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Jason Clark - Assuming Office 2013
STATEMENT OF ECONOMIC INTERESTS COVER PAGE Please type or print in ink. Date Received 06,1011 Only i CLERKLSujt <. 4; NAME OF FILER (LAST) (FIRST) (MIDDLE) Clark Jason Russell 1. Office, Agency, or Court Agency Name Gilroy General Plan Advisory Committee (GPAC) Cj L o Cj 1 ro Division, Board, Department, District, if applicable Your Position cl__� � Ac_ , 6 ;lI rn M 6Cv)ar,_( Ql y) "visors GPAC member J C�v�� i- ► If filing for multiple positions, list below or on an attachment. Agency: Position: 2. Jurisdiction of Office (Check at least one box) ❑ State ❑ Multi- County © City of Gilroy 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 —J I through December 31. 2012. © Assuming Office: Date assumed 08 / 06 / 2013 ❑ Candidate: Election year ❑ Judge or Court Commissioner (Statewide Jurisdiction) F-1 r niinfv of ❑ Other ❑ Leaving Office: Date Left I I (Check one) 0 The period covered is January 1, 2012, through the date of leaving office. p The period covered is —J I through the date of leaving office. 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- W] None - No reportable interests on any schedule 5. Verification MAILING ADDRESS STREET CITY (Business or Agency Address Recommended - Public Document) 1670 El Dorado Drive Gilroy DAYTIME TELEPHONE NUMBER E -MAIL ADDRESS ( 408 ) 842 -9911 STATE ZIP CODE CA 95020 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 fore ng true and correct. Date Signed 10/01/2013 (month, day, year) Signatu with your rilinq official.) FPPC Form 700 (2012/2013) FPPC Advice Email: advice @fppc.ca.gov FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov