Wayne Co - Annual (Public Safety Manager) RECEIVED
CITY OF ROSEMEAD
STATEMENT OF ECONOMIC INTERESTS Date Initial Filing Received
CALIFORNIA FORM 700 Fll%p�vIHJ(ci(I(( 6d e 2112,1FAIR POLITICAL PRACTICES COMMISSION COVER PAGE
A PUBLIC DOCUMENT CITY CLERK'S OFFICE
Please type or print in ink. BY:
NAME OF FILER (LAST) (FIRST),/,,--1/9- (MIDDLE)
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1. Office, Agency, or Court /
Agency Na (Do not use acr ms) C/'
Division, oard, 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, Retired Judge, Pro Tern Judge, or Court Commissioner
(Statewide Jurisdiction)
❑Multi-County ❑County of
❑City of 4 giti ice/}-I) ❑Other
3. Type of Statement (Check at least one box)
XAnnual: The period covered is January 1, 2020,through
December 31,2020. f Leaving Office: Date Left_/______/(Check one circle.)
-or-
The period covered is____/______/ ,through 0 The period covered is January 1, 2020, through the date of
December 31,2020. -or-leaving office.
❑ Assuming Office: Date assumed—J—/ 0 The period covered is______/_/ ,through
the date of leaving office.
f Candidate: Date of Election and office sought, if different than Part 1:
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5. Verification te0l r, 6,,,,,/,/,,-/ / ; f-4p 7/'�0
MAILING ADDRESS STREET CITY T"5 ATE ZIP CODE
or A enc Address Recommended-Public Document
(BusinessAgency )
DA M T LEPI-IONE NUMBER EMAIL DDRESS
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bfoff8 � eI have used afl reasodiligence in preparing this statement. I have reviewed this statement and to thebest of myknowledge the information contained
9 P P 9 9
herein and in any attached schedules is true and complete. I acknowledge this is a public document.
I certify under penalty of erjury under the laws of the State of California that the foregoing
is tue and corr t.
2-5 -2-"°7 /
Date Signed Signature
(mo lb,day,year) (File the originally signed paper statement with your filing official.)
FPPC Form 700-Cover 101141.121)
advice@fppc.ca.gov•866-275-3772•www.fppc.ca.gov
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