700 Long - 2016 from 01/01 - 12/31i
a PUBLIC DOCUMENT
Please type or print in ink
COVER PAGE
J
NAME OF FILER (LAST)
1. Office, Agency, or Court
(MST)
0/9/?? / 91,16 i'.
/4411 , 7
Agency Nave (Do not use acronyms)
e
Division, Board, r '-.. , ent, District, if applicable
Your Position
► If fling for multiple positions, list below or on an attachment (Do not use acronyms)
Agent
Position:
IVSD
7 111 7
CITY OF LA QUINTA
CI CLERK( DEPARTMENT
2. Jurisdiction of Office (Check at least one box)
El State 0 Judge or Court Commissioner (StateNide Jurisdiction)
0 MIlti-Countyr 0 County of
.City of f/ t) I rr7 ❑ Other
3. Type of Statement (Check at least one box)
4. Annual: The period covered is January 1, 2015, through ❑ Leaving Office: Date Left
December 31, 2015. (Check one)
-or-
The period covered is through 0 The period covered is Januay 1, 2015, through the date of
December 31, 2015. -0r- leaving office.
0 The period covered is rl_ __ J through
the date of leaving office.
❑ Candidate: Election year and office sought, if different than Part 1
0 Assuming Office: Date assumed Jam.
4. Schedule Summary (must complete) b. Total nwnber of pages including Ibis cover page:
Schedules attached
❑ Schedule A-1 - Investments — schedule attached
j ❑ Schedule A-2 - Investments — schedule attached
❑ Schedule B - Real Property — schedule attached
-or-
xl None - No reportable interests on any schedule
❑Schedule C - Income, Loans, & Business Positions — schedule attached
❑ Schedule D - Income — Gills — schedule attached
❑ Schedule E - Income — Gilts — Travel Payments — schedule attached
5. Verification
MAILING ADDRESS STREET
(Business or Agency Address Recommended - Pubic
. ,DAME TELEPHONE NUMBER
(
CITY
STATE
ZIP CODE
E-MAIL ADDRESS
92z.,
I have used al 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 adcna ledge this is a public document
I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct
Date Signed ICZiler
( th,dexy
Signature".=
(Fie the eV* signed
FPPC Form 700 (2015/2(116)
wlh your Ong ntbcia I)
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