST) FIRST) (rAIPDLE)
Clark Margaret
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
City of Rosemead
Division, Board, Department,District, if applicable Your Position
Council Member
r If fling for multiple positions, Ilst below or on an attachment. (Do not use acronyms)
Agency: Position:
2. Jurisdiction of Office (Check at least one box)
❑State D Judge or Court Commissioner(Statewide Jurisdiction)
❑Multi-County E County of
I]City of Rosemead ❑Other
3. Type of Statement (Check at least one box)
O Annual: The period covered is January 1, 2016, through 0 Leaving Office: Date Left J�
December 31,2016. (Check one)
eM1
The period covered is through C The period covered is January 1,2016, through the date of
December 31,2016. or leaving office.
❑ Assuming Office: Date assumed J / 0 The period covered is ,through
the date of leaving office.
O Candidate: Election year and office sought, if different than Part 1:
4. Schedule Summary (must complete) ► Total number of pages including this cover page:
Schedules attached
❑ Schedule A-I -Investments-schedule attached 0 Schedule C-Income,Loans, 6 Business Positions-schedule attached
• ❑ Schedule 42-Investments-schedule attached 0 Schedule 0-Income-Gifts-schedule attached
❑ Schedule B-Real Property-schedule attached D Schedule E-Income-Gifts-Travel Payments-schedule attached
-or-
_ ❑ None- No reportable interests on any schedule
5. Verification
MAIIJNG ADDRESS STREET CITY STATE ZIP CODE
(Business orAgency Address Recommended-Pot1 Oaaumen)
3109 Prospect Ave. Rosemead CA 91770
DAYTIME TELEPHONE NUMBER E-MAIL ADDRESS
( 626 ) 833-6673 clarkeeesc@yahoo.com
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 hue and complete. I acknowledge this is a public document.
I certify under penally of perjury under the laws of the State of California that the foregoing is true and correct.
en
Date Signed Ma-L.-1-L. /.O/7 Signature ' "A-c-yer-t . Cht...—ii
Imammvtax ye„1 ( mpnmy sg ed statement w hwuraamv otnaa,)
FPPC Form 700(2016/2017)
FPPC Advice Email:advice@fppc.ca.gov
FPPC Toll-Free Helpline:866/275-3772 www.fppc.ca.gov
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Income, i Ebjj C
ADDRESS
FellpWShiP C.OME (Other than G�oand,�S Ba me ess Name
PAIR theoRtviA roR�or„7
NAME Op SOURCE or
BUSINESS O•UBoss"ddress AccePt6e - t.INC Mls o
Ess ACTlig0 Ro Nd LoSAnge/es NAME OMEou GEIVED Margaret /ark
YOUR EU OF SOURCE S, CA 9po6 RCE OF INCOME
ENS/NESS POSITION 5 ADDRESS/aOsine E
+Adores
GROSS INCOMEEUS` Accept
O5600.g/,000 RECEIVED QNP IncomeNESS ACTIVITY IFANT OF
$l0
,001-$100,000 031,Oo, Eusin YOUR
BUSINESS SOURpE
O aSary RAT/ON FOR O OyE 0 ess Position Only
E,000 POSITION
WH/ R$to a0 N
ME
O PartneShi O(For self mPSpouse's or reBieOSr:.de AE RECEIVED
Q SOSOE IN
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ScM1eauleqLess then Orseit%o yer us S eo°Partner's in O E,,000 EIVEO
wnersh� I A.2) "eme QE,0.00,, QNO In
Sale of
A Far
CONSIDERATION
QS1, come'„nes Pos"
Loan repayment
10%or greater use O Salay RATION Fp// Q OVER E10,o00 oGon OnrY
W/IICHINCO Ef0000
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commission or �'acro wy /Ear Belie regi to EIVED
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•N[each ssurre o�8vo Sale of hfl For lO o 0
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ELENDER• regartl to youmade ins
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CALIFORNIA FORM 700
(Am POLITICAL PRACTICES CONI(FISSION
SCHEDULE
D Name
Income
Gifts Margaret Clark
InIncome —
NAME OF SOURCE(Not an Acronym) ir. NAME OF SOURCE(Not an Acrronym)
yPlable)
ADDRESS(Business Redress
on
Burke,Williams&Sorensonpe LP
ADDRESS(Business Address AttePa Angeles,CA BUSINESS ACTIVITY,IF ANY,OF SOURCE
444 S. Flower Street,Los DESCRIPTION OF GIFT(S)
ANY,OF SOURCE IdaNY) VALUE
BUSINESS ACTIVITY,.IF PN DATE(mm —
Legal Firm DESCRIPTION of GIFT(S) —J—J—
J— s—
DATE(mmId&YYl VALUE —
Dinner at LCCA s—
�� 16 $85 b� JJ—
Dinner at league_G :� —
7 16 $728� JJ— s�
JJ
16 58 00 Prize Drawing G71
_19_
J rr,) NAME OF SOURCE Not an Acronym)
e Address Acceptable)
anADDRESS(Business NAME OF SOURCE(Not re Acmnym
ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY'IF ANY,OF SOURCE
DESCRIPTION OF GIFT(S)
DATE(mmltltllyY) VALUE
BUSINESS ACTIVITY.IF RNV,OF SOURCE —
DESCRIPTION OF GIFT(S)qwE JJ— s�
DATE(mMdd1YY1 —
JJ— $ JJ o.---_ --------J— s— JJ— s--____— SOURCE(Not an Acronym)_ . NAME OF
—J—1— a
ADDRESS(Business Address Acceptable)
NAME OF SOURCE(Not Acronym)
BUSINESS ACTIVITY,IF ANY,OF SOURCE
ADDRESS(Bus^ess Address Acceptable)
DESCRIPTION OF GIFT(S)
IF ANY,OF SOURCE (dtl1YY) VALUE
BUSINESS ACTIVITY, DATE(mm —
DESCRIPTION OF GIFT(E)DATE lm
,Names) VALUE JJ— s--____ --------JJ s---- JJ s---_ -------J J— s--- J J— s----_JJ— s----_
Comments: FPPC Form 700(2016/2017)Sc
FPPC Advice Email:advice@ fp Pcca
FPPC Toil-Free Helpline:866/275-3772 Tv'M P