Teresa Mack - Annual 2012Please type or print In Ink.
OF FILER
Mack
1. Office, Agency, or Court
MST)
STATEMENT OF ECONOMIC INTERESTS
COVER PAGE
Teresa
Agency Name
City of Gilroy
Division, Board, Department, District, if applicable Your Position
Public Works Division
► If filing for multiple positions, list below or on an attachment.
Senior Engineer (Development)
Agency: Position:
2. Jurisdiction of OM CS (Check at least one box)
❑ State
❑ Multi- County
m City of Gilroy
3. Type of Statement (check at least one box)
m Annual: The period covered is January 1, 2012, through
December 31, 2012.
-or-
The period covered is I I through
December 31, 2012.
❑ Assuming Office: Date assumed —J I
`Vbte ReccsW
Official Use Only
❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ County of
❑ Other
❑ Leaving Office: Date Left I I
(Check one)
0 The period covered is January 1, 2012, through the date of
leaving office.
0 The period covered is I I through
the date of leaving office.
❑ Candidate: Election year and office sought, if different than Part 1:
4. Schedule Summary
1
Check applicable schedules or "None." lip. Total number of pages including this cover page:
❑ Schedule A-1 - Investments - schedule attached ❑ Schedule C - Income, Loans, & Business Positions - schedule attached
❑ Schedule A -2 - Investments - schedule attached ❑ Schedule D - Income - Gifts - schedule attached
❑ Schedule B - Real Property - schedule attached ❑ Schedule E - Income - Gifts - Travel Payments - schedule attached
-or-
None - No reportable interests on any schedule
5. Verification
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Bustness or Agency Address Recommended - Public Document)
7351 Rosanna St Gilroy CA 95020
( 408 ) 486 -0255
teresa.mack@cityofgilroy.org
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
Date Signed 03/11/2013
(month, day, year)
FPPC Form 700 (2012/2013)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov