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FORM RECEIVED 700 STATEMENT OF ECONOMIC INTERESTS COMMISSION FAIR POLITICAL PRACTICES APR 0 4 2013 ` PUBLIC • COVER PAGE City of Riverside Please type or print in ink. City Clerk's{fge NAME OF FILER (LAST) (FIRST) (MIDDLE) Rossouw Maartin Johannes 1. Office, Agency, or Court Agency Name City of Riverside Division, Board, Department, District, if applicable Your Position Planning Commission Commissioner o If filing for multiple positions, list below or on an attachment. Agency: Position: 2. Jurisdiction of Office (Check at least one box) ❑State ❑Judge or Court Commissioner(Statewide Jurisdiction) ❑Multi-County ❑County of ❑✓ City of Riverside ❑Other 3. Type of Statement (check at least one box) ❑ Annual: The period covered is January 1, 2012,through ❑ Leaving Office: Date Left I -or- December 31,2012. (Check one) The period covered is I through O The period covered is January 1,2012,through the date of December 31,2012. leaving office. ❑✓ Assuming Office: Date assumed 03 1 05 1 2013 O The period covered is--I through the date of leaving office. ❑ Candidate: Election year and office sought, if different than Part 1: 4. Schedule Summary Check applicable schedules or"None." ► Total number of pages including this cover page: ❑ 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- El None- No reportable interests on any schedule 5. Verification MAILING ADDRESS STREET CITY STATE ZIP CODE (Business or Agency Address Recommended-Public Document) Riverside CA 92506 DAYTIME TELEPHONE NUMBER I E-MAIL ADDRESS 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 fore oin is true an Date Signed 04/0212013 Si (month,day,year)