700 Nelson (RASA) - 2019 from 01/01 to 12/31STATEMENT OF ECONOMIC INTERESTS
RECEIVED
Date Initial Filin R ved
COVER PAGE
Please type or print in ink. A PUBLIC DOCUMENT
NAME OF FILET (LAST)
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
Division, Board, Department, District, if applicable
(FIRST)
z) G
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
0C,tP.4IL-
Position:
CITY OF LA pUINTA
CITY CLEHK DEPARTMENT
(MIDDLE)
A to t-]
❑ Judge, Retired Judge, Pro Tern Judge, or Court Commissioner
(Statewide Jurisdiction)
❑ County of
city of 1—,4 iQU I E-I-rA- ❑ Other
3. Type of Statement (check at least one box)
j�Annual: The period covered is January 1, 2019, through El Leaving Office: Date Left —J I
�/ -or-
December 31, 2019. (Check one circle.)
The period covered is
December 31, 2019.
❑ Assuming Office: Date assumed +
❑ Candidate: Date of Election
through O The period covered is January 1, 2019, through the date of
.or-
leaving office.
O The period covered is through
the date of leaving office.
and office sought, if different than Part 1
Schedule Summary (must complete) ► Total number of pages including this cover page:
Schedules attached
.or -
❑ Schedule A-1 - Investments — schedule attached
❑ Schedule A-2 - Investments — schedule attached
❑ Schedule B - Real Property — schedule attached
None - No reportable interests on any schedule
5. Wrification
MAILING ADDRESS STREET
(t3usina- or Agency Address Recommended -Public Document)
314 2A Nc_L,%o IfarL
DAYTIME TELEPHONE NUMBER
CITY
❑ Schedule C - Income, Loans, & Business Positions — schedule attached
❑ Schedule D - Income — Gifts — schedule attached
❑ Schedule E - Income — Gifts — Travel Payments — schedule attached
EMAIL ADDRESS
STATE ZIP CODE
I have used all reasonable diligence in preparing this statement. I have reviewed this statement and to the best of my
herein and in any attached schedules is true and complete. I acknowledge this is a public document.
y . C�® k'
the information contained
I certify under penalty of perjury under the laws of the State of California that the iqlagoing is true and
Date Signed 6 0Signature Y'_�G
{morr r, day, year) (File the originally signed paper s.a emenl with your filing official.)
FPPC Form 700 - Cover Page (2019/2020)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
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