700: Larson - 2018 Leaving Office 06/01/2018Please type or print in ink.
NAME OF FILER (LAST)
Lq,r Sod
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
City of La Quinta
Division, Board, Department, District, if applicable
RECEIVT- Z<
STATEMENT OF ECONOMIC INTERESTS Liate�, fttfeived
(FIRST)
COVER PAGE
CITY OF LA 0ILI t 1 A
CITY CLERK DEPARTMENT
SLAmj S s 4A. y <
Your Position
► 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 Quinta
3. Type of Statement (Check at least one box)
❑ Annual: The period covered is January 1, 2016, through
December 31, 2016.
.or -
The period covered is ��`J through
December 31, 2016.
❑ Assuming Office: Date assumed / /
❑ Candidate: Election year
(MIDDLE)
l� •elm rnc��
❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ County of
❑ Other
Leaving Office: Date Left _��_J� ZO��
(Check one)
p The period covered is January 1, 2016, 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: .
4.� Schedule Summary (must complete) Tota/ number of pages including this cover page:
Schedules attached
❑ Schedule A-1 - Investments — schedule attached
I ❑ Schedule A-2 - Investments — schedule attached
71vone
edule B - Real Property — schedule attached
r -
o - No reportable interests on any schedule
❑ Schedule C - Income, Loans, & Business Positions — schedule attached
❑ Schedule D - Income - Gifts — schedule attached
❑ Schedule E - Income — Gifts — Travel Payments — schedule attached
5. Verification r
MAILING ADDRESS TREET Clr r T IIP On,
(Business or Agency Address Recommended - Public Document)
DAYTIME TELEPHONE NUMBERI 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 docum nt.
I certify under penalty of perjury under the laws of the State of California that the for of g is true and co ect.
Date Signed �_ Z �� Signature
-
(monlh, day, year) ff fwe IN wlgin statement with official.)
FPPC Form 700(2016/2017)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov