Raymond A. Chavira - Leaving NO RECEIVED
CITY OF ROSEMEAD
Date InitiaFj
l�,yFilin Received
CALIFORNIA FORM 700 STATEMENT OF ECONOMIC INTERESTS Of+,!se my
FAIR POLITICAL PRACTICES COMMISSION
A PUBLIC DOCUMENT COVER PAGE CITY CLERK'S OFFICE
Please type or print in ink. BY'---4
NAME OF FILER (LASE (FI (MIDDLE)
( iauiv „ U ei 4ti► vt4 /1-
1.
T1. Office, Agency, or Court
Agency NNTTVo no u e acronyms) -
t "Oris (26 AA�1csibv 0A*6.5i tyYt el ".
Division, Board, Department, District, if applicable Your Position
► 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 ElCounty of
Vedy y
of I K)bae e &Ad ❑Other
3. Type of Statement (Check at least one box) / �y
111 Annual: The period covered is January 1, 2017,through eaving Office: Date Left / l c2 D/ a
December 31, 2017. (Check one) !!!
-or-
The period covered is______I___I , through 0 The period covered is January 1,2017, through the date of
December 31, 2017. -or-leaving office.
❑ Assuming Office: Date assumed_j—J 0 The period covered is_J___/ ,through
the date of leaving office.
❑ Candidate: Date of Election 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-1 - 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 Property-schedule attached ❑Schedule E-Income-Gifts-Travel Payments-schedule attached
or-
None - No reportable interests on any schedule —
5. Verification
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Rusin or AgencYAddress Recoded�Puhlip umenf) 6 l /f /AUp' (ba , q f U('''f/ est d. Ci� 9 C�
DAYTIME TELEPHONE NU BER V E-MAIL ADDRESS
( Oa-� P7I °If 0
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 pen ty of perjury under the laws of the State of California that the foregoing is true and correct.
Date Signed /' 1 /U Signature44440-401( 6,
so .. I _
(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