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Due By April 28, 2006 die! 2005 YEARLY FINANCIAL STATEMENT " 7 Ot NEILL ANF con Det. PERRY HWY WAKEFIELD RT 02879 L 1 ALL QUESTIONS REFER TO THE CALENDAR YEAR JANUARY 1, 2005 THROUGH DECEMBER 31, 2005 UNLESS OTHERWISE SPECIFIED. Please answer all questions and where your answer is “none or “not applicable"-so state. ANSWERS SHOULD BE PRINTED OR TYPED, and additional sheets may be used if more space is heeded. For clarification of any question, read instruction sheet, Note: Ifyou are a state or municipal official or employee that is required to file a Yearly Financial Statement, a failure to file the Statement is a violation of the law and may subject you to substantial penalties, including fines. If you received 2 2005 Yearly Financial Statement in the mail but believe you did not hold a public postion in 2006 or 2006 that requires such fling, you should contact the Ethics Commission (See Instruction Sheet for contact information) 2 Taewes oe 2 BIa7 Cott, 0.1. (tary Huey Mihheitel fee O25? 3. List Public Position(s) you hold and governmental uni Tew Covwc:l Seoth Megs tours TLIC POSTON THORICPALTED STATE OR REGION ruBLEFoETGR ‘WORGPALT, STATE OR RECORATY Iwas elected in 2707, was appointed in | was hired in (ear) Gear) wear) Ifyou no longer hold a public position, state year of termination or resignation 4. Utes foruien you weft a candela ear206 or 2008 (Read stucton wh 5. List the following: NAME OF SPOUSE NAME(S) OF DEPENDENT CHILD OR CHILDREN Avee & OVE! 6. List the names of any employer from which you, your spouse, or dependent child received $1,000 or more gross income during calendar year 2005. If self-employed, list any occupation from which $1,000 or more gross income was received. If employed by a state or municipal agency, or if self-employed and services were rendered to a state or municipal agency for an amount of income in excess of $250.00, list the date and nature of services rendered. If the public position or employment listed in #3, above, provides you with an amount of gross income in excess of $250.00 it must be listed here. (Do Not List Amounts.) NAME OF FAMILY NAME AND ADDRESS DATES AND NATURE wc uA oreD OF EUPLOYER OF OCUPATION OF SERICES RENDERED Tanes w. ove Consta. Frepentes Real Gtte 380 (laine St Brokeonse LA OFELG, RE CZ89F , Counts pit teed t Aue 8.0. well eed o TS Fespi Ce ee beac nae KS me eesF 7. List the address or legal description of any real estate, other than your principal residence, in which you, your ‘spouse, or dependent child had a financial interest. NAMES NATURE OF INTEREST ADDRESS OR DESCRIPTION Tig + Awe Oe / Reektd Real Ebile BO ate ee AE: 8. List the name of any trust, name and address of the trustee of any trust, from which you, your spouse, or dependent child or children individually received $1,000 or more gross income. List assets if known. (Do Not List Amounts.) nawe oF trust: _ AZO) & [NAME OF TRUSTEE AND ADDRESS: NAME OF FAMILY MEMBER RECEIVING TRUST INCOME: ASSETS: 9. List the name and address of any business, profit or non-profit, in which you, your spouse, or dependent child held a position as a director, officer, partner, trustee, or a management position, NAME OF FAMILY MEMBER NAME AND ADORESS OF BUSINESS Postion Tiuees 2. OWE Constal hopenties Cees Bee hte St Presi ote’ REE ALO RT ORT oon Constal Mort ¢ Servius Cop en ‘ 360 Mao dt Cee oat WakKE EAD, RE Arne 9. Onell — ~ Suite ingstoe Lad Go pncertcg — Thoster Adu $. One1) Sovth Cre Covatheusre Celen tntlerikts § DiRgeT ol oe 1 ogi RE TAR 410. List the name and address of any interested person, or business entity, that made total gifts or total contributions in ‘excess of $100 in cash or property during calendar year 2005 to you, your spouse, or dependent child. Certain

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