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Home My WebLink About2016-07-29 Form 700 - KellyR"WipaW Rece,ved STATEMENT OF ECONOMIC INTERS" Y C L E R x 6 ME" ALM DESERT FA ' ' ' • tnIEAT COVER PAGE Please type or print in Ink. 2016 JUL 24 PH 4: 16 NAME OF FILER tM DLEi 9 0 �N-TN4 xxE MKRIE I. Office, Agency, or Court Agency Name (Do not use acronyms) C-4- j o � Palm )De Division, Board, rtment, District, if applicable Ci u CoUY►CiI erg Your Position CarnAtAo_`e- ► If filing for mulk`ple positions, list below or on an attachment (Do not use acronyms) Agency: 2. Jurisdiction of Office (check at least one box) ❑ State ❑ Multi -County N'City of PA m -D e 5 e rt Position- ❑ Judge or Court Commissimer Statewide Jurisdiction) ❑ County of ❑ Other 3. Type of Statement {Check at least one box) ❑ Annual: The period covered is January 1, 2015, through ❑ Leaving Office: Date Left _J^I December 31, 2015. (Check ona) -or- The period covered is _ I I through December 31, 2015. ❑ Assuming Office: Date assumed I O The period covered is January 1, 2015. through the date of .or. leaving office. O The period covered is _ I I through the date of leaving office. �j Candidate: Election year a.8 k and office sought, I 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 A-2 - Investments — schedule attached ❑ Schedule B - Real Property — schedule attached .or - El None - No reportable interests on any schedule 5. Verification Schedule C - Income, Loans, & Business Positions — schedule attached ❑ Schedule D - Income — Gift — schedule attached ❑ Schedule E - Income — Gifts — Travel Payments — schedule attached MAILING ADDRESS STREET MY STATE ZIP ODE (Business or Apmy Address Reo ymmded - ""k Dowwv Para `pe�er�- CR Q nivrruc rcr counuc ui nwco _ . _... . _ _ _ _ . 4",nn,L AV VI�CJO (' I have used all reasonable diligence in preparing this statement I have reviewed this statement Ad to the hest of herein and in any attached schedules is true and complete. I acknowledge this is a public document. I rtl d ce fy un or penalty of perjury under the laws of the State of Califomla that the foregoing 0true and correct Date Signed %W al q 0 Signature p m. dry, r�) g the information contained "W WO YMF RMa!5W) FPPC Form 7W 12015/2016) FPPC Advice Email: advlce@fppc.ca.gov FPPC Toll -Free Flelpline:866/275-3772 www.fppc.ca.gcv X SCHEDULE A-2 Investments, Income, and Assets of Business Entities/Trusts (Ownership Interest is 10% or Greater) I- I. BUSINESS ENTITY . TRUST - c irn Te5erj' Gol � Ve%ifure5 , LLC Name 3-S60 Ircin Igood s- . Pea,, Address (Business Address Acceptable) Check one 1 C ❑ Trust, go to 2 A(Business Entity, complete the box, then go to 2 GENERAL DESCRIPTION OF THIS BUSINESS h our ' oufl'cL i n Gel Glut) FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ so - $1,999 ❑ $2,000 - $10,000 ❑ $10,001 - 5100,000 ACQUIRED DISPOSED a $100,001 - $1,000,000 115��f Over $1,000,000 NATURE OF INVESTMENT �� ❑ Partnership ❑ Sale Proprietorship YOUR BUSINESS POSITION OVerSti C mi*ee -• • •7rX= '071M AIN 0rC) SHARE OF •SS INCOME TO THE ENTITYiTRUST) 50 - $499 0 $10,001 - $100,000 ❑ $SOo - S1,000 ❑ OVER $100,000 ❑ 51,001 - 510,000 ur ❑ Names listed below Check one box. ❑ INVESTMENT NrREAL PROPERTY S _ows Motor+ain C o 1�- Ck u b Name of Business Entity, 9 Investment, gs Assessor's Parcel Number or Street Address of Real Property %ol �- Coxw6e Description of Business Activity gt City or Other Precise Location of Real Properly FAIR MARKET VALUE ❑ $2 000 - $10,000 ❑ 510,001 - $100,000 ❑ 5100,001 - $1,000,000 Over $1,000,000 VATURE OF INTEREST Property Ownership/Deed of Trust IF APPLICABLE, LIST DATE. —j—.l? 5$ —j—iis ACQUIRED DISPOSED ❑ Leasehold ❑ Other Yrt remaining ❑ Stock ❑ Partners`°p ❑ Check box if additional schedules reporting investments or real property are attached Name CALIFORNIA FORM 700 FAIR POLITICAL PRACTICES CW.7M1SSIOrJ Address (Business Address Acceptable) Check one ❑ Trust, go to 2 0 Business Entity, complete the box, then go to 2 GENERAL DESCRIPTION OF THIS BUSINESS FAIR MARKET VALUE IF APPLICABLE, UST DATE ❑ so - $1,999 ❑ $2,000 - $10,000 ❑ $10,001 - SI00,000 ACQUIRED DISPOSED ❑ s10o,001 - s1,000,00u ❑ Over s1,000,000 NATURE OF INVESTMENT ❑ Partnership ❑ Sole Proprietorship ❑ YOUR BUSINESS POSITION ❑ s0 - s499 ❑ ss00 - s1,000 ❑ $1,001 - $10,000 None or ❑ $10.0011 - $100 000 ❑ OVER $100,000 listed below c:necx one box ❑ INVESTMENT ❑ REAL PROPERTY Name of Business Entity. if Investment, 9S Assessor's Parcel Number or Street Address of Real Property Description of Business Activity QI City or Other Precise Location of Real Property FAIR MARKET VALUE IF APPLICABLE, LIST DATE ❑ $2 000 - $10 000 ❑ S10 001 - $100,000 �J 15 J`� 115 ❑ S100,001 - $1,000 000 ACQUIRED DISPOSED ❑ Over $1,000,000 NATURE OF INTEREST ❑ Property Ownership/Deed of Trust ❑ Leasehold ❑ Other Yrs. remaining ❑ Stock ❑ Partnership ❑ Check box it additional schedules reporting investments or real property are attached Comments: MiA sob bT n , J iYl t v e bf LOQ FPPC Form 700 (2015/2026) 5ch. A-2 �1 FPPC Advice Email: advice@fppc.ca.gov t� o i r e d i n a 6 1 16 b D 5h tame b FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov p n A tJ i 1 6e In l eon er SCHEDULE C Income, Loans, & Business Positions (Other than Gifts and Travel Payments) NAME OF SOURCE OF INCOME Co PQ1 Gh Urch o� +Ae (awd AD15RESS (Business Address Acceptable) (— era �d� � . 1�a.G�a. Ave• � �erm�� , � A BUSINESS ACTIVITY, IF ANY, OF SOURCE ��=r C_ UVh q a5 3 YOUR BUSINESS PC 9C,5iz, IR eckor I Pri e 5� GROSS INCOME RECEIVED ❑ s50o - $1,000 ❑ sl,0ol - s1o,o00 N's1Q001 - s1o0,000 ❑ 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 prWeq. tar, boat. ere.) ❑ Loan repayment ❑ Commission or ❑ Rental Income• NV each source of S1Q0W or more (0esanbe) NAME OF SOURCE OF INCOME ADDRESS {Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF SOURCE YOUR BUSINESS POSITION GROSS INCOME RECEIVED ❑ $Soo - $1.000 ❑ s1.001 - $10,000 ❑ $70,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED E] Salary ❑ Spouse's or registered domestic partners income (For self-employed use Schedule A-2.) ❑ Partnership (Less than 10% ownership. For 10% or greater use Schedule A-2.) ] Sate of (Real property, tar, boat etc) ❑ Loan repayment ] Commission or ❑ Rental Income, list each sowte of S10,000 or more (Descibe) Other (Describe) ❑ Other (Describe) * You are not required to report loans from commercial lending institutions, or any indebtedness created as part of a retail installment or credit card transaction, made in the fender'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 ❑ 5500 - $1,00o ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100.000 Comments: INTEREST RATE TERM (Months)Years) 96 ❑ None SECURITY FOR LOAN ❑ None ❑ Personal residence ❑ Real Property Street aWress ❑ Guarantor ❑ Other City (Describe) FPPC Form 700 (2015/2016) Sch. C FPPC Advice Email: advice@fppc.ce.gov FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov