Adam Jacobb Davis - Assuming (Code Enforcement Officer) IiEG IVED
OIT f @F ROSEMEAD
CALIFORNIA 700 STATEMENT OF ECONOMIC INTERESTS . Date InitiallaFiling oReceived
FAIR POLITICAL PRACTICES COMMISSION COVER PAGE ` 021
Please type or print in ink. A PUBLIC DOCUMENT . CITY CLERK'S OFFICE
BY:
NAME OF FILER (LAST) (FIRST) (MIDDLE)
AQ 1 S Dint\ c--)-c.0(It
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
0k (=At) LOce r+71vv r- F(CGt2
Division, Yoard,.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 ❑County of
I City ofS-t tT) P t ❑Other
3. Type of Statement (Check at least one box)
❑ Annual: The period covered is January 1,2018,through ❑ Leaving Office: Date Left—J—1
December 31,2018. (Check one circle.)
-or-
The period covered is—J—J ,through 0 The period covered is January 1,2018,through the date of
December 31,2018.
.0r.leaving office.
jg Assuming Office: Date assumed 07 i 224 Z I 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 Blvd. 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 penalty of perjury under the laws of the State of California that the foregoing Is true and correct.
Date Signed 02. 2 2!f 2 0 Z( Signature
/ (month,day,year) (File t!/ originally signed paperslatement 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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