HomeMy WebLinkAbout2016-07-26 Form 700 -Tannerdi�rig Received
STATEMENT OF ECONOMIC INTEREqTl� RMT ft, ise Only
Y CLERK'S OFFICE
COVER PAGE PALM DESERT. CA
Please type or print in ink, 2016 JUL 26 a 1: -27
NAME OF FILER (LAS r) (FIRST) (MIDDLEI
TANNER VAN G
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
CITY OF PALM DESERT CITY COUNCIL
Division, Board, Department District, if applicable Your Position
RIVERSIDE CITY COUNCIL
io� If filing for multiple positions, list below or on an attachment. (Do not use acronyms)
Agency:
2. Judsdicflon of Office (Check at least one box)
Position:
[-] State El Judge or Court Commissioner (Statewide Jurisdiction)
El Multi -County
a6i'Iyof
3. Type of Statement (Check at least one box)
E] Annual: The period covered is January 1, 2015. through
December 31, 2015.
-or- The period covered is 06 1 30 1 2016 through
December 31, 2015.
F-1 Assuming Office: Date assumed I I
E] County of
El Other
El Leaving Office: Date Left
(Check one)
0 The period covered is January 1, 2015, through the date of
-or- leaving office.
0 The period covered is - I -- through
the dale of leaving office.
[a- i5andidate: Section year - 2016 and office sought, if different than Part 1:
4
4. Schedule Summary (must complete) o. Total number of pages including this cover page:
Schedules affached
Z Schedule A-1 - Investments - schedule attaiched
F1 Schedule A-2 - Investments - schedule attached
P9 Schedule B - Real Property - schedule allxhed
-or-
-[] None - No reportable interests on any schedule
5. Verification
3'9'r'hadule C - Income, Loans, & Business Positions - schedule attached
[] Schedule 0 - Income - Gifts - schedule attached
C:] Schedule E - Income - Gifts - Travel Payments - schedule attached
FAMUNG ADDRESS STREET CITY STATE ZIP co()E
(Busiriess; or Agemy Address Recommended - Pudic Dxwieni!)
PALM DESERT CA 92211
(
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
Date Signed 2-
Signature
(Month. diW yW (Re the WWn* SVned stalwxW Wh YW &V offical I
FPPC Form 700 (2015/2016)
FPPC Advice Email: adv1ce@fppcca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov
SCHEDULE A-1 CALIFORNIA FORm 700
Investments FAIR POLITICAL PRACTICES COMMISSION
Stocks, Bonds, and Other Interests Name
(Ownership Interest is Less Than 10%)
Do not attach brokerage or financial statements.
11� NAME OF BUSINESS ENTITY
DESERT EMPIRE INSURANCE
GENERAL DESCRIPTION OF THIS BUSINESS
GENERAL INSURANCE
FAIR MARKET VALUE
$2.000 - $10.000 $10.001 - $100,000
$100,001 - $1,000,000 Over $1,000,000
NATURE OF INVESTMENT
Stock F1 Other
(Descnbe)
Partnership 0 income Received of $0 - $499
0 Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE
1. t 16 t 15
ACQUIRED DISPOSED
P- NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE
F1 S2,000 - S10,000 $10,001 - $100.000
C] S100.001 - $1,00o.000 Over $1,000,000
NATURE OF INVESTMENT
Stock Other
(Describe)
Partnership 0 income Received of $0 - $499
0 Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE�
1. / 15 1. / 15
ACQUIRED DISPOSED
IN- 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 E] Over $1.000,000
NATURE OF INVESTMENT
EJ Stock F-1 Other
(Descnbe�
El Partnership 0 Income Received of $0 - 5499
0 Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
I /. 15 1. /. 15
ACQUIRED DISPOSED
Comments:
b.
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE
$2.000 - $10,000 $10.001 - sloo,000
$100,001 - $1,000,000 Over $1.000,000
NATURE OF INVESTMENT
Stock Other
(Describe)
Partnership 0 income Received of So - $499
0 Income Received of $500 or Mom (Report on Schedule C.
IF APPLICABLE. LIST DATE�
1. /A5-- 1. 1 16
ACQUIRED DISPOSED
b- NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE
$2.000 - $10.000 $10.001 - $100,000
$10o.ow - S1,0oo,000 Over $1,000.000
NATURE OF INVESTMENT
El Stock Other
(Desmbe�
Partnership 0 Income Received of $0 - $499
0 Income Received of $500 or Marc tReporr an Schedule C.
IF APPLICABLE, LIST DATE:
115 / 16
ACQUIRED DISPOSED
I,- NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE
52.000 - S10,000 $10.001 - sloo,00o
Sloo.001 - $1.000,000 Over $1,000,000
NATURE OF INVESTMENT
Stock Other
(Describe)
El Partnership 0 income Received of $0 - $499
0 Income Received of $500 or More (Report on Schedule C.:
IF APPLICABLE, LIST DATE:
1 1-1-5- 1. / 15
ACQUIRED DISPOSED
FPPC Form 700 (2015/2016) Sch. A-1
FPPC Advice Email: advice@fppc.ca.gov
FPPCToll-FreeHelpline:866/275-3772 wwwJppc-ca-gov
SCHEDULEB
Interests in Real Property
(including Rental Income)
10- ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS
CITY
PALM DESERT
FAIR MARKET VALUE
$2.000 - $10.000
$10.001 - sloo.000
$100,001 - $1,000.000
Over $1,000,000
NATURE OF INTEREST
0 Ownership/Deed of Trust
r-1 Leasehold
YrSL remaining
IF APPLICABLE, LIST DATE
1 1. 15 —j—j-L5-
ACQUIRED DISPOSED
E] Easement
11
Other
IF RENTAL PROPERTY. GROSS INCOME RECEIVED
[:] So - $499 C] $500 - $1,000 [] $1,001 - $10,000
Fj 310,001 - 5100,00o C-] OVER $100,000
SOURCES OF RENTAL INCOME If you own a 10% or greater
interest, list the name of each tenant that is a single source of
income of $10,000 or more
El None
li- ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS
CITY
FAIR MARKET VALUE
[-] $2.000 - $10.000
n $10,001 - $100,000
(-] $100,001 - $1,000.000
C] Over $1.000,000
NATURE OF INTEREST
Ownership/Dead of Trust
Leasehold
Yrs. remaining
IF APPLICABLE, LIST DATE
1. / 15 —j---j-L5-
ACQUIRED DISPOSED
[:] Easement
LE
r. ",
IF RENTAL PROPERTY, GROSS INCOME RECEIVED
EI$O-$499 El s5co - $1,000 [:] 51.001 - $10,000
El $10,001 - $100,wo [] OVER $100.000
SOURCES OF RENTAL INCOME If you own a 10% or greater
interest, list the name of each tenant that Is a single source of
income of $10,000 or more.
0 None
You are not required to report loans from commercial lending institutions 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* NAME OF LENDER*
ADDRESS (Business Addmss Acceptable) ADDRESS (Business Address Acceptable)
BUSINESS ArTIVITY, IF ANY, OF LENDER BUSINESS ACTIVITY, IF ANY, OF LENDER
INTEREST RATE TERM Manth"ars
—% n None
HIGHEST BALANCE DURING REPORTING PERIOD
[] $600 - $1,000 $1.001 - $10.00o
F1 $10,001 - $100.000 OVER $100,000
[-] Guarantor, W amicable
Comments:
INTEREST RATE TERM (Months/Years)
% [:] None
HIGHEST BALANCE DURING REPORTING PERIOD
0 $5DO - s-.,000 E] $1.001 - $10,000
Smoot - $100 00o Ej OVER sioo�000
Guarantor, if applicable
FPPC Form 700 (2015/2016) Sch. 6
FPPC Advice Email: advice@fppc.ca.gov
FPPCToll-FreeHelpline:866/275-3772 www.fppc.ca.gov
SCHEDULE C
Income, Loans, & Business
Positions
(Other than Gifts and Travel Payments)
NAME OF SOURCE OF INCOME
DESERT EMPIRE INSURANCE
ADDRESS (Business Address Acceptable)
77564 COUNTRY CLUB DR PALM DESERT 92211
BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOUR BUSINESS POSITION
RETIRED OWNER-25% OWNER
GROSS INCOME RECEIVED
$500 - $1.000 $1,001 - S10.000
$10,001 - S100,00 OVER S100.000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
Salary C] Spouse's or registered domestic partner's Income
(For self-employed use Schedule A-2.)
Partnership (Less than 10% ownership. For 10% at greater use
Schedule A-2.)
1771 q.i. �t BUSINESS INTEREST
(Rea) PfopeflY Caf. boal etc)
Loan repayment
rj Commission or rl Rental income, fist each source of S10.0w or more
(Describe)
Other
(Des -be)
NAME OF SOURCE OF INCOME
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY. IF ANY. OF SOURCE
YOUR BUSINESS POSITION
GROSS INCOME RECEIVED
$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 then 10% ownership, For 10% or greater use
Schedule A-2,)
R Sale of
(Resi property car, boat. etc)
Loan repayment
Commission or [] Rental Income. list eac4 source of Sio.00 or rnore
(Des -be)
n Other
IDescribe)
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 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
171 $600 - $1,000
$1,001 - $10,000
$10,001 - $100,000
OVER $100,000
Comments:
INTEREST RATE TERM (Months/Years)
_% n None
SECURITY FOR LOAN
[] None [] Personal residence
[:] Real Property Street address
[] Guarantor
F1 Other
023f
(Descobe)
FPPC Form 700 (20IS/2016) Sch. C
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpilne: 866/27S-3772 www.fppc.ca.gov