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Tom Haglund - Annual 2011
STATEMENT OF ECONOMIC INTERESTS COVER PAGE Please type or print in ink. �' CLERKS NAME OF FILER (LAST) (FIRST) (MIDDLE) HAGLUND THOMAS JOHN 1. Office, Agency, or Court Agency Name City of Gilroy Division, Board, Department, District, if applicable Your Position City Administrator P. If filing for multiple positions, list below or on an attachment. Agency: South County Regional Wastewater Authority Position: SCRWA Manager 2. Jurisdiction of Office (Check at least one box) ❑ State ❑ Multi- County — © City of Gilroy ❑ Judge or Court Commissioner (Statewide Jurisdiction) n Cnuntv of ❑ Other 3. Type of Statement (Check at least one box) ❑x Annual: The period covered is January 1, 2011, through ❑ Leaving Office: Date Left I I December 31, 2011. (Check one) .or- The period covered is I I through December 31, 2011. ❑ Assuming Office: Date assumed I ❑ 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, 2011, through the date of leaving office. O The period covered is _ the date of leaving office. Office sought, if different than Part 1: through ► Total number of pages including this cover page: T ❑ 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) 7351 Rosanna Street Gilroy CA 95020 UAY I Wt I tLtFhUNt NUMbLK E -MAIL AUUKESS (UPI IUNAL) ( 408 ) 846 -0202 tom.haglund @ci.gilroy.ca.us I have used all reasonable diligence in preparing this statement. I have review herein and in any attached schedules is true and complete. I acknowledge tl I certify under penalty of perjury under the laws of the State of Californi Date Signed March 14, 2012 Signature (month, day year) ent and to the best of my knowledge the information contained document. UM4 is true and correct. (File the FPPC Form 700 (2011/2012) FPPC Toll -Free Helpline: 866 /275 -3772 www.fppc.ca.gov