700 Long - 2017 from 01/01 - 12/31Please type or print in ink
NAME OF FILER (LAST)
1. Office, or cy, or Court
Agency a (Do nPt use acronyms)
Divi'on, Board, Depdent, District. If applicable
STATEMENT OF ECONOMIC INTERESTS
(FIRST)
COVER PAGE
Your Nam
► If filing for multiple positions, list below or on an attachment (Do not use acronyms)
Agency: Position
2. Jurisdiction of Office (check at lease one box)
❑ State
❑ Muf6-County
0 City of
3. Type of Statement (check at toast one box)
RECEIVED
MAR 12 2018
CW
�r �4 QUINTA
CITY CLERK DEPARTMENT
zIr"
(MIDDLE)
❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ Counly of
❑ Other
Annual: The period covered is January 1, 2017, through ❑ Leaving Office: Date Left ► l
December 31, 2017. (Check one)
-or-
The period covered is — I through O The period covered is January 1, 2017, through the date of
December 31, 2017. -0r-
leaving office.
❑ Assuming Office: Date assumed r l O The period covered is r l through
the date of leaving office.
❑ Candidate: Date of Election and office sought, if different than Part 1:
4. Schedule Summary (must complete) oo- Total number of pages including this cotter page.
Schedules attached
❑ Schedule A-1 - tmestments – schedule attached
❑ Schedule A-2 - Investments – schedule attached
❑ Schedule B - Real Pmpenty – schedule attached
-Or-
fA None - No reportable interests on ally schedule
5. Verification
MAILING ADDRESS STREET CITY
(Busimm or Agency Adckw Reemunerded - Pubk Docu nenq
DAYTIME TELEPHONE Flt MBER
❑ Schedule C - Intorno, Loans, 8 Business Positions – schedule attached
❑ Schedule D - Income – Gifts – schedule attached
❑ Schedule E - Income – Gifts – Travel Payments – schedule attached
E-MAIL.ti'DI :ESS'
STATE ZIP CODE
( )
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 foregoin is a correct
Date Signed „'�►�� ` �� 5i natur •� ✓��' .
[ +, dw,, Ye.j (Fik Ube originalysigrxdswbyovy 5i qv ia1)
�FPPC Form 700 (2017/2018)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helplirte: 866/275-3772 www.fpp-ca.gov