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1 10 W% <br />a-fej z too <br />NAME <br />00:4.zAN 0 0 44 .1.0 <br />M <br />(This date shall be <br />considered as the <br />date of filing and <br />the ann iversary <br />date) <br />a <br />This f orm has been prepared as the suggested guide to be used <br />Pursuant to Ordinance an ordinance titled "Ordinanc <br />Establishinig.,a Code of Ethics for the Public Officiais of the <br />City of Roseville". I <br />APPLICABILITY: Completion of a disclosure of f innancial interest <br />required of all Public Officials of the City of Rodeville. rt <br />i.,is also pointed out that the interest of a spouse, minor ch'ld,, <br />or ather member of his/her 'Immediate household shall be <br />considered to be an interest of �y,ours. <br />F144*0 <br />0 <br />10 Names of all business corporationst companieso, firms, <br />olther business enterprises, partnerships, licensees or <br />Permit holders, knowingly doing business with or in the <br />Cjty of Roseville. <br />3.1 <br />In which you are connected as an employee, <br />of f icer , director , truistee partner advisor <br />consultant or li,cienslee or <br />In which you have any continuing f iriancia-11 <br />interest, through, a pension or retiorement plan, <br />shared income or otherwise . as a result of any <br />current or prior employment or business or <br />professional assiolcon, or <br />C, In which you have any f inancial interest through <br />the ownership of stocks, bonds or other <br />securities, require additional space, <br />,state the number of enclosures if thi S <br />section is not applicable,, please initial. <br />