700: Perez - 2017 from 01/01 - 12/31Please type or print in ink.
NAME F FILER (LAST)
EIR.yIz- _,
1. Office, Agency, or Court
STATEMENT OF ECONOMIC INTERESTS
(FIRST)
COVER PAGE
Agency Name (Do not use acronyms) �7+
c
Divislon, oard, Department, Distri if applicable Your PositiQ
► If filing for multipvositions, list below or on an attachment (Do not use acronyms)
2. Jurisdiction of Office (check at least one box)
❑ State
❑ Multi -County
City of_ 0 In�1n-f7)1�
3. 7Arnual:
of Statement (Check at least one box)
The period covered is January 1, 2017, through
December 31, 2017.
.or -
The period covered is / I
December 31, 2017.
❑ Assuming Office: Date assumed
❑ Candidate: Date of Election
RECEIVED
I ate In! ti cling Received
U!'- 'T 12QI$
CITY OF LA QUINTA
CITY CLERK. DEPARTMENT
(MIDDLE)
❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ County of
❑ Other
❑ Leaving Office: Date Left ____J ---- J
(Check one)
through O The period covered is January 1, 2017, through the date of
-or-
leaving office.
O The period covered is I I through
the date of leaving office.
and office sought, if -different than Part 1:
4. Schedule Summary (must complete) 0- 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
[DINone - 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
(fBusiness or Agency Address iRecommended - Public Document)
r
` na) ICCA.v�f lncs lfllki]fY_h ruin �Ra.vk O W lvG, CA 922'7
DAYTTME TELEP tNE NUMBER I E-MAIL DDRESS;) (
I have used all reasonable diligence in preparing this statement. I have reviewed th4iment and to the best of my nowledge the Ift ation 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.
�� + r
Date Signed •_ Signature � A
day, year) (Fie orignaN T statement wdh your filing official.)
FPPC Form 700(2017/2018)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov