Palacios, Monserrat - 2019-2020 FPPC Form 700STATEMENT OF ECONOMIC INTERESTS RECEIIVEDI�%/ 'ved
POLITICALFAIR COVER PAGE CITY CLERK'S OFFICE
Please type or print in ink. A PUBLIC DOCUMENT Z/`
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
Community Services Senior 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)
❑X State ❑ Judge, Retired Judge, Pro Tern Judge, or Court Commissioner
(Statewide Jurisdiction)
❑ Multi -County ❑ County of
❑ City of El Segundo ❑ Other
3. Type of Statement (Check at least one box)
(] Annual: The period covered is January 1, 2019, through ❑ Leaving Office: Date Left
December 31, 2019. (Check one circle.)
-or-
The period covered is ___J__J—
December 31, 2019.
❑ Assuming Office: Date assumed
❑ Candidate: Date of Election
through O The period covered is January 1, 2019, through the date of
-or-
leaving office.
O The period covered is I I through
the date of leaving office.
and office sought, if different than Part 1:
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
-or- 0 None - No reportable interests on any schedule
❑ Schedule C - Income, Loans, & Business Positions - schedule attached
❑ Schedule D - Income - Gifts - schedule attached
❑ Schedule E - Income - Gifts - Travel Payments - schedule attached
5. Verification
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business or Agency Address Recommended - Public Document)
350 Main St. ElSegundo CA 90245
DAYTIME TELEPHONE NUMBER EMAIL ADDRESS
(310524) 1 mpalacios@elsegundo.org
I have used all reasonable diligence in preparing this statement. I have reviewed this statement and t the best of/nod a the information contained
herein and in any attached schedules is true and complete. I acknowledge this is a public docum rI certify under penalty of perjury under the laws of the State of California that the foregoi i r d
Date Signed 2/17/2021
(month, day, year)
Signature
(File the o4nJ4-4ned paper statement with your filing official.)
FPPC Form 700 - Cover Page (2019/2020)
advice@fppc.ca.gov - 866-275-3772 - www.fppc.ca.gov
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