Tom Haglund - Annual 2012STATEMENT OF ECONOMIC INTERESTS t
�A PUBLIC DOCUMENT COVER PAGE
Please type or print in ink, w T►
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
► If filing for multiple positions, list below or on an attachment.
Agency: Gilroy Community Development Agency Position: Executive Director
2. Jurisdiction of Office (Check at least one box)
❑ State ❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ Multi- County
❑ County of
Z 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 I I through
December 31, 2012.
❑ Leaving office: Date Left I I
(Check one)
O The period covered is January 1, 2012, through the date of
leaving office.
❑ Assuming Office: Date assumed I 1 O 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
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-
m 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
DAYTIME TELEPHONE NUMBER E -MAIL ADDRESS (OPTIONAL)
( 408 ) 846 -0202 tom.haglund @ci.gilroy.ca.us
I have used all reasonable diligence in preparing this statement. I have reviewed this statem nt and to the best of my knowledge the information contained
herein and in any attached schedules is true and complete. I acknowledge this is ublic doc ment.
I certify under penalty of perjury under the laws of the State of California th f is true and correct.
Date Signed 03/06/2013 Signature
(month, day, year) (File the originally siglKstatement with your riling official.)
FPPC Form 700 (2012/2013)
FPPC Advice Email: advice CZfppc.ca.gov
FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov