700: Berumen - 2018 from 01/01 - 12/31STATEMENT OF ECONOMIC INTERESTS
COVER PAGE
Please type or print in ink. A PUBLIC DOCUMENT
RECEIVED
Initial Filing Received
NRR' t�sa W2019
CITY OF LA QUINTA
Y CLERK DEPARTMENT
NAME OF FILER (LAST) (FIRST) (MIDDLE)
Berumen Alfred Jason
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
City of La Quinta
Division, Board, Department, District, if applicable Your Position
Facilities Department Building Superintendent
► 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
❑R City of La Quinta
3. Type of Statement (Check at least one box)
❑R Annual: The period covered is January 1, 2018, through
December 31, 2018.
.or -
The period covered is through
December 31, 2018.
❑ Assuming Office: Date assumed `_ _ _ I
❑ Candidate: Date of Election
Position:
❑ Judge or Court Commissioner (Statewide Jurisdiction)
I —I Cniinty of
❑ Other
❑ Leaving Office: Date Left I I
(Check one circle.)
O The period covered is January 1, 2018, 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) ► 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- X 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)
78-495 Calle Tampico La Quinta Ca 92253
DAYTIME TELEPHONE NUMBER EMAILADDRESS
( 760 ) 777-7000 1 a5erumen@laquintaca.gov
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,Igo
correct.
Date Signed 4/1/2019 Signature
(month, day, year) File ha ( grn sgn paper sfalementwith your filing olfidal.)
FPPC Form 700(2018/2019)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov
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