HomeMy WebLinkAboutEileen Jacobs - Leaving Office 2017STATEMENT OF ECONOMIC INTERESTS °at Filing Rece'te�i
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DOCUMENT FAIR POLITICAL PRACTICES COMMISSION
A PUBLIC COVER PAGE a 4y4 -
Please type or print in ink.
NAME OF FILER (LAST) (FIRST) (MIDDLE)
Jacobs Eileen lie
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
City of Gilroy
Division, Board, Department, District, if applicable Your Position
Public Works Department Budget analyst
► If filing for multiple positions, list below or on an attachment. (Do not use acronyms)
Agency: Position:
2. Jurisdiction of Office (Check at least one box)
❑ State ❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ Multi- County ❑ County of
❑x City of Gilroy ❑ Other
3. Typ 9 of Statement (Check at least one box)
nnual: The period covered is January 1, 2016, through ❑x Leaving Office: Date Left 3 1 3 1 2017
December 31, 2016. (Check one)
-or-
The period covered is I I through • The period covered is January 1, 2016, through the date of
December 31, 2016. or-
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 (must complete) ► Total number of pages including this cover page:
Schedules attached
❑ Schedule A -1 - Investments — schedule attached
❑ Schedule A -2 - Investments — schedule attached
❑ Schedule B - Real Property — schedule attached
-or-
❑R None - No reportable interests on any schedule
5. Verification
MAILING ADDRESS STREET CITY
(Business or Agency Address Recommended - Public Document)
7351 Rosanna Street Gilroy
❑ Schedule C - Income, Loans, & Business Positions — schedule attached
❑ Schedule D - Income — Gifts — schedule attached
❑ Schedule E - Income — Gifts — Travel Payments — schedule attached
STATE ZIP CODE
CA 95020
DAYTIME TELEPHONE NUMBER E- MAILADDRESS
( 408 ) 846 -0206 eileen.jacobs @cityofgilory.org
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 erju ' and r the laws of the State of California that the f Ing is and correct.
Date Signed Signature
( onth, da . year) (File the originally signed statement with your filing official.)
FPPC Form 700(2016/2017)
FPPC Advice Email: advice @fppc.ca.gov
FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov