700 Fitzpatrick - 2014 from 01/01 - 12./31Da FFN la fling
CALIFORNIA FORMI STATEMENT OF ECONOMIC INTERESTS Received
FAIR POLITICAL PRACTICES COMMISSION I MARO uM
DOCUMENTCOVER PAGE
CITY OF LA QUlNTA
Please type or print in ink. CM
NAME OF FILER
�'`� (LAST) (FIRST)
F1 2_ rl• 1l1 K_aAe. e
- N
1. Office, Agency, or dourt
Agency Name (Do not use acronyms)
Division, Board, Department, District, if appl' able
LA. tr -G
Your Position
o r-. rel t s s lone r
► If filing for multiple positions, list b ow or on an attachment. (Do not use acronyms)
Agency: Position:
2. Jurisdiction of Office (Check at least one box)
❑ State ❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ Multi -County ❑ County of
B City of La Quinta ❑ Other
3 Type of Statement (Check at least one box)
® Annual: The period covered is January 1, 2014, through ❑ Leaving Office: Date Left I I
December 31, 2014. (Check one)
-or-
The period covered is I through O The period covered is January 1, 2014, through the date of
December 31, 2014. leaving office.
❑ Assuming Office: Date assumed I 1 O The period covered is I through
the date of leaving office.
❑ Candidate: Election year and office sought, if different than Part 1:
Schedule Summary
1
Check applicable schedules or "None." ► Total number of pages including this cover page:
❑ Schedule A-1 Investments — schedule attached ❑ Schedule C - Income, Loans, & Business Positions — schedule attached
❑ Schedule A-2 - Investments — schedule attached ❑ Schedule D - Income — Gifts — schedule attached
❑ Schedule B - Real Property — schedule attached ❑ Schedule E - Income — Gifts — Travel Payments — schedule attached
-or-
® None - No reportable interests on any schedule
5. Verification 78-495 Calle Tampico, La Quinta CA 92253
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business or Agency Address Recommended - Public Document)
DAYTIME TELEPHONE NUMBER E-MAIL ADDRESS
( 760 ) 393-2919 carmelabungalow@gmail.com
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 penal perjury under the laws of the State of California that the'foregoing is true and correct.
Date Signed Signature ; ~
(month, day, year) (File the originally sin atement with your filing official.)
FPPC Form 700 (2014/2015)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov