HomeMy WebLinkAboutEileen Jacobs - Annual 2011CALIFORNIA FORm 700 STATEMENT OF ECONOMIC INTERESTS
COMMISSION FAIR POLITICAL PRACTICES Coy CLERKS CK,
A PUBLIC DOCUMENT COVER PAGE
Please type or print in ink.
NAME OF FILER (LAST) (FIRST) (rPflDDLE)
Jacobs Eileen Julie
1. Office, Agency, or Court
Agency Name
City of Gilory
Division, Board, Department, District, if applicable Your Position
Finance Department Budget Analyst
► If filing for multiple positions, list below or on an attachment.
Agency:
2. Jurisdiction of Office (Check at least one box)
Position:
❑ State ❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ Multi- County —
❑x City of Gilroy
❑ County 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
December 31, 2011. (Check one)
-or The period covered is January 1, 2011, through the date of
The period covered is �� ,through O P Y 9
December 31, 2011. leaving office.
❑ Assuming Office: Date assumed O The period covered is f I through
the date of leaving office.
❑ Candidate: Election Year 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-
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 I E -MAIL ADDRESS IOPTIONALI
( 408 ) 846 -0206
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 foregoing is tr a and cor ct.
Date Signed 3/20/12 g Si nature t�-
g (month, day year) /File the originally signed statement with your filing official.)
FPPC Form 700 (2011/2012)
FPPC Toll -Free Helpline: 866 /275 -3772 www.fppe.ca.gov