Scot Smithee - Annual 2012Please type or print in ink.
Smithee
1. Office, Agency, or Court
STATEMENT OF ECONOMIC INTERESTS
Scot
COVER PAGE
(FIRST)
Agency Name
City of Gilroy
Division, Board, Department, District, if applicable Your Positi
Police Department Captain
► If filing for multiple positions, list below or on an attachment.
Agency:
2. Jurisdiction of Office (Check at least one box)
Position:
12
.Date Received
orrio,Use Only,
APR 2013
G937 CLERKS let-
❑ State ❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ Mulfi- County ❑ County of
❑✓ City of Gilroy ❑ Other —
3. Type of Statement (Check at least one box)
Q Annual: The period covered is January 1, 2012, through ❑ Leaving Office: Date Left --- J__J
December 31, 2012. (Check one)
-or.
The period covered is through O The period covered is January 1, 2012, through the date of
December 31, 2012. leaving office.
❑ Assuming Office: Date assumed __J__J O The period covered is ___J__J , through
the date of leaving office.
❑ Candidate: Election year 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 - 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-
F4 None - No reportable interests on any schedule
5. Verification
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business or Agency Address Recommended - Public Document)
7301 Hanna Street Gilroy CA 95020
DAYTIME TELEPHONE NUMBER E -MAIL ADDRESS (OPTIONAL)
( 408 ) 846 -0310 scot.smithee @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 foregoing is true and correct.
Date Signed 04/02/2013 Signature O
(month, day, year) a onginallysigned statement w lh yourkling official.)
FPPC Form 700 (201212013)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov