Form 700 HR Green Pacific Inc 2018 (York)CALIFORNIA _ STATEMENT OF ECONOMIC INTERESTS Date Initial Filing Received
Orflclal Use Only
POLITICALFAIR
COVER PAGE
Please type or print In Ink.
A PUBLIC DOCUMENT
NAME OF FILER (LAST)
(FIRST) (MIDDLE)
YORK
TINA MARIE
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
CITY OF LA QUINTA
Division, Board, Department, District, if applicable
Your Position
ENGINEERING DEPARTMENT
DEVELOPMENT SERVICES MANAGER
► 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 or Court Commissioner (Statewide Jurisdiction)
❑ Multi -County
❑ County of
❑x City of LA QUINTA
❑ Other _
3. Type of Statement (check at least one box)
❑x Annual: The period covered is January 1, 2018, through ❑ Leaving Office: Date Left ----J----J
December 31, 2018.
(Check one circle.)
-or-
The period covered Is 1— I
through O The period covered is January 1, 2018, through the date of
December 31, 2018.
-or- leaving office.
❑ Assuming Office: Date assumed 1
O The period covered is I I through
the date of leaving office.
❑ Candidate: Date of Election
and office sought, if different than Part 1:
4. Schedule Summary (must complete) o. 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- ❑ None - No reportable interests on any schedule
❑X Schedule C - Income, Loans, & Business Positions - schedule attached
❑ Schedule D - Income - Gifts - schedule attached
❑ Schedule E - Income - Gifts - Travel Payments - schedule attached
5. Verification
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business or Agency Address Recommended - Public Document)
78495 CALLE TAMPICO LA QUINTA CA 92253
DAYTIME TELEPHONE NUMBER EMAILADDRESS
( 760 ) 777-7000
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 7/1/11 /19 Signature ' i AIIC].
(month, day, year) (file the odglnelly sipnadpspa enl W*h yourzo a
FPPC Form 700 (201812019)
Advice Email: advice@fppc.ca,gov
FPPC Tall -Free Helpllne: 866/275-3772 www.fppc.ca.gov
Page-5
SCHEDULE C
Income, Loans, & Business
Positions
(Other than Gifts and Travel Payments)
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 REVIEW GROUP LEADER
GROSS INCOME RECEIVED ❑ No Income - Business Position Only
❑ $500 - $1,000 ❑ $1,001 - $10,000
❑ $10.001 - $100,000 0 OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
❑X 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
rrtuer properly, car, Doer, ercr
❑ Loan repayment
❑ Commission or ❑ Rental Income, Ilst each source of $10,000 or more
(Describe)
❑ Other
Name
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 salt -employed use Schedule A-2.)
❑ Partnership (Less than 10% ownership, For 10% or greater use
Schedule A-2.)
❑ Sale of
(Reel property, car, boat, ofa)
❑ Loan repayment
❑ Commission or ❑ Rental Income, list each source of $10,000 or more
❑ Other
(Describe)
(Describe) I I (Describe)
0- 2. LOANS RECEIVED OR OUTSTANDING DURING THE REPORTINGOD
* 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
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500 - $1,000
❑ $1,001 - $10.000
❑ $10-00, - $1o0,o00
❑ OVER $100,000
Comments: _
INTEREST RATE TERM (Months/Years)
% ❑ None
SECURITY FOR LOAN
❑ None ❑ Personal residence
❑ Real Property
❑ Guarantor
❑ Other
Street address
City
(Describe)
FPPC Form 700(2018/2019)
FPPC Advice Email: advice@fppc.ca.gav
FPPC Toll -Free Helpllne: 866/275-3772 www.fppc.ca.gov
Page -13