Robert Ornelas RECIEVED
CITY OF ROSMEAD
CALIFORNIA FORM Date Ic t a� RI rat Received
700 STATEMENT OF ECONOMIC INTERESTS
APR. 03`2017
FAIR POLITICAL RACTICES COMMISSION
A PUBLIC DOCUMENT COVER PAGE CITY CLEF OFFICE
Please type or print in ink. BY: NIJ
NAME OF FILER (LAST) (FIRST) (MIDDLE)
O2,IFC 45 tCUc,c/€,C Ai(/ w L/
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
C/17/ C7F /fOSE/`'/ek tF/�
Division, Board, Department, District, if applicable Your Position
-TCI EF/C L19/4-447VSS/04/r<
I. 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 E Judge or Court Commissioner(Statewide Jurisdiction)
E Multi-CountytyE County of
City of 752o5Fe9E U ❑Other
3. Type of Statement (Check at least one box)
uE Annual: The period covered is January 1, 2016, through E Leaving Office: Date Left JJ
December 31,2016. (Check one)
or-
The period covered is , through O The period covered is January 1,2016, through the date of
December 31, 2016. leaving office.
-or-
❑ Assuming Office: Date assumed___JJ - 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) I. Total number of pages including this cover page:
Schedules attached
❑ Schedule A-1 -Investments-schedule attached ❑Schedule C-Income, Loans. &Business Positions-schedule attached
❑ Schedule A-2-Investments-schedule attached ❑Schedule 0-Income-Gifts-schedule attached
❑ Schedule B-Real Properly-schedule attached ❑Schedule E-Income-Gifts-Travel Payments-schedule attached
-Or-
cs-None- No reportable interests on any schedule
5. Verification
MAIuNG ADDRESS STREET Or, STATE ZIP CODE
(Business or Agency Address Recommended-PuNic Document)
E, u&Ler SZ-vv /17asFHF•¢o CA 9/770
DAYTIME TELEPHONE NUMBER E-MAIL ADDRESS
(6'20S9_a/00 ,apet ern c /S 6:2 Gy )Har/ Corr J
I have used all reasonable diligence in preparing this statement. I have reviewed this statement and to the best of my knowlealte 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 04//37W/ Signature a/7;
(morn.day yea') (File the owyna* soamsl?)Prom)With your Wna ofaa'I
FPPC Form 700(2016/2017)
FPPC Advice Email:advice@fppc.ca.gov
FPPC Toll-Free Helpline:866/275-3772 www.fppc.ca.gov