Bill Headley - Annual 2012Date Received
STATEMENT OF ECONOMIC INTERESTS 0 L'Se onty
PUBLIC DOCUMENT COVER PAGE PAR 2013
CG if CLERP C,'-,
Please type or print in ink. r - "
NAME OF FILER (LAST) (FIRST) (MIDDLE)
1 / t
1. Office, Agency, or Court
gengy Name
}1• OF ` �!
0
Division, Board, Department, District, if applic le Your Position
W
. If filing for multiple positions, list below or on an attachment.
Agency: Position:
2. Jurisdiction of Office (Check at least one box)
❑ State ❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ Multi- County ❑ County of
City of Ge ❑ Other
3. Type of Statement (Check at least one box)
4&X Annual: The period covered is January 1, 2012, through ❑ Leaving Office: Date Left _lam
December 31, 2012. (Check one)
-or-
The period covered is I I through
December 31, 2012.
❑ Assuming Office: Dale assumed I
❑ Candidate: Election year
0 The period covered is January 1, 2012, through the date of
leaving office.
Q The period covered is I through
the date of leaving office.
and office sought, if different than Part 1:
4. Schedule Summary
Check applicable schedules or "None." ► Total number of pages including this cover page: —
❑ Schedule A -1 - unrest ;iients — schedule attached ❑ Schedule C - lacnme, Loans, & Business Positions — schedule attached
❑ Schedule A -2 - Investmuni , - schedule attached Schedule D - Income — Gifts — schedule attached
❑ Schedule B - Real Property — schedule atlarhed ❑ Schedule E - Income — Gifts — Tiav ! Payments — schedule attached
,or"
El None - No reportable interests on any schedule
5. Verification
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Businesss rAgencyAddress Recommended - Public Document)_ ` — f
DAYTIME TELEPHONE NUMBER I E fAILODDRESS (OPTIONAL)
(4 - 0 2 A4 I F3tLL. .
I have used all reasonable diligence in preparing this statement. I have reviewed this statement and to the best of my knowdO the in ation 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.
02 1 A ft 1 �11111 ok wg� I&I Ao�l
Date Signed so Q W Signature •
(mont , day, year) (File the originally signed statement with your rq Of_llj
FPPC Form 700 (201212013)
1 HIC Advice Email: advice @rppc.ca.00v
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