700 Blakeley 2018STATEMENT OF ECONOMIC INTERESTS
COVER PAGE
Please type or print in ink. A PUBLIC DOCUMENT
NAME OF FILER (LAST) (FIRST)
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
Division, Board, Department, rict ' app' [ble
r Position
► If filing for multiple positions, list Wow 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)
Annual: The period covered is January 1, 2018, through
December 31, 2018.
.or -
The period covered is
December 31, 2018.
❑ Assuming Office: Date assumed _ _J
❑ Candidate: Date of Election
RECEIVED
Date Initial Filing Received
V , � t"ho
`J� r'
C CITY OF LA OUINTA
CITY CLERK DEPARTMENT
(MIDDLE)
7�/!'7�•ra/d v��•r�
❑ Judge or Court mmissioper (Statewide Jud fiction)
a
❑ ou
❑ Other
❑ Leaving Office: Date Left r_
(Check one circle.)
through O The period covered is January 1, 2018, through the date of
-or- leaving office.
O The period covered is 1 11 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
P19'C'hedule A-1 - Investments — schedule attached ❑tchedute C - Income, Loans, 8 Business Positions — schedule attached
❑ Schedule A-2 - Investments — schedule attached ❑ Schedule D - Income — Gifts — schedule attached
r
❑ Schedule B - Real Property — schedule attached ❑ Schedule E - Income — Gifts — Travel Payments — schedule attached
i
-or- ❑ None - No reportable interests on any schedule
5. Verification
MAILING ADDRESS STREET CITY
(Business or Agency Address Recommended - Public Document)
STATE ZIP
DAYTIME TELEPHONE NUMBER EMAIL ADDRESS
I have used all reasonable diligence in preparing this statement. I have reviewed this statement and to the best of my kno dge 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 fore oing is true and correct.
Date Signed 49 -a4' —Z / gSignature
[month, day, year) (File the originally signed paper sfaf ent with your filing 'I fi . i
FPPC Form 700(2018/2019)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov
Page - 5
SCHEDULE A-1
Investments
Stocks, Bonds, and Other Interests
(Ownership Interest is Less Than 10%)
Investments must be itemized.
Do not attach brokerage or financial statements.
► NAME OF B SINESS ENTITY
GENERAL DESCRIPTION OF THIS KLISINESS
FAIR MARKET VALUE
❑ $2,000 - $10,000 ❑ $10,001 - $100,000
❑ $100,001 - $1,000.000 ❑ Over $1,000,000
NATURE OF INVESTMENT
❑ Stock ❑ Other
(Describe)
❑ Partnership O Income Received of $0 - $499
O Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
1 1 18 18
ACQUIRED DISPOSED
► NAM OF BUSINESS ENTITY
GENER L DESCRIPTION OF THIS BUSINESS
J
FAIR MARKET VALUE
❑ $2,000 - $10,000
$10,001 - $100,000
❑ $100,001 - $1,000,000
❑ Over $1,000,000
NATURE OF INVESTMENT
❑ Stock ❑ Other
(Describe)
❑ Partnership O Income Received of $0 - $499
O Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
ACQUIRED DISPOSED
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE
❑ $2,000 - $10,000 ❑ $10,001 - $100,000
❑ $100,001 - $1,000,000 ❑ Over $1,000,000
NATURE OF INVESTMENT
❑ Stock ❑ Other
(Describe)
❑ Partnership O Income Received of $0 - $499
O Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
ACQUIRED DISPOSED
Comments:
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE
❑ $2,000 - $10,000 ❑ $10,001 - $100,000
❑ $100,001 - $1,000,000 ❑ Over $1,000,000
NATURE OF INVESTMENT
❑ Stock ❑ Other
(Describe)
❑ Partnership O Income Received of $0 - $499
O Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
ACQUIRED DISPOSED
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE
❑ $2,000 - $10,000 ❑ $10,001 - $100,000
❑ $100,001 - $1,000,000 ❑ Over $1,000,000
NATURE OF INVESTMENT
❑ Stock ❑ Other
(Describe)
❑ Partnership O Income Received of $0 - $499
O Income Received of $500 or More (Report on schedule C)
IF APPLICABLE, LIST DATE:
—J / 18
ACQUIRED DISPOSED
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE
❑ $2,000 - $10,000 ❑ $10,001 - $100,000
❑ $100,001 - $1,000,000 ❑ Over $1,000,000
NATURE OF INVESTMENT
❑ Stock ❑ Other
(Describe)
❑ Partnership O Income Received of $0 - $499
O Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
ACQUIRED DISPOSED
FPPC Form 700 (2018/2019)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov
Page - 7
SCHEDULE C
Income, Loans, & Business
Positions
(Other than Gifts and Travel Payments)
NAME OF SOURCE OF INCOME
ADDRESS (BosirMS Ad ss Acceptable)
oa-zo -- v s
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
(Real property, car, boat, etc.)
❑ Loan repayment
❑ Commission or ❑ Rental Income, list each source of $fo,000 or more
r
p
._yam
NAME OF SOURCE OF INCOME
ADDRESS (Businfss Adds Acceptable) (J
BUSINESS ACTIVITY, IF ANY, OF SOURCE
Q�'� ad"C,� gx mhz-
YOUR BUSINESS POSITION
GROSS INCOME RECEIVED ❑ No Income - Business Position Only
❑ $500 - $1,000 ❑ $1,001 - $10,000
K$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
(Real property, car, boat, etc)
❑ Loan repayment
❑ Commission or ❑ Rental Income, list each source of $10,000 or more
(Describe)
4c5t
(Describe)
1� 2. LOANS RECEIVED OR OUTSTANDING DURING THE REPORTING PERIOD
* You are not required to report loans from a commercial lending institution, or any indebtedness created as part 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
regular course of business must be disclosed as follows:
NAME OF LENDER*
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF LENDER
INTEREST RATE TERM (Months/Years)
% ❑ None
SECURITY FOR LOAN
❑ None ❑ Personal residence
❑ Real Property
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500 - $1,000
❑ $1,001 - $1o,0oo
❑ $10,001 - $1o0,000 ❑ Guarantor
❑ OVER $100,000 ❑ Other —
Comments:
Street address
city
(Describe)
FPPC Form 700(2019/2019)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov
Page - 23