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HomeMy Public PortalAboutForm 700 (Economic Interest Statements, SEI) Ty Peabody 2022 ALIFORNIA FORM700 FAIR POLITICAL PRACTICES COMMISSION Please type or print in ink. STATEMENT OF ECONOMIC INTERESTS COVER PAGE A PUBLIC DOCUMENT Date Initial Filing Received Filing Ofticia' Use Only NAME OF FILER (LAST) 1. Office, Agency, or Court (FIRST) &-b (MIDDLE) Agency Name (Do not use acronyms) CITY OF INDIAN WELLS Division, Board, Department, District, if applicable Your Position CITY COUNCIL COUNCIL MEMBER ► If filing for multiple positions, list below or on an attachment. (Do not use acronyms) Agency. Position 2. Jurisdiction of Office (Check at least one box) State Multi -County *City of INDIAN WELLS 71 Judge, Retired Judge, Pro Tem Judge, or Court Commissioner (Statewide Jurisdiction) County of Other 3. Type of Statement (Check at least one box) Annual: The period covered is January 1, 2021, through December 31, 2021. -or- The period covered is _1_1 1 through December 31, 2021. Assuming Office: Date assumed E. Candidate: Date of Election 11 /08/2022 Leaving Office: Date Left (Check one circle.) — - The period covered is January 1, 2021, through the date of leaving office. -Or- The period covered is , 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 II- chedute A•1 • Investments - schedule attached chedule A-2 • Investments - schedule attached Schedule B • Real Property - schedule attached -or- ❑ None - No reportable interests on any schedule �hedule C - Income, Loans. & Business Positions - schedule attached Schedule D - Income - Gifts - schedule attached Pi Schedule E • Income - Gifts - Travel Payments - schedule attached 5. Verification MAILING ADDRESS STREET (Business or Agency Address Recommended - Public Document) CITY DAYTIME TELEPHONE NUMBER (. LA209S EMAIL ADDRESS STATE ZIP CODE 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 your filing official.) Print Clear FPPC Form 700 - Cover Page (2021/2022) advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov Page - 5 SCHEDULE A-2 Investments, Income, and Assets of Business EntitieslTrusts (Ownership Interest is 10% or Greater) 1.1. BUSINESS ENTITY OR TRUST P&R RESTAURANT ENTERPRISE/DON DIEGO Name 74969 HIGHWAY 111 INDIAN WELLS CA 92210 Address (Business Address Acceptable) Check one 0 Trust. go to 2 0 Business Entity, complete the box, then go to 2 GENERAL DESCRIPTION OF THIS BUSINESS FAIR MARKET VALUE IF APPLICABLE, LIST DATE: 0 20 - $1,999 ❑ $2,000 - $10,000 —J_/-19 —J_/-1_9_" © 210,001 - 2100,000 ACQUIRED DISPOSED • 2100.001 - 51,000,000 III Over 21,000,000 NATURE OF INVESTMENT SEE #3 • Partnership I. Sole Proprietorship © Other YOUR BUSINESS POSITION NOT APPLICABLE ► 2, IDENTIFY THE GROSS INCOME RECEIVED (INCLUDE YOUR PRO RAT SHARE OF THE GROSS INCOME To THE ENTITY/TRUST) $0 - $499 • 510,001 - 5100,000 2500 - S1,000 Ill OVER 5100,000 ❑ 51,001 - 510.400 P. 3. LEST THE NAME OF EACH REPORTABLE SINGLE SOURCE OF If4COME OF S10,000 OR MORE[eradtaLepatatcsheet itncccssar.) ll None or 1 Names fisted below Restaurant is the separate property of my spouse. I receive no income from the restaurant except for consulting services when provided. ► 4. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD OR LEASED BY THE BUSINESS ENTITY OR TRUST Chock one box: ill INVESTMENT Ill REAL PROPERTY Name of Business Entity, if Investment, g Assessor's Parcel Number or Street Addross of Real Property Description of Business Activity City or Other Precise Location FAIR MARKET VALUE IIII S2.000 - 210,000 or of Real Property IF APPLICABLE. LIST DATE: / / 1 9 19 • 210,001 - 2100.000 • 2100,001 - $1,000,000 r1 n„o, ci nnn nnn —_J—/ ACQUIRED DISPOSED NATURE OF INTEREST El Property Ownership/Deed of Trust Leasehold Yrs. remaining Check box if additional schedules reporting investments or real property are attached O Stock ❑ Partnership Other CALIFORNIA FORM 700 FAIR POLITICAL PRACTICES COLIMISSION Name EDWARD TY PEABODY 1. BUSINESS ENTITY OR TRUST Namo Address (Business Address Acceptable) Chock one 0 Trust, go to 2 0 Business Entity. complete the box, then go to 2 GENERAL DESCRIPTION OF THIS BUSINESS FAIR MARKET VALUE IF APPLICABLE, LIST DATE: 0 $0 - $1,999 ■ $2,000 - $10,000 _/ / 19 _J___La • Ill NATURE Ni 510.001 - 2100,000 ACQUIRED DISPOSED 2100.001 - $1,000,000 Over $1,000,000 OF INVESTMENT Partnership Sole Proprietorship O YOUR Other BUSINESS POSITION I. 2. IDENTIFY THE GROSS INCOME RECEIVED (INCLUDE YOUR PRO RAT' SHARE OF THE GROSS INCOME TO THE ENTITYITRUST) In 20 - $499 ❑ 510,001 - 5100,000 IN 5500 - S1,000 III OVER 5100.000 • $1,001 - 210.000 3. LIST THE NAME OF EACH REPORTABLE SINGLE SOURCE OF INCOME OF 510,000 OR MORE (Attach asepara:e sheet itrescssory.) • None or • Names listed below 4. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD OR LEASED BY THE BUSINESS ENTITY OR TRUST Check one box: 0 INVESTMENT • REAL PROPERTY Name of Business Entity, if tnvestmont, or Assessor's Parcel Number or Street Addross of Real Property Description of Business Activity 1 City or Other Precise Location of Real Property FAIR MARKET VALUE IF APPLICABLE, LIST DATE: III 52,000 - 210,000 ❑ 210,001 5100,000 / / 19 1 9 - ____/_� El 5100,001 - 21,000,000 ACQUIRED DISPOSED III Over 51,000,000 NATURE OF INTEREST 0 Property Ownership/Deed of Trust • Stork III Partnership Leasehold 0 Other 1.1 Yrs. remaining III Check box if additional schedules reporting investments or real property are attached Comments: FPPC Form 700 • Schedule A-2 (2019/2020) advice@fppc.ca.gov • 056-275-3772 • www.fppc.ca.gov Page -9 SCHEDULE B Interests in Real Property (Including Rental Income) P. ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS 76471 PALA PALMS DRIVE CITY INDIAN WELLS FAIR MARKET VALUE ❑ 52.000- 510.000 ❑ 510.001-5100.000 O 5100.001-51.000.000 ❑ Over 51,000.000 NATURE OF INTEREST ❑X Ownership/Deed aflTrust ❑ Leasehold Yrs. ❑ Other ( IF RENTAL PROPERTY. GROSS INCOME RECEIVED ❑ 50 - 5499 ❑ (5500 - 51.000 0 51.001 - 510.000 o 510.001 - 5100,000 ❑ OVER 5100.000 SOURCES OF RENT1L INCOME: If you own a 10% or greater interest. list the name of each tenant that Is a single source of income of 510,000 or more. IF APPLICABLE. LIST DATE: ACQUIRED DISPOSED 4s: f hS' ❑ Easement ❑ None cC CALIFORNIA FORM 700 FAIR POLITICAL PRAC7lCES COi1 iISSIQN Name EDWARD TY PEABODY P. ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS CITY FAIR MARKET VALUE ❑ 52.000 - S10.000 ❑ 510,001 - 5100,000 ❑ 5100,001 -51.000.000 ❑ Over 51,000,000 IF APPLICABLE, UST DATE: ACQUIRED DISPOSED NATURE OF INTEREST ❑ Ownership/Deed of Trust 0 Easement ❑ Leasehold 0 Yrs. remaining Other IF RENTAL PROPERTY, GROSS INCOME RECEIVED ❑ 5o - 5499 0 5500 - 51.000 0 51.001 -51%000 ❑ 510,001 - 5100.000 ❑ OVER 5100.000 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 510.000 or more. ❑ None * You are not requi[ed to report loans from a commercial lending institution 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' j ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY. 1t ANY. OF LENDER INTEREST RATE TERM (Months/Years) S6 0 None • HIGHEST BALANCE DURING REPORTING PERIOD 05500- 51.000 0 51.501 - 510,000 ❑ 510.001 - 5100.000 I. 0 OVER 5100.000 ❑ Guarantor, if applicable Comments: NAME OF LENDER' ADDRESS (Badness Address Acceptable) BUSINESS ACTIVITY. IF ANY. OF LENDER INTEREST RATE TERM (Months/Years) 96 0 None HIGHEST BALANCE DURING REPORTING PERIOD ❑ 3500 - 31.000 ❑ 510.001 - 5100.000 ❑ Guarantor. if applicable ❑ 51,001 - 510.000 0 OVER 5100,000 C L ...a +t ' C 1 '' kC-4 ht.) FPPC Form 700 -Schedule 8 (2019/2020) advice@fpne.ce.gov • 866.275.3772 • www.fppc.co.gov Page -11 NAME OF SOURCE OF INCOME EDWARD PEABO,DY ❑ asoo - 31.0ao ` ❑X $io.00i - 5100.000 SCHEDULE C Income, Loans, & Business Positions (Other than Gifts and Travel Payments) ADDRESS (Business Address Acceptable) 76471 PALA PALMS DRIVE, INDIAN WELLS 92210 BUSINESS ACTIVITY. IF ANY, OF SOURCE CONSULTING YOUR BUSINESS POSITION CONSULTANT GROSS INCOME RECEIVED 0 No Income - Business Position Ordy ❑ $1,001 - 510.000 ❑ OVER $100.000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary 0 Spouse's or registered domestic partner's become (For self-employed use Schedule A-2.) Q Partnership (Less than 10% ownership. For 10% or greater use Schedule A-2.) ❑ Sale of ❑ Loan repayment ❑ Commission or I (Reel propertyy, car boat, etc) t 0 Rental Income, list each source of 510.000 or roam (Describe) Q Other CONSULANT FEES (Describe) 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 tender's regular course of business must be disclosed as follows: NAME OF LENDER' INTEREST RATE TERM (Months/Years) ► 1. INCOME RECEIVED CALIFORNIA FORM 700 FAIR POLITICAL PRACTICES COf:7i,31S514t7 Name EDWARD TY PEABODY NAME OF SOURCE OF INCOME ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, OF SOURCE YOUR BUSINESS POSITION GROSS INCOME RECEIVED 0 No Income - Business Position Only D $500 - $1.000 0 stool - 510.000 ❑ sio.00i - 5100,000 ❑ OVER 5100.000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary 0 Spouse's or registered domestic partner's income (Far self-employed use Schedule A-2.) ❑ Partnership (Less than 10% ownership. For 10% sr greater use Schedule A-2.) ❑ Sate of ❑ Loan repayment 0 Commission or (Meal popeify cal; boat etc) ❑ Rental Income, fist each source 01510,000 or more (Desur0e) ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF A►NY. OF LENDER HIGHEST BALANCE DURING REPORTING PERIOD ❑ 5500 - 51.000 ❑ stool - 510.000 ❑ 510,001 • 5100.000 Q OVER 5100,000 Comments: 0 Other % ❑ None (Describe) SECURITY FOR LOAN 0 None 0 Personal residence 0 Real Property 0 Guarantor 0 Other Street address city (Describe) FPPC Form 700 - schedule C12019/20201 advlee®fppc.ca.gov • 866-275-3772 • www.ippc.ca.gov Page -13