Teresa Mack - Annual 2011STATEMENT OF ECONOMIC INTERESTS
A PUBLIC �pR 2012
• • COVER PAGE ;i CLERKS C {�N
Please type or print in ink.
NAME OF FILER (LAST) (FIRST) (MIDDLE)
Mack Teresa
1. Office, Agency, or Court
Agency Name
City of Gilroy
Division, Board, Department, District, if applicable Your Position
Engineering Department Senior Civil Engineer
► If filing for multiple positions, list below or on an attachment.
Agency:
Position:
2. Jurisdiction of Office (Check at least one box)
❑ State ❑ Judge (Statewide Jurisdiction)
❑ Multi- County ❑ County of
❑X City of Gilroy ❑ Other
3. Type of Statement (Check at least one box)
Q Annual: The period covered is January 1, 2010, through December 31, ❑ Leaving Office: Date Left 1 1
2010. -or- (Check one)
The period covered is I I , through December 31, O The period covered is January 1, 2010, through the date of
2010, leaving office.
❑ Assuming Office: Date I 1� O The period covered is I , through the date
of leaving office.
❑ Candidate: Election Year
4. Schedule Summary
Check applicable schedules or "None."
❑ Schedule A -1 - Investments — schedule attached
❑ Schedule A -2 - Investments — schedule attached
❑ Schedule B - Real Property — schedule attached
Office sought, if different than Part 1:
► Total number of pages including this cover page: 1
❑ Schedule C - Income, Loans, & Business Positions — schedule attached
❑ Schedule D - Income — Gifts — schedule attached
❑ Schedule E - Income — Gifts — Travel Payments — schedule attached
.or-
0 None - No reportable interests on any schedule
5. Verification
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business or Agency Address Recommended - Public Document)
7351 Rosanna Street Gilroy CA. 95020
DAYTIME TELEPHONE NUMBER I E -MAIL ADDRESS
( 408 ) 846 -0255
teresa.mack@ci.gilroy.ca.us
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 foregoingis true and correct.
Date Signed March 23, 2012
(month, day, year)
Signature
(File the originally sign d state ent with your
FPPC Form 700 (2010/2011)
FPPC Toll -Free Helpline: 8661275 -3772 www.fppc.ca.gov