Palacios, Monserrat - 2017-2018 Form 700• ' • ' STATEMENT OF ECONOMIC INTERESTPEddVt �ecdved
FAIR POLITICAL PRACTICES COMMISSION
A PUBLIC • COVER PAGE CITY CLERK'S OFFICE
Please type or print in ink. /i � �"_? 0 P�
NAME OF FILER (LAST) (FIRST) (MIDDLE)
Palacios Monserrat
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
City of El Segundo
Division, Board, Department, District, if applicable Your Position
Recreation & Parks Sr. Administrative Analyst
► 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
0 City of El Segundo ❑ Other
3. Type of Statement (Check at feast one box)
❑x Annual: The period covered is January 1, 2017, through ❑ Leaving Office: Date Left I
December 31, 2017. (Check one)
-or-
The period covered is I through O The period covered is January 1, 2017, through the date of
December 31, 2017. -or- leaving office.
❑ Assuming Office: Date assumed O The period covered is —l—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:
Schedules attached
❑ Schedule A-1 - Investments — schedule attached
❑ Schedule A-2 - Investments — schedule attached
❑ Schedule B - Real Property — schedule attached
None - No reportable interests on any schedule
5. Verification
❑ Schedule C - Income, Loans, & Business Positions — schedule attached
❑ Schedule D - Income — Gifts — schedule attached
❑ Schedule E - Income — Gifts — Travel Payments — schedule attached
MAILING ADDRESS STREET GTY STATE ZIP CODE
(Business or Agency Address Recommended - Public Document)
401 Sheldon St. El Segundo CA 90245
( 310 )524-2882
mpalacios@elsegundo.org
I have used all reasonable diligence in preparing this statement. I have reviewed this statement andEF
e the information contained
herein and in any attached schedules is true and complete, I acknowledge this is a public docume
I certify under penalty of perjury
under the laws of the State of California that the foreg ing
Date Signed ' v `� u Signature
(monh. day, year) oa odgm signed statement with your (ling official.)
FPPC Form 700(2017/2018)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov