Qui D. Nguyen - Assuming (Parks Commissioner) CALIFORNIA FORM 700 STATEMENT OF ECONOMIC INTERESTS Date t'+�"F�"�g Received
HRIft Only
ROSEMEAD
FAIR POLITICAL PRACTICES COMMISSION COVER PAGE CRY OF
Please type or print in ink. A PUBLIC DOCUMENT AUG 22 2019
NAME OF FILER (LAST) (FIRST) CITY CIAK1)OFFICl6
NGUYEN QUI DANG BY:
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
CITY OF ROSEMEAD
Division, Board, Department, District, if applicable Your Position
PARKS COMMISSION COMMISSIONER
► 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 ❑County of
City of ROSEMEAD ❑Other
3. Type of Statement (Check at least one box)
❑ Annual: The period covered is January 1, 2018, through ❑ Leaving Office: Date Left I—J
December 31, 2018. (Check one circle.)
•or-
The period covered is , through 0 The period covered is January 1, 2018, through the date of
December 31, 2018.
.0r.leaving office.
Assuming Office: Date assumed 07 l 23 I 2019 0 The period covered is ,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:
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
(Business or Agency Address Recommended-Public Document)
8838 E. VALLEY BOULEVARD ROSEMEAD CA 91770
DAYTIME TELEPHONE NUMBER EMAIL ADDRESS
( 626 )569-2100
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�penaallty of perjury under the laws of the State of California that the foregoing is true and correct.
L'�/ ��a� j Signature
Date Signed 9
(month,day,year) (File the originally signed paper statement with your filing official.)
FPPC Form 700(2018/2019)
FPPC Advice Email:advice@fppc.ca.gov
FPPC Toll-Free Helpline:866/275-3772 www.fppc.ca.gov
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