HomeMy WebLinkAboutKalina Robles
(Revised 03 26 19)
CITY OF PALM SPRINGS PUBLIC INTEGRITY DISCLOSURE
Why Must I File?
Your position requires you to file this Public Integrity Disclosure Form regarding potential conflicts
of interest you might have under Palm Springs Municipal Code Chapter 2.60. This form will assist
you in identifying and avoiding conflicts between official duties on the one hand, and other legal
duties you have, or conflicts arising from real property that you rent or lease on the other hand.
The information you provide will become a public record (with the exception of your home address,
which will be redacted). The completed form will be posted on the City’s website for all elected
officials. Some information required by this form may also be required in your Form 700. Please
ensure that the information you provide is complete and accurate.
When Must I File?
New Official: The report is due within 30 days of your assuming a position designated for filing,
unless the City requests the report earlier or grants you a filing extension.
Annual Filer: The report is due no later than the end of the first business day in April, unless the
City grants you an extension.
Update Filer: The report is due no later than 30 days after the end of a quarter when the reportable
change take place unless the City grants you an extension.
What is the Reporting Period?
New Official: Report the required information for the 12 months preceding your filing of this form.
Annual Filer: Report the required information for the preceding calendar year (January 1 –
December 31).
Update Filer: Report changes that took place during the prior quarter.
What if I Have Questions?
If you have any questions about how to complete this form, please contact:
City Clerk, (email: cityclerk@palmspringsca.gov)
PENALTIES
Falsification of information or failure to report information required to be reported
may subject you to administrative action by the City.
(Revised 03 26 19)
PUBLIC INTEGRITY DISCLOSURE REPORT
Name (Print last, first, middle initial) E-mail Address
Position/Title
Address
Work Phone Reporting Status
New Official
Annual
Update
If New Official, Date of Election or
Appointment:
(mm/dd/yy)
Reportable Information – Every official shall disclose each and all of his/her interests, wherein
he/she serves as a voting member of a board of directors of a non-profit entity without
compensation, as an attorney or accountant for such an entity who provides pro bono services,
or as the trustee of a charitable trust.
Organization:
(include the address, city and state where the the organization is located)
Type of organization: Position: No
longer
held:
1 Ƒ Voting Board Member
Ƒ Attorney
Ƒ Accountant
2 Ƒ Voting Board Member
Ƒ Attorney
Ƒ Accountant
3 Ƒ Voting Board Member
Ƒ Attorney
Ƒ Accountant
4 Ƒ Voting Board Member
Ƒ Attorney
Ƒ Accountant
5 Ƒ Voting Board Member
Ƒ Attorney
Ƒ Accountant
6 Ƒ Voting Board Member
Ƒ Attorney
Ƒ Accountant
Check here if additional pages attached.
(Revised 03 26 19)
Reportable Information – Every official shall disclose each and all of his/her rented or
leased interests in real property located in the City of Palm Springs. This disclosure shall
include leases executed with the Agua Caliente Band of Cahuilla Indians in relation to real
property that you own.
Property Address:
Type of Property: Term of Rental
Agreement/
Lease:
No
longer
held:
1 Ƒ Home/Residence
Ƒ Business/Commercial
Ƒ Investment/Other
2 Ƒ Home/Residence
Ƒ Business/Commercial
Ƒ Investment/Other
3 Ƒ Home/Residence
Ƒ Business/Commercial
Ƒ Investment/Other
4 Ƒ Home/Residence
Ƒ Business/Commercial
Ƒ Investment/Other
5 Ƒ Home/Residence
Ƒ Business/Commercial
Ƒ Investment/Other
6 Ƒ Home/Residence
Ƒ Business/Commercial
Ƒ Investment/Other
I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF
CALIFORNIA THAT THE FOREGOING IS TRUE AND CORRECT.
Signature of Disclosing Party Date
On the basis of information contained in this report, I conclude that the filer is in
compliance with Palm Springs Municipal Code Section 2.60, except as noted in the
“comments” box below.
Comments:
Signature and Title of Agency’s Final Reviewing Official
Check here if additional pages attached.