NADC Dale: 6/3/2009 Time: 2:41:04 PM

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POSTMARK
NEBRASKA DATE
ACCOUNTABILITY AND
DISCLOSURE COMMISSION STATEMENT MICROFILM
NUMBER
11111 Floor, State Capitol
P.O. Box 95086 OF
Lincoln, NE 68509
(402) 471~2522
FINANCIAL
INTERESTS
BEFORE COMPLETING
READ FILING REQUIREMENTS
NADC FORM C-1

ITEM 2 OCCASION FOR FILING (Check Appropriate Box)

o A candidate for elective office o office or position

Left
~nual officeholder's or state employee's report o Newly appointed to office or position
ITEM 3 OFFICE HELD & TERM OF OFFICE (Incumbent elected/appointed officials and state employees. See
IB of Instructions
List the office or position you currently hold which requires this filing. f you have left office, Ust the office you ld.
Office or Position: .5? ~ ~. - ~ ~
Term: . IJ.
~~G~IN~S~--~~~--~
Name of City, County, District, or State Agency: L/v· /
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ITEM.. OFFICE SOUGHT (C,andldates only. See 1A of Instructions)
List the office sought which requires this filing.
Office: .

Name of City, County, District, or State OffICe:

ITEM 5 P£RIODCOVERED BY THIS STATEMENT

This statement must cover aUfinancial intereetsforthe ~tire .~n9 calendar year" and not just as ·of year-ilnd. If you have
left office, this statement must cover all financial·intEirests from the end of the calendar year for which you previously filed up to and
including the date you left office.! .. .

This statement covers

I
the preceding calendar year January1 through December 31. r
o Left office. this statement covers thepariod January 1,:
---- to
(DATE YOU L.EFT OFFiCe OR POSITION)

I Revised August 2007

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NADC--------------t-1 Dale:
61312009 Time:
2:41 :04 PM
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ITEM 6 1 SOURCES OF INCOME OF OVER $1.000

body of govemment, political subdivision or body corporate) from I

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Income inctudes moneY or anY other form of recomoense constltutina Income under the Internal Revenue Code. (See definitionsl
Name and address of any source' (including an individUal, buaine~, Ust the nature of the source's business and the nature of the services you
rendered or the circumstances under which Income was received. NOTE: Do not
whom income of over $1.000 was received. list the amount of the iooome. .
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CLIENTSTHEREOF.· . .
ITEM 71 BUSINESSES WITH WHICH YOU ARE AS,SOCIATED (See definitions)
Name and address of aUbusi~as. organizations. or associationS (profit and nonllrofit) withwhidl you held a position of ofIicer, director, limited liability
company member, partner, or stockholder and any entity In YA1idl ~ held a position of trustee. Such reporting is required based on the position held, not
. on Ylhether income was reoeived. You need not reoort business 8S$Odalions whldl are oItlEIrMse fisted und.et Item 6.
Name and Addmss of Busine5$ or Organization I Nature of Association

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6.) ______
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7.) ________________ -+-1 7a).

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 Dale: 6/3/2009 Time: 2:41:04 PM
NADC

C)
ITEM 8 I REAL PROPERTY OF THE FILER fNNEBRASKA
personal residence need not be. r8oorteci.)
(Real property valued at less than $1,000 and your
.
List all real property in your name or In which you have a direct ownership. interest. The description required must be sufficient to identify
the location of the property. Exceptions: You need not report real estate owned by a business Hsted in Item 6 or 7, your personal
residence or real property valued at less than $1,000. Personal residence refers to your principal dwelling-house and adjacent land used
for house-hold purpesas, such as lawns and aardens.
Location of Property Nature of Property
(Description or Address (such as: agricultural. commercial, industrial, residential-rental)

ITEM 9 I OTHER FINANCIAL

WHICH EXCEEDED
INTERESTS AND PROPERTY HELD DURiNG THE PERIOD OF THIS STATEMENT
A FAIR MARKET VALUE OF $1,000 AT ANY TIME DURING THE REPORTING PERIOD
(a) Ust the names and addresses of the institutions in which you had checking and savings accounts and certificates of deposit.

Financial Institution Address

#/eUS L1...~$tJ
'/FC If1t[.at/tJLf.J'~ 041Hf4r C~J;
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(b) list the names of the issuers of all stocks, bonds, and government securities, ndtothelwise listed under Items 6 or 7 .

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(c) Describe otherpropertyO'M'led or held forthe production of income not otherwise disclosed In It~s 6,7,8 or9(a)(b) .. Include
leaseholds and Clther interests in real estate, promissol:y notes and .other obligations ~ to you, beneficiallnteteslS in trusts and
estates. cash value life insurance. IRAs, deferred income and retirement plans. Exeeption: 00 not include accounts receivable,
inventory, fixtures and eqUipment owned or used by a business listed in Items 6 & 7 or household goods, personal automobiles snd
other taOQible Dersonal orooortv unless such Drooertv was held Drlmarllv for sale or exchanae. .' . .
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 NADC
'_.; •• r' •• f------lO_-------.f()~---- Date: 6/3/2009 Time:2:41:04 PM

ITEM 10 CREDITORS TO WHOM $1,000 OR MORE WAS OWED OR GUARANTEED BY YOU OR A MEMBER OF
YOUR IMMEDIATE fAMILY.
Exception: Loans from a relative and land contracts which have been recorded with the Courity Clerk or Register of Deeds need not be
reported. Accounts payable •.debts arising out of retail instailment transactions or loans made by a financial institution In the ordinary
course of business need not be reported.
Name Address

ITEM 11 SOURCES OF GIFTS OF A VALUE OF MORE THAN $100 RECEIVED EXCEPT GIFTS FROM RELATIVES.
(See definitions)
Name and address of Donor Occupation or nature of business of Value of Gift Description of Gift and
Donor (See Key Below) Circumstances or Occasion fur
Gift
Choose Value:

Choose Value:

Choose Value:

Choose Value:

Choose Value:

Choose Value:

Choose Value:

Choose Value:

The monetary value of each gift shall be categorized based on the good faith eStimate of the filer. For each reported gift insert in the
Value column the letter which corresponds to the value category of the gift. The value categories are:

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