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Form 700 ClearSource Financial 2019 (T. Madsen)CALIFORNIA _ STATEMENT OF ECONOMIC INTERESTS RECEWED Date Initial Filing Received Filing Official Use Only POLITICALFAIR COVER PAGE JUN 1 1 2020 Please type or print in ink. A PUBLIC DOCUMENT CITY OF LA QUINTA NAME OF FILER (LAST) (FIRST) Madsen Terrance Michael 1. Office, Agency, or Court Agency Name (Do not use acronyms) ClearSource Financial Consulting Division, Board, Department, District, if applicable Your Position President ► If filing for multiple positions, list below or on an attachment. (Do not use acronyms) Agency: Position: 2. Jurisdiction of Office (Check at least one box) ❑ State ❑ Judge, Retired Judge, Pro Tern Judge, or Court Commissioner (Statewide Jurisdiction) ❑ Multi -County ❑ County of ❑ City of © Other Independent Contractor to City of La Quinta 3. Type of Statement (Check at least one box) ❑X Annual: The period covered is January 1, 2019, through ❑ Leaving Office: Date Left 1. December 31, 2019. (Check one circle.) -or- The period covered is . , through O The period covered is January 1, 2019, through the date of December 31, 2019. leaving office. -or- ❑ Assuming Office: Date assumed 1 O The period covered is through the date of leaving office. ❑ Candidate: Date of Election 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 ❑ 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- © None - No reportable interests on arty schedule 5. Verification MAILING ADDRESS STREET (Business or Agency Address Recommended - Public Document) CITY STATE ZIP CODE 7960 B Soquel Drive #363 Aptos CA 95003 DAYTIME TELEPHONE NUMBER )288-0608 FEMAILDDRESS831 en@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 ��'t Z9 �'� s.o Signature �' 1 (month, day, year) (File th onglnaNy signed papersfatement with your filing official) FPPC Form 700 - Cover Page (2019/2020) advice@fppc.ca.gov - 866-275-3772 - www.fppc.ca.gov Page - 5 STATEMENT OF ECONOMIC INTERESTS Date Initial Filing Received O imal Ilse only COVER PAGE Please type or print in ink. A PUBLIC DOCUMENT NAME of FILER (LAST) (FIRST) (MIDDLE) Madsen 1. Office, Agency, or Court Agency (Jame (Do not use acronyms) ClearSource Financial Consulting Division, Board, Department, District, if applicable Terence Your Position President ► If filing for multiple positions, list below or on an attachment. (Do not use acronyms) Agency: Position: 2. Jurisdiction of Office (Check at least one box) ❑ State ❑ Multi -County ❑ City of 3. Type of Statement (check at least one box) ❑x Annual: The period covered is January 1, 2018, through December 31, 2018. .or - The period covered is l— I through December 31, 2018. ❑ Assuming Office: Date assumed ❑ Candidate: Date of Election Michael ❑ Judge or Court Commissioner (Statewide Jurisdiction) ❑ County of ❑x Other Consultant to City of La Quinta ❑ Leaving Office: Date Left (Check one circle.) O The period covered is January 1, 2018, through the date of -or- leaving office. O The period covered is f through the date of leaving office. and office sought, if different than Part 1: 4. Schedule Summary (must complete) P. 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 -or- ❑x 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) 7960 B Soquel Drive, #363 Aptos CA 95003 DAY I IME I ELEh HONE NUMBEK EMAIL ADDRESS ( 831 ) 288-0608 �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 February 12, 2019 Signature (month, day, year) (File th4 alginaliySigned paper statement with your filing ofFcia! ) FPPC Form 700(2018/2019) FPPC Advice Email: advice@fppc.ca.gov FPPC Ton -Free Helpline: 866/275-3772 Ww Jppc.ca.gov Page - 5