700 Pacheco 2019STATEMENT OF ECONOMIC INTERESTS
COVER PAGE
Please type or Print in ink. A PUBLIC DOCUMENT
NAME ILER (LAST)
1. Office, Agency, or Court
Agency NameAo not use acronyms)
(FIRST)
Division, Board, Department, District, if applicable Your Position
m 9 C re>yy y-
► 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
ity of L—" >1 1 e�a___
Position:
RECEIVED
Date Initial Filing Received
F1hn
CITY OF LA QUINTA
CITYCLERrr DEPARTMENT
(MIDDLE)
❑ Judge, Retired Judge, Pro Tern Judge, or Court Commissioner
(Statewide Jurisdiction)
[Kounty of c114G
❑ Other
3. Ty Of Statement (Check at least one box)
Annual: The period covered is January 1, 2019, through ❑ Leaving Office: Date Left I
-or-
December 31, 2019. (Check one circle.)
The period covered is I I through O The period covered is January 1, 2019, through the date of
December 31, 2019, or -
leaving office.
-
❑ Assuming Office: Date assumed .1.O The period covered is through
the date of leaving office.
❑ Candidate: Date of Election and office sought, if different than Part 1.
'4. Schedule Summary (must complete) ► Total number of pages including this cover page:
I 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
Schedule C - Income, Loans, & Business Positions — schedule attached
❑ Schedule D - Income — Gifts — schedule attached
❑ Schedule E - Income — Gifts — Travel Payments — schedule attached
5. Verification
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business or Agency Address Recommended - Public Document) r1\
Ck 9-2-Z-5-2
DAYTIME TELEPHONE NUMBER " EMAII. ADDRESS
Ilk) ) _n -7 - a QQ •
diligence in preparing this statement. I have reviewed thi ement and to the best of my�ed�g�eetthe 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 is true and correct.
Date Signed _ 3 12DZ
(month, day, year)
Signature
4 died paper statement with your filing official.)
FPPC Form 700 - Cover Page (2019/2020)
advice@fppc.ca.gov - 866-275-3772 - www.fppc.ca.gov
Page - 5
SCHEDULE C
Income, Loans, & Business
Positions
(Other than Gifts and Travel Payments)
NAME OF SOURCE OF INCOME
ADDRESS (Business Address Acceptable
,513 40 C--C AG ��de W C&'—:
BUSINESS ACTIVITY. IF ANY, OF SOURCE
Sa-,1-i,�-;
YOUR BUSINESS POSITION
GROSS INCOME RECEIVED ❑ No Income - Business Position Only
❑ $500 - $1,0D0 ❑ $1,001 - $10,D00
P1110,001 - $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
(Real property, car, boat, etc)
❑ Loan repayment
❑ Commission or ❑ Rental Income, list each source of $10,000 or more
❑ Other
(Describe)
(Describe)
NAME OF SOURCE OF INCOME
�c{vse
ADb RRESS (Business Address Acceptable)
Lo C 6��
BUSINESS ACTIVITY, IF ANY, OF SOURCE A
sc-f1/
YOUR BUSIASS POS �
GROSS INCOME RECEIVED ❑ No Income - Business Position Only
❑ $50D - $1,000 ❑ $1,001 - $10,000
Q $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
(Real property, car, boat, etc)
❑ Loan repayment
❑ Commission or ❑ Rental Income, list each source of $10,000 or more
❑ Other
(Describe)
(Describe)
* You are not required to report loans from a commercial lending institution, 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'
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY. IF ANY. OF LENDER
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500 - $1,000
❑ $1.001 - $10.000
❑ $10,001 - $100,000
❑ OVER $100,000
Comments:
INTEREST RATE TERM (MonthsNears)
% ❑ None
SECURITY FOR LOAN
❑ None ❑ Personal residence
❑ Real Property
❑ Guarantor
❑ Other
Street address
City
(Describe)
FPPC Form 700 - Schedule C (2019/2020)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
Page -13