Hensley Form700 2018.2019CALIFORNIA FORm7OO'STATEMENT OF ECONOMIC INTERESTS Date Initial Flling Received
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COMMISSIONFAIR POLITICAL PRACTICES COVER PAGE
Filed Date: 04/01 /2019 10:51 AM
Please type or print in ink. A PUBLIC DOCUMENT SAN: FPPC
NAME OF FILER (LAST) (FIRST)
Hensley Mark
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
City of Monterey Park
Division, Board, Department, District, if applicable
(MIDDLE)
D
Your Position
Citv Attornev
► If filing for multiple positions, list below or on an attachment. (Do not use acronyms)
Agency: _SEE ATTACHED LIST
2. Jurisdiction of Office (Check at least one box)
❑ State
❑ Multi -County
❑x City of Monterey Park
Position:
❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ County of
❑ Other
3. Type of Statement (check at least one box)
❑x Annual: The period covered is January 1, 2018, through ❑ Leaving Office: Date Left
December 31, 2018. (Check one circle.)
-or-
The period covered is through O The period covered is January 1, 2018, through the date of
December 31, 2018. -or- leaving office.
❑ Assuming Office: Date assumed O The period covered is through
❑ Candidate: Date of Election
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: 5
Schedules attached
❑x Schedule A-1 - Investments — schedule attached
0 Schedule A-2 - Investments — schedule attached
❑ Schedule B - Real Property — schedule attached
-or- ❑ None - No reportable interests on any schedule
5. Verification
❑x Schedule C - Income, Loans, & Business Positions — schedule attached
❑ Schedule D - Income — Gifts — schedule attached
❑ Schedule E - Income — Gifts — Travel Payments — schedule attached
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business or Agency Address Recommended - Public Document)
2600 W Olive Ave Ste 500 Burbank CA 91505-4572
DAYTIME TELEPHONE NUMBER EMAIL ADDRESS
( 310 ) 488-0782 mhensley@hensleylawgroup.com
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 04/01/201910:51 AM
(month, day, year)
Signature
Electronic Submission
(File the originally signed paper statement with your filing official.)
FPPC Form 700(2018/2019)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov
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STATEMENT OF ECONOMIC INTERESTS
COVER PAGE ATTACHMENTF Name
Mark Henslev
EXPANDED STATEMENT LIST
SCHEDULE A-1
Investments
Stocks, Bonds, and Other Interests
(Ownership Interest is Less Than 10%)
Investments must be itemized.
nn not attach hrnkPranA nr finanrial statements_
► NAME OF BUSINESS ENTITY
KPMG Accounting Firm
GENERAL DESCRIPTION OF THIS BUSINESS
Accounting Firm
FAIR MARKET VALUE
❑ $2,000 - $10,000 ❑ $10,00, - $100,000
Q $100,001 - $1,000,000 ❑ Over $1,000,000
NATURE OF INVESTMENT
❑ Stock ❑ Other
(Describe)
❑X Partnership 0 Income Received of $0 - $499
® Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
/ / 18 18
ACQUIRED DISPOSED
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE
❑ $2,000 - $10,000 ❑ $10,001 - $100,000
❑ $100-00, - $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:
I / 18 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 Q Income Received of $0 - $499
Q Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
/ / 18 18
ACQUIRED DISPOSED
Comments:
Name
Mark HPnslPv
► 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 0 Income Received of $0 - $499
Q Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
1 18 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 Q Income Received of $0 - $499
Q Income Received of $500 or More (Report on schedule C)
IF APPLICABLE, LIST DATE:
I—J 18 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 Q Income Received of $0 - $499
Q Income Received of $500 or More (Report on schedule C)
IF APPLICABLE, LIST DATE:
1 1 18 18
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
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SCHEDULE A-2
Investments, Income, and Assets
of Business Entities/Trusts
(Ownership Interest is 10% or Greater)
Hensley Law Group
Name
2600 W Olive Ave, Burbank CA 91505
Address (Business Address Acceptable)
Check one
❑ Trust, go to 2 ❑x Business Entity, complete the box, then go to 2
GENERAL DESCRIPTION OF THIS BUSINESS
Law Practice
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
❑ $0 - $1,999
❑ $2,000 - $10,000 18 if / 18
$10.001 - $100,000 ACQUIRED DISPOSED
$100.001 - $1,000.000
Over $1,000,000
NATURE OF INVESTMENT
❑ Partnership ❑X Sole Proprietorship ❑
Other
YOUR BUSINESS POSITION Owner
IDENTIFY• • • (INCLUDE YOUR•• RATA
SHARE OF ••SS INCOME TO THE ENTITY/TRUST)
$0 - $499 ❑ $10,001 - $100,000
$500 - $1,000 ❑X OVER $100,000
❑ $1,001 - $10,000
p- 3. LIST THE NAME OF •••TABLE SINGLE SOURCE OF
INCOMEOF $10,000 OR MORE
❑X None or ❑ Names listed below
Pi 4. INVESTMENTS • INTERESTS IN REAL PROPERTY• OR
LEASED BY THE BUSINESS ENTITY OR
Check one box:
❑ INVESTMENT ❑ REAL PROPERTY
Name of Business Entity, if Investment, or
Assessor's Parcel Number or Street Address of Real Property
Description of Business Activity or
City or Other Precise Location of Real Property
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
❑ $2,000 - $10,000
❑ $10,001 - $100,000 18 1. 18
❑ $100,001 - $1,000,000 ACQUIRED DISPOSED
❑ Over $1,000,000
NATURE OF INTEREST
❑ Property Ownership/Deed of Trust ❑ Stock ❑ Partnership
❑ Leasehold ❑ Other
Yrs. remaining
❑ Check box if additional schedules reporting investments or real property
are attached
CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
Name
Mark Hensley
li� 1. BUSINESS ENTITY OR TRUST
Name
Address (Business Address Acceptable)
Check one
❑ Trust, go to 2 ❑ Business Entity, complete the box, then go to 2
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
❑ $0 - $1,999
❑ $2,000 - $10,000 _/_/ 18 if / 18
❑ $10,001 - $100,000 ACQUIRED DISPOSED
❑ $100,001 - $1,000,000
Over $1.000,000
NATURE OF INVESTMENT
❑ Partnership ❑ Sole Proprietorship ❑
Other
YOUR BUSINESS POSITION
2. IDEATIFf
SHARE OF •SS INCOME TO THE ENTITY/TRUST)
❑ $0 - $499 ❑ $10,001 - $100.000
❑ $500 - $1,000 ❑ OVER $100,000
❑ $1,001 - $10,000
0- 3. LIST THE NAME OF •••TABLE SINGLE SOURCE OF
INCOME OF $10,000 OR MORE (Attach a separate sheet if necessary.)
❑ None or C3 Names listed below
• INTERESTS IN REAL PROPERTY• OR
LEASED BY THE BUSINESS ENTITY OR
Check one box:
❑ INVESTMENT ❑ REAL PROPERTY
Name of Business Entity, if Investment, or
Assessor's Parcel Number or Street Address of Real Property
Description of Business Activity or
City or Other Precise Location of Real Property
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
❑ $2,000 - $10,000
❑ $10,001 - $100,000 �� 18 �� 18
❑ $100,001 - $1.000,000 ACQUIRED DISPOSED
❑ Over $1,000,000
NATURE OF INTEREST
❑ Property Ownership/Deed of Trust ❑ Stock ❑ Partnership
❑ Leasehold ❑ Other
Yrs. remaining
❑ Check box if additional schedules reporting investments or real property
are attached
Comments:
FPPC Form 700(2018/2019)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov
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SCHEDULE C
Income, Loans, & Business
Positions
(Other than Gifts and Travel Payments)
NAME OF SOURCE OF INCOME
KPMG Accounting Firm
ADDRESS (Business Address Acceptable)
355 S. Grand Ave, Los Angeles
BUSINESS ACTIVITY, IF ANY, OF SOURCE
Accounting Firm
YOUR BUSINESS POSITION
Partnership (spouse's business)
GROSS INCOME RECEIVED ❑ No Income - Business Position Only
❑ $500 - $1,000 ❑ $1,001 - $10,000
❑ $10,001 - $100,000 ❑X 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.)
RI Partnership (Less than 10% ownership. For 10% or greater use
Schedule A-2.)
❑ Sale of
❑ Loan repayment
(Real property, car, boat, etc.)
❑ Commission or ❑ Rental Income, list each source of $10,000 or more
(Describe)
Name
Mark Hensley
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
❑ Loan repayment
(Real property, car, boat, etc)
❑ Commission or ❑ Rental Income, list each source of $10,000 or more
(Describe)
❑ Other (Describe) I I ❑ Other
(Describe)
PP. 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(2018/2019)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov
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