700 HR Green Pacific (York) 2021STATEMENT OF ECONOMIC INTEREST Dale rnG&IP I&,DR.,
COVER PAGE Filing Official 17; Only
APR 0 4 2022
A PUBLIC DOCUMENT
Please type or print in ink. L-F%'
CITY OF LA QUINTA
NAME OF FILER (LAST) (FIRST) (MIDDLE)e�l�� ��� nOTAAt�1T
YORK TINA MARIE
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
CITY OF LA QUINTA
Division, Board, Department, District, if applicable
ENGINEERING DEPARTMENT
Your Position
CIVIL PLAN CHECK DIVISION MANAGER
► 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
City of LA QUINTA
Position:
❑ Judge, Refired Judge, Pro Tern Judge, or Court Commissioner
(Statewide Jurisdiction)
❑ County of
❑ Other
3. Type of Statement (Check at least one box)
�5-1.I Annual: The period covered is January 1, 2021, through ❑ Leaving Office: Date Left I
December 31, 2021. (Check one circle.)
-or-
The period covered is I through
December 31, 2021.
❑ Assuming Office: Date assumed
❑ Candidate: Date of Election
❑ The period covered is January 1, 2021, through the date of
-or-
leaving office.
❑ The period covered is I 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: 2
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
5. Verification
Schedule C - Income, Loans, & Business Positions — schedule attached
Schedule D - Income — Gifts — schedule attached
❑ Schedule E - Income — Gifts — Travel Payments — schedule attached
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business or Agency Address Recommended - Public Document)
1260 CORONA POINTE COURT, STE 305 CORONA CA 92879
DAYTIME TELEPHONE NUMBER EMAIL ADDRESS
( 951 ) 255-3478 TYORK(L HRGREEN.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 the foregoing is true and correct.
Date Signed 3/23/2022
(month, day, year)
Signature
(
FPPC Form 700 -Cover Page (2022/2022)
advice@fppc.ca.gov - 866-275-3772 - www.fppc.ca.gov
Page - 5
SCHEDULE C CALIFORNIA FORM
Income, Loans, & Business '
Positions Name
(Other than Gifts and Travel Payments) TINA YORK
NAME OF SOURCE OF INCOME
HR GREEN PACIFIC, INC.
ADDRESS (Business Address Acceptable)
1260 Corona Pointe Ct, Ste 305/Corona, CA 92879
BUSINESS ACTIVITY, IF ANY, OF SOURCE
MUNICIPAL CONSULTING
YOUR BUSINESS POSITION
CIVIL PLAN REVEIW DIVISION MANAGER
GROSS INCOME RECEIVED ❑ No Income - Business Position Only
❑ $500 - $1,000 ❑ $1,001 - $10,000
7 $10,001 - $100,000 14 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
❑ Loan repayment
❑ Commission or
(Real property, car, boat, etc.)
❑ Rental Income, list each source of $10,000 or more
(Describe)
I I
NAME OF SOURCE OF INCOME
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOUR BUSINESS POSITION
GROSS INCOME RECEIVED ❑ No Income - Business Position Only
❑ $500 - $1,000 ❑ $1,001 - $10,000
❑ $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
❑ Loan repayment
❑ Commission or
(Real property, car, boat, etc.)
❑ Rental Income, list each source of $10,000 or more
(Describe)
• Other
(De .-
► 2- LOANS RECEIVED OR OUTSTANDING
* You are not required to report loans from a commercial lending institution, or any indebtedness created as pal 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
iogular course of business must be disclosed as follows:
NAME OF LENDER'
.A.DDRESS (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 (Months/Years)
% ❑ None
SECURITY FOR LOAN
❑ None ❑ Personal residence
❑ Real Property
Street address
❑ Guarantor
❑ Other
city
(Describe)
FPPC Form 700 -Schedule C (2021/2022)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
Page -13