McCollum, Melissa - 2018-2019 FPPC Form 700STATEMENT OF ECONOMIC INTERESTS
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Official Use
POLITICALFAIR COVER PAGE
Please type or print in ink. A PUBLIC DOCUMENT
CITY CLERK'S OFFICE
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NAME OF FILER (LAST) (FIRST) (MIDDLE)
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1. Office, Agency, or Court
Agency Name (Do not use acronyms)
C I li of -EL T6uN 1�0
Division, Board, Department, District, if applicable Your Position
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P. If filing for multiple positions, list below or on an attachment. (Do not use acronyms)
Agency. S(pjTV1E4;1J CAUFvV/-IA Position: 1�Nt'��/Fj�JE CA4UMil"Icii Xl&kb4-
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2. Jurisdiction of Office (Check at least one box)
❑ State
❑ Multi -County
City of P- S%()1410
3. Type of Statement (Check at least one box)
Annual: The period covered is January 1, 2018, through
-or-
December 31, 2018.
The period covered is through
December 31, 2018.
❑ Assuming Office: Date assumed 1 1
❑ Candidate: Date of Election
❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ County of
❑ Other
❑ Leaving Office: Date Left '.
(Check one circle.)
O The period covered is January 1, 2018, through the date of
-or- leaving office.
O The period covered is —J 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
❑ Schedule A-1 - Investments - schedule attached
❑ Schedule A-2 - Investments - schedule attached
❑ Schedule B - Real Property- schedule attached
-or- N None - No reportable interests on any schedule
❑ 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 Sl REET CITY STATE ZIP CODE
(Business or Agency Address Recommended - Public Document)
I I I WFST MARIPOSA fl'1itNUE C S,�Cst,NAo t CA `i 0245
DAYTIME TELEPHONE NUMBER EMAIL ADDRESS
( 910 ) 524 - 2Z 30 "U,u CC01tU -4 ®CIz-GUN1So - cv-
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.
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Date Signed 11Ssj 7,0%q Signature 24
(month, day, year) (File the originally signed paper statement with your riling 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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