700 Chapman 2022STATEMENT OF ECONOMIC INTERESTS Da�ey5jRli��iajved
COVER PAGE 1''L L� LJ
A PUBLIC DOCUMENT MAR 0 8 2023 4
Please type or print in ink.
NAME OF FILER (LAST) (FIRST) (MIDDLE) CITY CLERK DEPARTMENT
SHIWA
Chapman Capri Monique
1. Office, Agency, or Court
Agency Name To not use acronyms)
City of a Quinta
Division, Board, Department, District, if applicable
Housing Commission
Your Position
Commissioner
► 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
0 City of La Quinta [:]Other
3. Type of Statement (Check at least one box)
Annual: The period covered is January 1, 2022, through ❑ Leaving Office: Date Left —J I
December 31, 2022. (Check one circle.)
.or -
The period covered is
December 31, 2022.
❑ Assuming Office: Date assumed �.
❑ Candidate: Date of Election
Schedule Summary (required)
Schedules attached
through ❑ The period covered is January 1, 2022, through the date of
-or-
leaving office.
❑ The period covered is —J I through
the date of leaving office.
and office sought, if different than Part 1:
► Total number of pages including this cover page: i
❑ Schedule A-1 - Investments — schedule attached
❑ Schedule A-2 - Investments — schedule attached
❑ Schedule B - Real Property — schedule attached
-or- 7 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)
La Qunta CA 92253
UAY IIMt ItLkF 11UNt NUMtitR EMAIL ADDRESS
( 1
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 theAaregoing is true and correct.
Date Signed , g
month, day, year)
with your filing official.)
FPPC Form 700 -Cover Page (2022/2023)
advice@fppc.ca.gov - 866-275-3772 - www.fppc.ca.gov
Page - 5