700 Johnson - 2018 Leaving 11/06/2018STATEMENT OF ECONOMIC INTERESTS
RECEIVED
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COVER PAGE
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CITY OF LA quINTA
CITY CLERK DEPARTMENT
NAME OF FILER (LAST) (FIRST)
(MI D)D}E
I/,vsf70) 1- 15SC��
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
01 j j` 1/-- 1-4- ipc/i A-1719
Division, Board, Department, District, if applicable
h/D Wei Nj�; CC) "r` Iffluit-)
Your Position
► If filing for multiple positions, list below or on an attachment. (Do not use acronyms)
Agency:
2. Jurisdiction of Office (Check at least one box)
❑ State
❑ Multi -County
City of L-14 V✓l"M
3. Type of Statement (Check at least one box)
❑ Annual: The period covered is January 1, 2017, through
December 31, 2017.
.or -
The period covered is I I
December 31, 2017.
❑ Assuming Office: Date assumed
❑ Candidate: Date of Election
Position:
❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ County of
❑ Other
eaving Office: Date Left f/ l—(. i It
(Check one)
through O The period covered is January 1, 2017, through the date of
leaving office.
.or-
�e period covered is I I / I 2Ot through
the date of leaving office.
and office sought, if different than Part 1
4. Schedule Summary (must complete) ► Total number of pages including this cover page:3�
Schedules attached
❑ Schedule A-1 - Investments — schedule attached
Schedule A-2 - Investments — schedule attached
❑ Schedule B - Real Property — schedule attached
.or-
❑ None - No reportable interests on any schedule
5. Verification
MAILING ADDRESS STREET
(Business or Agency Address Recommended • PuNNic Document)
7 YV 9S- 0* CC 7XOy ICO
DAYTIME TELEPHONE NUMBER
c 7Ga)
Schedule C - Income, Loans, & Business Positions — schedule attached
❑ Schedule D - Income — Gifts — schedule attached
❑ Schedule E - Income — Gifts — Travel Payments — schedule attached
STATE ZIP CODE
LA t/iN7A CA- "22S'
.TcaESi�
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 IsyeC and correct.
Date Signed — �
ln_llg' -
h, day, year)
vAtr your filing official.)
J FPPC Form 700(2017/2018)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov
SCHEDULE A-2
Investments, Income, and Assets
of Business Entities/Trusts
(Ownership Interest is 10% or Greater)
J, 1. BUSINESS ENTITY OR TRUST
Z-L_
Name
3 0 OCLO, -e L) 9W 5-vv'C DAB
Address (Business Address ceptable)
Check one
❑ Trust, go to 2 C&Business Entity, complete the box, then go to 2
GENERAL DESCRIPTION OF THIS BUSINESS
-ry SkID ij t fit} D i/C r'l
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
❑ s0 - $1,999
❑ $2,000 - $10.000 -2! f / 17
❑ $10.001 - $100,000 ACQUIRED DISPOSED
❑ $100,001 - $1,000,000
ED.Q*er $1,000,000
NATURE OF INVESTM
❑ Partnership ale Proprietorship ❑
Cher
YOUR BUSINESS POSITION 06We?p-
■ • • ■ ■ • •
SHARE
OF •SS INCOME TO THE ENTITY/TRUST)
$0 - $499 0 $10,001 - $100,000
El $500 - $1,000 ❑ OVER $100,000
❑ $1,001 - $10,000
ll� 3. LIST THE NAME OF •RTABLE SINGLE SOURCE OF
INCOMEOF $10,000 OR •
e or ❑ Names listed below
■ INTERESTS IN REAL PROPERTY■ OR
LEASED BY OR
Check one box:
INVESTMENT ❑ REAL PROPERTY
Giflosr LLc
Name of Business Entity, if Investment, or
Assessor's Parcel Number or Street Address of Real Property
CWy ,IV62 f P-t4Kr9-fW 5?X florS
Description of Business Activity or
City or Other Precise Location of Real Property
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
$2,000 - $10.000 q
$10,001 - $100,000 UI 14; __j_/ 17
❑ $100,001 - $1,000.000 ACQUIRED DISPOSED
P-6er $1,000,000
NATURE OF INTEREST
❑ Property Ownership/Deed of Trust ❑ Stock ❑ Partnership
❑ Leasehold ❑ Other
Yrs.remaining
❑ Check box if additional schedules reporting investments or real property
are attached
Comments:
CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
ll� 1. BUSINESS ENTITY OR TRUST
Name
Address (Business Address Acceptable)
Check one
❑ Trust, go to 2 ❑ Business Entity, complete the box, then go to 2
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
$0 - $1,999
$2,000 - $10,000 --j --- J17 --J--J17
❑ $10,001 - $100,000 ACQUIRED DISPOSED
❑ $100,001 - $1,000,000
❑ Over $1,000,000
NATURE OF INVESTMENT
❑ Partnership ❑ Sole Proprietorship ❑
Other
YOUR BUSINESS POSITION
IDENTIFY• • ■ (INCLUDE YOUR• RATA
SHARE OF •SS INCOME TO THE ENTITY[TRUST)
❑ $0 - $499 ❑ $10,001 - $100,000
❑ $500 - $1,000 ❑ OVER $100,000
❑ $1,001 - $10,000
No. 3. LIST THE NAME OF ••RTABLE SINGLE SOURCE OF
INCOMEOF rir OR •
❑ None or 71 Names listed below
■ INTERESTS IN REAL PROPERTY■ OR
LEASED BY THE BUSINESS ENTITY OR
Check one box:
❑ INVESTMENT ❑ REAL PROPERTY
Name of Business Entity, if Investment, or
Assessor's Parcel Number or Street Address of Real Property
Description of Business Activity or
City or Other Precise Location of Real Property
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
❑ $2,000 - $10,000
❑ $10,001 - $100,000 1 17 __j__j17
❑ $100,001 - $1,000,000 ACQUIRED DISPOSED
❑ Over $1,000,000
NATURE OF INTEREST
❑ Property Ownership/Deed of Trust ❑ Stock ❑ Partnership
❑ Leasehold ❑ Other
Yrs. remaining
❑ Check box if additional schedules reporting investments or real property
are attached
FPPC Form 700 (2017/2018) Sch. A-2
FPPC Advice Email: advice@fppc.ca.gov
FPPCToll-Free Helpline:866/275-3772 www.fppc.ca.gov
SCHEDULE C
Income, Loans, & Business
Positions
(Other than Gifts and Travel Payments)
NAME OF SOURCE OF INCOME
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ADDRESS (Business� Address Acceptable) y
30 +ur dl dvr 1l J r'ie �ci 3 /�:n /
BUSINESS ACTIVITY, IF ANY, OF SOURCE
-r✓ Swc)(,) P/Mo C/Cy0
YOUR BUSINESS POSITION
GROSS INCOME RECEIVED Q- Income - Business Position Only
❑ $500 - $1,000 ❑ $1,001 - $10,000
❑ $10,001 - $100.000 ❑ OVER $100.000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
❑ Salary ❑ Spouse's or registered domestic partner's income
(For self-employed use Schedule A-2.)
❑ Partnership (Less than 10% ownership. For 10% or greater use
Schedule A-2.)
❑ Sale of
❑ Loan repayment
❑ Commission or
(Real property, car, boat, etc)
❑ Rental Income, list each source of $10,000 or more
(Describe)
NAME OF SOURCE OF INCOME
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOUR BUSINESS POSITION
GROSS INCOME RECEIVED ❑ No Income - Business Position Only
❑ $500 - $1,000 ❑ $1,001 - $10,000
❑ $10.001 - $100,000 ❑ OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
❑ Salary ❑ Spouse's or registered domestic partner's income
(For self-employed use Schedule A-2.)
❑ Partnership (Less than 10% ownership. For 10% or greater use
Schedule A-2.)
❑ Sale of
❑ Loan repayment
❑ Commission or
(Real property, car, boat, etc)
❑ Rental Income, list each source of $10,000 or more
(Describe)
❑ Other I I ❑ Other
(Describe) (Describe)
ll� 2. LOANS RECEIVED OR OUTSTANDING DURING THE REPORTING PERIOD
* You are not required to report loans from commercial lending institutions, or any indebtedness created as part of a
retail installment or credit card transaction, made in the lender's regular course of business on terms available to
members of the public without regard to your official status. Personal loans and loans received not in a lender's
regular course of business must be disclosed as follows:
NAME OF LENDER'
AUUHLbb (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF LENDER
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500 - $1,000
❑ $1,00, - $10,000
❑ $10,001 - $10o,000
❑ OVER $100,000
Comments:
INTEREST RATE TERM (MonthslYears)
❑ None
SECURITY FOR LOAN
❑ None ❑ Personal residence
❑ Real Property
❑ Guarantor -
❑ Other
Street address
City
FPPC Form 700 (2017/2018) Sch. C
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline:866/275-3772 www.fppc.ca.gov