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Drake Haglan & Associates - Annual 2012Date Received STATEMENT OF ECONOMIC INTERESTS Offlciai Use ONY FAIR POLITICAL PRACTICES COMMISSION „&,3 DOCUMENT A PUBLIC COVER PAGE V 5v,,." , Please type or print in ink. i-tl " � �K ^ � 'a NAME OF FILER (LAST) (FIRST) IDDLE) Haglan Dennis Mark 1. Office, Agency, or Court Agency Name City of Gilroy Division, Board, Department, District, if applicable Your Position Engineering Division Engineering Consultant P. 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 Gilroy ❑ Other 3. Type of Statement (Check at least one box) © Annual: The period covered is January 1, 2012, through December 31, 2012. -or- The period covered is through December 31, 2012. ❑ Assuming Office: Date assumed ❑ Candidate: Election year ❑ Leaving Office: Date Left --J---J (Check one) Q The period covered is January 1, 2012, through the date of leaving office. Q The period covered is — the date of leaving office. and office sought, if different than Part 1: through 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- None - No reportable interests on any schedule 5. Verification MAILING ADDRESS STREET CITY STATE ZIP CODE (Business or Agency Address Recommended - Public Document) Rancho Cordova CA 95670 NUMBER ( 916 ) 363 -4210 ADDRESS (OPTIONAL) dhaglan @drakehaglan.com 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 with your filing official.) FPPC Form 700 (2012/2013) FPPC Advice Email: advice @fppc.ca.gov FPPC Toll -Free Helpline: 866 /275 -3772 www.fppc.ca.gov