700 Blakeley 2019STATEMENT OF ECONOMIC INTERESTS
COVER PAGE
Please type or print in ink. A PUBLIC DOCUMENT
NAME OF FILER �ST
1. Office, Agency, or Court
Agency Name (Do not use acronym
eL
Division, Board, Department, District,
1.4, 4,4-e.�
RECEIVED
Date Initial Filing ?deceived
C17Y i F LA QUINTAN
CITY CLERK:7EPARTMENT
(MIDDLE)
Your PQsi11'0n
► 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
❑ Multi -County
❑ City of
3. Type of Statement (Check at least one box)
XAnnual: The period covered is January 1, 2019, through
December 31, 2019.
.or -
The period covered is I i
December 31, 2019.
❑ Assuming Office: Date assumed i__i
❑ Candidate: Date of Election . -
Positiom
❑ Judge, Retired Judge, Pro Tern Judge, or Court Commissioner
(Statewide Jwisi ' n)
❑ County of
❑ Other
❑ Leaving Office: Date Left
(Check one circle.)
through O The period covered is January 1, 2019, through the date of
-or-
leaving office.
O The period covered is I I 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
XSchedule 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
5. Verification
Schedule C - Income, Loans, & Business Positions — schedule attached
❑ chedule D - Income — Gifts — schedule attached
❑ Schedule E - Income — Gifts — Travel Payments — schedule attached
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business or Agency Address
DAYTIME TELEP14ONE NUMBER EMA.I ,D RESS
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 f ofing is true and corn I.
Date Signed 3 -z/.-)_6 ' _ Signature
(rq&hday.year) (File the originally signed paper statement with your67i ria1.J
Clear Page � Print FPPCForm 700 -Cover Page(2019/2020)
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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 BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSI
FAIR MARKET VALUE
❑ $2,000 - $10,00.0 ❑ $10,00, - $1ou
❑ $100.001 - $1,000,000 ❑ Over $1,000,000
NATURE OF INVESTMENT
❑ Stock ❑ Other
(Describe)
❑ Partnership Q Income Received of $0 - $499
p Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
ACQUIRED DISPOSED
► NAME OF SINESS ENTITY
e
GENERAL DACRIPTION OF THIS BUSINESS
FAIR MARKET VALUE
❑ $2,000 - $10,000 .1<$10,001 - $100.000
❑ $100,001 - $1.000,000 ❑ Over $1,000,000
NATURE OF INVESTMENT
❑ Stock ❑ Other
(Describe)
❑ Partnership p Income Received of $0 - $499
p Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
1 1 19 / 19
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 p 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
p Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
1 1 19 19
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 Q Income Received of $0 - $499
Q Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
—� 1 19 19
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 p Income Received of $0 - $499
Q Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
1 1 19 19
ACQUIRED DISPOSED
FPPC Form 700 -Schedule A-1(2019/2020)
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Page - 7
SCHEDULE C
Income, Loans, & Business
Positions
(Other than Gifts and Travel Payments)
NAME OF SOURCE OF INCOME
ADDRESS (Business
BUSINESS ACTIVITY IF ANY, OF SOURCE
ex- �V
YOUR B SINESS POSITION
GROSS INCOME RECEIVED ❑ No Income - Business Position Only
❑ $500 - $1,000 ❑ $1,001 - $10,000
X$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
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 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)
❑ Other 4�2❑Other
(Describe) (Describe)
ll� 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
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500 - $1,000
❑ $1,001 - $10,000
❑ $10,001 - $100,000
❑ 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 - Schedule C (2019/2020)
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Page -13