700 Fahrion (NV5, Inc) - 2019 from 01/01 to 12/31STATEMENT OF ECONOMIC INTERESTS Date Initial Filing Received
Filing Official Use Only
COVER PAGE
Please type or print in ink. A PUBLIC DOCUMENT
NAME OF FILER (LAST) (FIRST) (MIDDLE)
Fahrion Jay S
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
NV5,lnc.
Division, Board, Department, District, if applicable
Your Position
Consultant
► 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
Position:
❑ Judge, Retired Judge, Pro Tern Judge, or Court Commissioner
(Statewide Jurisdiction)
❑ Multi -County ❑ County of
❑ City of La Quinta ❑ Other
3. Type of Statement (Check at least one box)
❑X Annual: The period covered is January 1, 2019, through ❑ Leaving Office: Date Left �l
December 31, 2019. (Check one circle.)
-or-
The period covered is J— I through
December 31, 2019.
❑ Assuming Office: Date assumed __J__J
❑ Candidate: Date of Election
4. Schedule Summary (must complete)
Schedules attached
O The period covered is January 1, 2019, through the date of
-or- leaving office.
O The period covered is I through
the date of leaving office.
and office sought, if different than Part 1:._
► Total number of pages including this cover page:
❑ 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 - Public Document)
42-829 Cook Street
DAYTIME TELEPHONE NUMBER
( 760 ) 341-3101
❑ Schedule C - Income, Loans, & Business Positions — schedule attached
❑ Schedule D - Income — Gifts — schedule attached
❑ Schedule E - Income — Gifts — Travel Payments — schedule attached
CITY STATE ZIP CODE
Palm Desert Ca 92211
EMAIL ADDRESS
jay.fahrion@nv5.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 penalty of perjury under the laws of the State of California that th 6/01 /20foregoing is rue and correct.
'C
Date Signed — 5ignatur
(month, day, year) (File the originally signed paper statement 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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