700 Johnson - 2017 Assuming 01/03CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
A PUBLIC DOCUMENT
Please type or print in ink.
STATEMENT OF ECONOMIC INTERESTS
COVER PAGE
NAME OF FILER (LAST)
(FIRST)
RECEIVED
Date initial Filing Received
Official Use Only
FEB 3 2017
CITY OF LA QUINTA
CITY
FFARTMFNT
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
017* a-/ LA 6) L/l z!2
Division, Board, Department, District, if applicable
I/O / i4 C4e/1/1/Sfi6»
Your Position
C11u/67/47/f$/ 452
► 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
❑ Multi -County
"'City of LA Qi. iicir
❑ Judge or Court Commissioner (Statewide Jurisdiction)
['County of
❑ Other
3. Type of Statement (Check at least one box)
❑ Annual: The period covered is January 1, 2015, through
December 31, 2015.
-or- -
The period covered is —J / , through
December 31, 2015.
t. Assuming Office: Date assumed / / 3 / 20/1
❑ Candidate: Election year
❑ Leaving Office: Date Left _/_/
(Check one)
p The period covered is January 1, 2015, through the date of
leaving office.
-or-
0 The period covered is / , through
the date of leaving office.
and office sought, if different than Part 1:
Schedule Summary;_{must.cott
Schedule attached
Schedule A»1- investments = schedule attached
hedule.A42 i vest encs: schedu a attached
Schedule;R 12eat'Properfy:=schedule aitactied=>?:
le#e:
Mone - .No repo table intetes
otal number of pages iq udirig ;this coiner page:
y schedule
Schedule C • Income,- Loans,:;&:Business -Possitions= schedule;attacheii.
Schedule. D 1., Income — 61#8 -, schedute,.attached
Schedule E -.!twine = .Gilts Travel'F a monis =:schedule attached
5. Verification
MAILING ADDRESS STREET CITY
(Business or Agency Address Recommended - Public Document)
..
STATE
L 9 L 4'/Q''A CA
ZIP CODE
DAYTIME TELEPHONE NUMBER
( °
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 foregoing is true ands, rect.
Date Signed
(month, day, year)
Signature
e the odginal�ign statemen' ' h your riling official.)
FPPC Form 700 (2015/2016)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov
SCHEDULE A-2
Investments, Income, and Assets
of Business Entities/Trusts
(Ownership Interest is 10% or Greater)
► 1. BUSINESS ENTITY OR TRUST
Name
Name
Address (Business Address Acceptable)
Check one
❑ Trust, go to 2 t'"Business Entity, complete the box, then go to 2
GENERAL DESCRIPTION OF THIS BUSINESS
pd'/ 67/04 T/0»e-,1 VICc:a
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
• $0 - $1,999
• $2,000 - $10,000 / 15 /_/ 15
[,]I'sio,00i - $100,000 ACQUIRED DISPOSED
• $100,001 - $1,000,000
• Over $1,000,000
NATURE OF INVESTMENT
• Partnership [ii/Sole Proprietorship •
Other
YOUR BUSINESS POSITION iJ4,6'34
2. IDENTIFY THE GROSS INCOME RECEIVED (INCLUDE YOUR PRO RATA
SHARE OF THE GROSS INCOME TO THE ENTITY/TRUST)
► 2. IDENTIFY THE GROSS INCOME RECEIVED (INCLUDE YOUR PRO RATA
SHARE OF THE GROSS INCOME TO THE ENTITY/TRUST)
E $0 - $499 - 11 10,001 - $100,000
E $500 - $1,000 • OVER $100,000
• $1,001 - $10,000
► 3. LIST THE NAME OF EACH REPORTABLE SINGLE SOURCE OF
INCOME OF $10,000 OR MORE (Attach a separate sheet if necessary.)
• None or [lames listed below
As'>}VL ?3I ,9j` %fV '.1'
4. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD OR
LEASED BY THE BUSINESS ENTITY OR TRUST
Check one box:
• INVESTMENT • REAL PROPERTY
► 4. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD OR
LEASED BY THE BUSINESS ENTITY OR TRUST
Check one box:
• INVESTMENT • REAL PROPERTY
Name of Business Entity, if Investment, or
Assessor's Parcel Number or Street Address of Real Property
Description of Business Activity or
City or Other Precise Location of Real Property
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
• $2,000 - $10,000
• $10,001 - $100,000 / / 15 / / 15
• $100,001 - $1,000,000 ACQUIRED DISPOSED
• Over $1,000,000
NATURE OF INTEREST
• Property Ownership/Deed of Trust • Stock ❑ Partnership
• Leasehold • Other
Yrs. remaining
II Check box if additional schedules reporting investments or real property
are attached
CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
Name
1. BUSINESS ENTITY OR TRUST
Name
Address (Business Address Acceptable)
Check one
0 Trust, go to 2 0 Business Entity, complete the box, then go to 2
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
• $0 - $1,999
• $2,000 - $10,000 / / 15 _/_/ 15
• $10,001 - $100,000 ACQUIRED DISPOSED
• $100,001 - $1,000,000
• Over $1,000,000
NATURE OF INVESTMENT
• Partnership • Sole Proprietorship •
Other
YOUR BUSINESS POSITION
2. IDENTIFY THE GROSS INCOME RECEIVED (INCLUDE YOUR PRO RATA
SHARE OF THE GROSS INCOME TO THE ENTITY/TRUST)
• $0 - $499 • $10,001 - $100,000
• $500 - $1,000 • OVER $100,000
• $1,001 - $10,000
3. LIST THE NAME OF EACH REPORTABLE SINGLE SOURCE OF
INCOME OF $10,000 OR MORE (Attach a separate sheet if necessary.)
0 None or • Names listed below
4. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD OR
LEASED BY THE BUSINESS ENTITY OR TRUST
Check one box:
• INVESTMENT • REAL PROPERTY
Name of Business Entity, if Investment, or
Assessor's Parcel Number or Street Address of Real Property
Description of Business Activity or
City or Other Precise Location of Real Property
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
• $2,000 - $10,000
• $10,001 - $100,000 / / 15 / 15
• $100,001 - $1,000,000 ACQUIRED DISPOSED
• Over $1,000,000
NATURE OF INTEREST
• Property Ownership/Deed of Trust • Stock • Partnership
0 Leasehold • Other
Yrs. remaining
• Check box if additional schedules reporting investments or real property
are attached
Comments"
FPPC Form 700 (2015/2016) Sch. A-2
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov