700: Maysels - 2016 from 01/01 - 12/31CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
A PUBLIC DOCUMENT
Please type or print in ink.
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STATEMENT OF ECONOMIC INTERESTS
COVER PAGE
RECEIVED
Initial Edina Received
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CITY OF LA QUINTA
CITY CLERK DEPARTMENT
NAME OF FILER (LAST) (FIRST)
MAYSELS SUSAN
(MIDDLE)
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
CITY OF LA QUINTA
Division, Board, Department, District, if applicable Your Position
CITY CLERK
► If filing for multiple positions, list below or on an attachment. (Do not use acronyms)
Agency: OVERSIGHT BOARD TO L.Q. SUCCESSOR AGY Position BOARD MEMBER
2. Jurisdiction of Office (Check at least one box)
❑ State ❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ Multi -County ❑ County of
❑x City of LA QUINTA ❑ Other
3. Type of Statement (Check at least one box)
❑x Annual: The period covered is January 1, 2016, through
December 31, 2016.
The period covered is _J_/ , through
December 31, 2016.
❑ Assuming Office: Date assumed J—I
-or-
❑ Leaving Office: Date Left
(Check one)
O The period covered is January 1, 2016, through the date of
leaving office.
-or-
O The period covered is , through
the date of leaving office.
❑ Candidate: Election year and office sought, if different than Part 1
4. 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-
111 None No reportable interests on any schedule
5. Verification
❑ Schedule C - Income, Loans, & Business Positions - schedule attached
❑ Schedule D - Income - Gifts - schedule attached
❑ Schedule E - Income - Gifts - Travel Payments - schedule attached
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business or Agency Address Recommended - Public Document)
78495 CALLE TAMPICO LA QUINTA CA 92253
DAYTIME TELEPHONE NUMBER E-MAIL ADDRESS
( 760 ) 777-7123 SMAYSELS@LA-QUINTA.ORG
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 and correct.
Date Signed 03/30/2017 Signature
(month, day, year) (File the originally signed statement yeuI r7ing othcial
FPPC Form 700 (2016/2017)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov