Natalie Haworth - Annual (Deputy City Clerk) RECEIVED
C
CALIFORNIA FORM700 STATEMENT OF ECONOMIC INTERESTS Date-Filmy afficia-nogronly
REd
FAIR POLITICAL PRACTICES COMMISSION COVER PAGE
A PUBLIC DOCUMENT MAR ,0-8 2021
Please type or print in ink. CITY CLERK'S OFFICE
NAME OF FILER (LAST) (FIRST) (MIDDLE) EIY:
Haworth Natalie D.
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
City of Rosemead
Division, Board, Department, District, if applicable Your Position
City Clerk's Office Deputy City Clerk
► 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, Retired Judge, Pro Tem 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, 2020, through ❑ Leaving Office: Date Left / I
December 31, 2020. (Check one circle.)
-or-
The period covered is-lam through O The period covered is January 1, 2020, through the date of
December 31, 2020. -or-leaving office.
❑ Assuming Office: Date assumed / ' 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: 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
(Business or Agency Address Recommended-Public Document)
8838 E. Valley Blvd. Rosemead CA 91770
DAYTIME TELEPHONE NUMBER ENTAIL ADDRESS
( 626 ) 569-2177 Nhaworth@cityofrosemead.org
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 2,ASignature 1iAAAA�i
Sib!onth, ay,year) (Ft a the originally signed pa stateme t with your filing official.)
FPPC Form 700-Cover Page(2020/2021)
advice@fppc.ca.gov•866-275-3772•www.fppc.ca.gov
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