700 ClearSource Financial (Madsen) 2021RECEIVED
STATEMENT OF ECONOMIC INTERESTS Date Initial Filing Received
• - • - 1 1 COVER PAGE APR.30t/-12022
A PUBLIC DOCUMENT CITY OF LA QUINTA
Please type or print in ink. DEPARLUEt
NAME OF FILER (LAST) (FIRST) (MIDDLE)
Madsen Terry Michael
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
ClearSource Financial Consulting
Division, Board, Department, District, if applicable Your Position
President
P. If fling for ioultiple positions, list below or on an attachment. (Do not use acronyms)
Agency:
2. Jurisdiction of Office (Check at least one box)
❑ State ❑ Judge, Retired Judge, Pro Tem Judge, or Court Commissioner
(Statewide Jurisdiction)
Multi -County ❑ County of
City of 19 Other Independent Contractor to City of La Quinta
3. Type of Statement (Check at least one box)
101 Annual: The period covered is January 1, 2021, through ❑ Leaving Office: Date Left I I
December 31. 2021. (Check one circle.)
.or -
The period covered is
December 31, 2021.
❑ Assuming Office: Date assumed I I
❑ Candidate: Date of Election
through
] The period covered is January 1, 2021, through the date of
leaving office.
.or-
] The period covered is I 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:
Schedules attached
❑ Schedule A-1 - Investments — schedule attached
❑ Schedule A-2 - Investments — schedule attached
❑ Schedule B - Real Property — schedule attached
❑ Schedule C - Income, Loans, &'Business Positions — schedule attached
❑ Schedule D - Income — Gifts — schedule attached
❑ Schedule E - Income — Gifts — Travel Payments — schedule attached
-or- J None - No reportable interests on any schedule
5. Verification
MAILING ADDRESS STREET
(Business or Agency Address Recommended - Public Document)
7960 B Soquel Drive, #363
DAYTIME TELEPHONE NUMBER
( 831 ) 288-0608
CITY
Aptos
CA 95003
EMAIL ADDRESS
tmadsen@clearsourcefinancial.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 5 tl 7,0VL Signature
official.)
FPPC Form 700 -Cover Page (2021/2022)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
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