Steven LySTATEMENT OF ECONOMIC INTERESTS Date f tti�allOnly ved
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NAME OF FILER (LAST) (FIRST) (MIDDLE)
Ly Steven
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
City of Rosemead
Division, Board, Department, District, if applicable Your Position
Councilman
► If fling for multiple positions, list below or on an attachment. (Do not use acronyms)
Agency:
2. Jurisdiction of Office (Check at least one box)
Position:
❑ State ❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ Multi -County
❑x City of Rosemead
3. Type of Statement (Check at least one box)
❑X Annual: The period covered is January 1, 2017, through
December 31, 2017.
-or.
The period covered is I J_ through
December 31, 2017.
❑ Assuming Office: Date assumed
❑ Candidate: Date of Election
❑ County of
❑ Other
❑ Leaving Office: Date Left
(Check one)
O The period covered is January 1, 2017, through the date of
•or -
leaving office.
O The period covered is —
the date of leaving office.
and office sought, if different than Part 1:
through
Schedule Summary (must complete) ► Total number of pages including this cover page:
Schedules attached
❑x Schedule A-1 - Investments - schedule attached ❑ Schedule C - Income, Loans, & Business Positions - schedule attached
❑ Schedule A-2 - Investments - schedule attached ❑X Schedule D - Income - Gifts - schedule attached
❑x Schedule B - Real Property - schedule attached ❑ Schedule E - Income - Gifts - Travel Payments - schedule attached
-or-
F-1 None - No reportable interests on any schedule
5. Verification
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business or Agency Address Recommended - Public Document)
8838 E Valley Blvd
( 626 ) 569-2100
Rosemead
CA 91770
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 trueandcorrect.
Date Signed Yrti8.-zo t 8 Signature`' �J
(month, day, year) (File the originally signed statement with your filing official)
FPPC Form 700(2017/2018)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov
SCHEDULE A-1
Investments
Stocks, Bonds, and Other Interests
(Ownership Interest is Less Than 10%)
Do not attach brokerage or financial statements.
NAME OF BUSINESS ENTITY
LBL Holding LLC
GENERAL DESCRIPTION OF THIS BUSINESS
Real Estate
FAIR MARKET VALUE
❑ $2,000 - $10,000 ❑ $10,001 - $100,000
❑X $100,001 - $1,000,000 ❑ Over $1,000,000
NATURE OF INVESTMENT Co -Owner
❑ Stock Q Other
(Describe)
❑ Partnership O Income Received of $0 - $499
O Income Received of $500 or More (Report on schedule C)
IF APPLICABLE, LIST DATE:
ACQUIRED DISPOSED
o. NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE
❑ $2,000 - $10,000 ❑ $10,001 - $100,000
❑ $100,001 - $1,000,000 ❑ Over $1,000,000
NATURE OF INVESTMENT
❑ Stock ❑ Other
(Describe)
❑ Partnership O Income Received of $0 - $499
O Income Received of $500 or More (Report on schedule c)
IF APPLICABLE, LIST DATE:
___I__j_17 _-j---j-17
ACQUIRED DISPOSED
® NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE
❑ $2,000 - $10,000 ❑ $10,001 - $100,000
❑ $100,001 - $1,000,00o ❑ Over $1,000,000
NATURE OF INVESTMENT
❑ Stock ❑ Other
(Describe)
❑ Partnership O Income Received of $0 - $499
O Income Received of $500 or More (Report on schedule C)
IF APPLICABLE, LIST DATE:
ACQUIRED DISPOSED
Comments:
Name
Steven Ly
NAME OF BUSINESS ENTITY
UFC Gym Garden Grove LLC
GENERAL DESCRIPTION OF THIS BUSI
Fitness Center
FAIR MARKET VALUE
❑ $2,000 - $10,000 ❑ $10,001 - $100,000
X❑ $100,001 - $1,000,000 ❑ Over $1,000,000
NATURE OF INVESTMENT Owner
❑ Stock ❑X Other
❑ Partnership O Income Received of $0 - $499
O Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
ACQUIRED DISPOSED
NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE
❑ $2,000 - $10,000 ❑ $10,001 - $100,000
❑ $100,001 - $1,000,000 ❑ Over $1,000,000
NATURE OF INVESTMENT
❑ Stock ❑ Other
(Describe)
❑ Partnership O Income Received of $0 - $499
O Income Received of $500 or More (Report on schedule C)
IF APPLICABLE, LIST DATE:
ACQUIRED DISPOSED
NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE
❑ $2,000 - $10,000 ❑ $10,001 - $100,000
❑ $100,001 - $1,000,000 ❑ Over $1,000,000
NATURE OF INVESTMENT
❑ Stock ❑ Other
(Describe)
❑ Partnership O Income Received of $0 - $499
O Income Received of $500 or More (Report on schedule C)
IF APPLICABLE, LIST DATE:
__j_/ 17 __j_—J-17
ACQUIRED DISPOSED
FPPC Form 700 (2017/2018) Sch. A-1
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov
SCHEDULE B
Interests in Real Property
(Including Rental Income)
► ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS
5631 Aldama St
CITY
Los Angeles, CA 90042
FAIR MARKET VALUE
❑ $2,000 - $10,000
❑ $10,001 - $100,000
❑X $100,001 - $1,000,000
❑ Over $1,000,000
NATURE OF INTEREST
X❑ Ownership/Deed of Trust
IF APPLICABLE, LIST DATE:
___l__j17 __j__j17
ACQUIRED DISPOSED
❑ Easement
❑ Leasehold ❑
Yrs. remaining
Other
IF RENTAL PROPERTY, GROSS INCOME RECEIVED
❑ $0 - $499 ❑ $500 - $1,000 X❑ $1,001 - $10,000
❑ $10,001 - $100,000. ❑ OVER $100,000
SOURCES OF RENTAL INCOME: If you own a 10% or greater
interest, list the name of each tenant that is a single source of
income of $10,000 or more.
❑ None
Name
Steven Ly
ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS
328 S Ave 59
CITY
Los Angeles, CA 90042
FAIR MARKET VALUE
❑ $2,000 - $10,000
❑ $10,001 - $100,000
❑X $100,001 - $1,000,000
❑ Over $1,OOD,000
NATURE OF INTEREST
❑X Ownership/Deed of Trust
IF APPLICABLE, LIST DATE:
�� 17 ___j .. j_17
ACQUIRED DISPOSED
❑ Easement
❑ Leasehold ❑
Yrs. remaining Other
IF RENTAL PROPERTY, GROSS INCOME RECEIVED.
❑ $0 - $499 ❑ $500 - $1,000 ❑X $1,001 - $10,000
❑ $10,0D1 - $100,000 ❑ OVER $100,000
SOURCES OF RENTAL INCOME: If you own a 10% or greater
interest, list the name of each tenant that is a single source of
income of $10,000 or more.
❑ None
* You are not required to report loans from commercial lending institutions made in the lender's regular course of
business on terms available to members of the public without regard to your official status. Personal loans and
loans received not in a lender's regular course of business must be disclosed as follows:
NAME OF LENDER`
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF LENDER
INTEREST RATE TERM (Months/Years)
❑ None
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500 - $1,000 ❑ $1,001 - $10,000
❑ $10,001 - $100,000 ❑ OVER $100,000
❑ Guarantor, if applicable
NAME OF LENDER'
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF LENDER
INTEREST RATE
❑ None
TERM (Months/Years)
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500 - $1,000 ❑ $1,001 - $10,000
❑ $10,001 - $100,000 ❑ OVER $100,000
❑ Guarantor, if applicable
Comments:
FPPC Form 700 (2017/2018) Sch. B
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov
SCHEDULE D
Income — Gifts
► NAME OF SOURCE (Not an Acronym)
Burke, Williams and Sorensen LLP
ADDRESS (Business Address Acceptable)
444 S Flower St. Suite 2400, Los Angeles, CA 90071
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
5 11 / 17 $ 137.26 CCCA Dinner
�— $
► NAME OF SOURCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFTS)
$
_/---/— $
P NAME OF SOURCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/dd/yy)
VALUE
—�_
$
$
—ice—
$
Comments:
DESCRIPTION OF GIFT(S)
Name
Steven Ly
► NAME OF SOURCE (Not an Acmnym)
Republic Services
ADDRESS (Business Address Acceptable)
72531 E 67th St, Long Beach, CA 90805
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/ddlyy) VALUE
5 2 17 $ 300.00
�— $
$
► NAME OF SOURCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
DESCRIPTION OF GIFTS)
Military Appreciation
Night at Dodgers
Stadium
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/dd/yy) VALUE
$
$
$
NAME OF SOURCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
DESCRIPTION OF GIFT(S)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/dd/yy) VALUE
—� $
DESCRIPTION OF GIFT(S)
FPPC Form 700 (2017/2018) Sch. D
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov