Consolidated CM - Annual 2012CALIFORNIA •.
STATEMENT OF ECONOMIC INTERESTS �P zPCeive
FAIR POLITICAL PRACTICES COMMISSION
A PUBLIC F�4� 2a1
DOCUMENT COVER PAGE 3�
Please type or print in ink.
NAME OF FILER (LAST) (FIRST) (MIDDLE)
Johnson Dan
1. Office, Agency, or Court
Agency Name
City of Gilroy
Division, Board, Department, District, if applicable
Your Position
Engineering COYyy,t,�Library Project Manager
► If filing for multiple positions, list below or on an attachment.
Agency:
2. Jurisdiction of Office (Check at least one box)
❑ State
❑ Multi- County
❑ Cily of Gilt
Position:
❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ County of
❑ Other
3. Type of Statement (Check at least one box)
0 Annual: The period covered is January 1, 2012, through ❑ Leaving Office: Date Left
December 31, 2012. (Check one)
-or-
The period covered is through
December 31, 2012.
❑ Assuming Office: Date assumed
❑ 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
O The period covered is January 1, 2012, through the date of
leaving office.
O The period covered is —
the date of leaving office.
and office sought, if different than Part 1:
► Total number of pages including this cover page:
through
❑ Schedule C - Income, Loans, & Business Positions – schedule attached
❑ Schedule D - Income – Gifts – 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
(Business or Agency Address Recommended Public Document)
Gilroy CA 95020
( 408 ) 846 -0454
dan.johnson@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
/2013)
FPPC Advice Email: advice @fppc.ca.gov
FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov