Академический Документы
Профессиональный Документы
Культура Документы
c ,
NEBRASKA
\
..
I"
I, .1 POSTMARK
DAlE
~
ACCOUNrABlLrrY AND
DISCLOSURE QQUMISSION
STATEME,NT MICROFI.M
NUMBER'
" 11930164
11th Floor; Stale capitol
P.O. Box 95086
OF OFFICE USE ONLY
,~U I'j. " e-,
(402) 471-2522
INTERESTS 7 'In
L•.\..;
Il'1n
iu- LO
r\ r:
BEFORE COMPlETING
REAO·AUNG REQUIREMENTS HADC FORM C-1
INS (: Lee: LlHE C C/j"·j h ll'~ ~;:!:5'1!!
-Individuals listed ooder Sections I-A & B of the GenemlInformaIiorrFiI Requirements ori page 5 must file 1hisform.
• Dollar values need not be reported for any item. except for Item 11.
• File with the NebraskaAcooun1abilily and Disclosure Commission and with the election oornmissioner or clerk of the county of your residence.
• Persons whO fail to file 1his report or oIheJwise do not comply with the repoelilg provisions of the law are subject to penalties.
Name 1- o ade. /\
lAST
j .a:
. FIRSI" I
\J
MIDDLE
Telephone No. (.JCtf) "7t7- S'03 6
' 11, a,dev & s: ' ,E / ISuiOI- -rli, lU.e-) j- 6' 9)'1'0
Address Sl"REEr ADDRESSOff FlUAALROI1TE CITY SOO'E ZlPCOOE
.,
rrEM2
.. /
I OCCASION FOR RUNG (Check appropriate
"
boX)
,.
List the office or position you currently hOld which requires this filing. If you have left office, list the office you held •
.'
J
ITEM 6 I SOURCES OF INCOIIE OF OVER $1,000
Income includes rIlOOOY or any oIher fonn Of recompense CClI'isiibJting incOOle under the Internal Revenue COde. (~ definitions)
Name and address of any source. ••flllCluding an inc:iviclJaI. business; , list the nabA'e d the source's business and the nature of the services
body of govemment, pollicai suIxIvision or body corpor.de) from you rendered or the cireumstances ooder which income was
whom income dover $1,000 was received. received.
2.} ..
If-cde pf JIt/~/J r-ftS /t« 2a.) S e.-PlA/l of-
<
-,'
4.) 4a.)
"
3.) 38.)
,
.... -.
4.) 4a.)
S.) 5a.)
-,
6.) Ga)
7.} 7a)
.'
~)
REAL PROPERlY oF'THE ALER IN NEBRASKA (Real propeny vawea 81 leSS man ~Uuu anu your
~J
I personal residence need not be reported.)
List all ~ property in .;;. ~ orin wtjQ)you helve a drect ownenIhip ~ The description required must 'be ~t to ~ the
location of the property. ExceptioIIS: You need not report real esIaie owned by a business listed in Item 6 or 7, your petS(lt'8 residence or real
property valued at less than $1000. PeJsonaI residence refers to your principal dweIing-hotJse and aqacem land used for flouse-hoId purposes,
such as lawns and gardens. ,-' ,
Gc~,.tJe-'1 GOf.VI,+/-e S
(b) List the names of the issueIs of au stocks, bonds, and government securities, not otherwise Iisled under Items 6 or 7.
(e) Describeother properly owned or heldfor1he production of income not oIheIwise disdose<i in Items~1.8 or 9(a)(b).lncIude~,~ "
other interests in real estate. promissoIy notes and oIher Obligations owed to' you, beneficial' ideiesls' i1 trusts and estates; Cash value ,life
insurance,lRAs;defened income andieliren1ent'pIans. Exception: DOriot inclUde ~'~' inventOry, fixtures arid equipffient
owned or used by a business IisIed in Items 6 & 7 or househokI goods, ,person8I'~' and Other ~ peIsonaJproperty unleSs
such ~ ~ tJeJdPrii'n8J:ilrfoi'SaJe Of. exchange. , " .1. -, ' "
. '
")
,., .
ITEM 10 CREDITORS TO wtIOlII-l1,OOO OR MORE WAS OWED OR ~ BY YOU OR A MEMBER OF
YOUR IllllEDlATE FAMILY. .
exception: l..clans from a relative and land c:onIrads which have been recorded with the ColBy CIeIk or Register of qeeds need not be repo~.
ACcounts payable. ~ ari5itig out ofret8il iI1sIaJIment1ransacIiOns. Or Ioarl::> made by a fiilanciaI instiIlJtion in the .~ course of ~ness
need nOt berepdrted. "', . . . .
. ' "':' '.' , ,:'
. , ~. .~~
Name Address
ITEM 11 SOURCES OF GIFTS OF A VALUE OF MORE TlfAN· $100 ReCEIVED EXCEPT' Gli=TS FROM
RELAllVES. (See definitions)
Name and address of Donor OQa!palion or nature of buSiness Value of Gift 0escripIi00 of Gift and
of Donor (See Key Below) Cin::umstances or Occasion for
Gift
'.....
~-------- ~ -L ~ -II.
The monetary value of each ~ shaI be categolized based on the good faiIh estimate of the filer. For each reported gift insert in the Value
~ the ~ wIlichconaspoIlds to the -..e category or the gift The vaIue.categories are:.
A) $100.0ftO $200; El)$2()O.01to $500;. C) $500.01
" ": ~.: '.:\; ;",;-".-:.
," . .... '." . r .
to $1,000;0)$1,000.01
. '. " -. .
or more.
...
..•.y:: .. ", '-.:~ :-
iTElii12
. .. ' -, ," ; SIGNATURE
.,
,'. -,
OF FILER AND
- ..
DATE. . . ,.... r::.', ". ~.,1. . ,;', ~ ..~.. ' ,':
Dale
I·