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Henry Servin - Annual 2014
Ang • " • ' STATEMENT OF ECONOMIC INTERESTS Date i DOCUMENT FAIR POLITICAL PRACTICES COMMISSION A PUBLIC COVER PAGE /�n,,�`J��6 2015 Please type or print in ink. C" -U SQ NAME OF FILER (LAST) (FIRST) E) Servin Henry 1. Office, Agency, or Court Agency Name (Do not use acronyms) City of Gllroy Division, Board, Department, District, if applicable Your Position Public Works City Transportation Engineer ► If filing for multiple positions, list below or on an attachment. (Do not use acronyms) Agency: Position: Z. 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, 2014, through ❑ Leaving Office: Date Left I I December 31, 2014. (Check one) -or- The period covered is I I through O The period covered is January 1, 2014, through the date of December 31, 2014. 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." ❑ Schedule A -1 - Investments - schedule attached ❑ Schedule A -2 - Investments - schedule attached ❑ Schedule B - Real Property - schedule attached 5. Verification ► Total number of pages including this cover page: 1 ❑ 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 MAILING ADDRESS STREET CITY STATE 7JP CODE (Business or Agency Address Recommended - Public Document) 7531 Rosanna Street Gilroy CA 95020 DAYTIME TELEPHONE NUMBER E -MAIL ADDRESS ( 408 ) 846 -0451 1 henry.servin @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 knowledg nformation contained herein and in any attached schedules is true and complete. I acknowledge this is a public n I certify under penalty of perjury under the laws of the State of California tha a foreg ' is true and correct ��— Date Signed 03/04/2015 (month, day, year) (/ FPP FF 700(2014/2015) FPPC Advice Evice @fppc.ca.gov FPPC Toll -Free Helpline: 866/27 www.fppc.ca.gov