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700: Maysels - 2015 from 01/01 - 12/31CALIFORNIA FORM 700 FAIR POLITICAL PRACTICES COMMISSION A PUBLIC DOCUMENT Please type or print in ink. _ RECEIVED STATEMENT OF ECONOMIC INTERESfT YI;' ?ail; irltY;tPEived COVER PAGE 2016 FEB 29 PM 5: t47 NAME OF FILER (LAST) (FIRST) MAYSELS SUSANNA CITY OF VIIRDi) .l1N lr'. . , IFORNIA 1. Office, Agency, or Court Agency Name (Do not use acronyms) CITY OF LA QUINTA, CA Division, Board, Department, District, if applicable CITY CLERK'S OFFICE Your Position CITY CLERK ► If filing for multiple positions, list below or on an attachment. (Do not use acronyms) Agency: LA QUINTA OVERSIGHT BOARD Position APPOINTED BOARD MEMBER 2. Jurisdiction of Office (Check at least one box) ❑ State ❑ Judge or Court Commissioner (Statewide Jurisdiction) ❑ Multi -County ❑ County of © City of LA QUINTA, CA ❑ Other 3. Type of Statement (Check at least one box) © Annual: The period covered is January 1, 2015, through ❑ Leaving Office: Date Left December 31, 2015. (Check one) -or- The period covered is _/_/ , through December 31, 2015. ❑ Assuming Office: Date assumed —J_/ ❑ Candidate: Election year p The period covered is January 1, 2015, through the date of leaving office. -or- 0 The period covered is , 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 O- 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 Ef'None - No reportable Interests on any schedule 5. Verification MAILING ADDRESS STREET (Business or Agency Address Recommended - Public Document) 78495 CALLE TAMPICO CITY LA QUINTA STATE ZIP CODE CA 92253 DAYTIME TELEPHONE NUMBER E-MAIL ADDRESS ( 760 ) 777-7123 SMAYSELS@LA-QUINTA.ORG 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 Califomia that the foregoing is true and correct. Date Signed 02/29/2016 (month, day, year) Signature (File the originally signed statement with your filin' Ficial.) FPPC Form 700 (2015/2016) FPPC Advice Email: advice@fppc.ca.gov FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov SCHEDULE D Income — Gifts ► NAME OF SOURCE (Not an Acronym) LEAGUE OF CALIFORNIA CITIES ADDRESS (Business Address Acceptable) 1400 K STREET, SACRAMENTO, CA 95814 BUSINESS ACTIVITY, IF ANY, OF SOURCE ADVOCATE -LOBBYIST FOR CITIES DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S) 01/16/15 $ 28.88 LUNCH 04/10/15 $ 33.33 LUNCH $ —/—/ I. NAME OF SOURCE (Not an Acronym) ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF SOURCE DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S) '$ ______/_/ $ _/_/— $ ____/_/ I. NAME OF SOURCE (Not an Acronym) ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF SOURCE DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S) $ _/_/ $ —J____I— ____II $ CALIFORNIA FORM 700 FAIR POLITICAL PRACTICES COMMISSION Name MAYSELS, SUSAN M. I. NAME OF SOURCE (Not an Acronym) ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF SOURCE DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S) $ _/_/ $ _/_/ ► NAME OF SOURCE (Not an Acronym) ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF SOURCE DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S) $ —/— $ _/_/ $ —/_J ► NAME OF SOURCE (Not an Acronym) ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF SOURCE DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S) $ _/_/ $ _/_— _1_1 $ Comments' FPPC Form 700 (2015/2016) Sch. D FPPC Advice Email: advice@fppc.ca.gov FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov