4
carmen mor wm
cis
aetna,
TO BE FILED WITH:
OFFICE OF THE CITY CLERK =
IDIN.LASALLE STREET, ROOM 107
CHICAGO, ILLINOIS 60602 ant
‘TYPE OR PRINTLEGIBLY ‘STATEMENT FOR CALENDARS EAR 2008"
NAME on Sherpa d 2
= Fear
womee Leg CB NAL Pe
PLEASE READ ATTACHED INFORMATION AND INSTRUCTION SHEET BEFORE FILLING
OUT STATEMENT. TERMS MARKED WITH AN ASTERISK ARE DEFINED IN
INSTRUCTION SHEET. IF NECESSARY, PLEASE ANSWER ALL QUESTIONS ON A.
‘SEPARATE SHEET OF PAPER AND ATTACH TO THIS FORM.
(OTHER EMPLOYMENT INCOME
‘Non-City Income
1. If. daring the preceding calendar year, you received in excess of $2,500 in income from any
professional Business or othe organization ther than the city) for your service as an office, director,
Bssociate, pane, proprietor, employee, or advisor, provide tbe information below.
Type of Organization NAME ADDRESS. POSITION
Mew
ther Government Employment
calendar year, you were employed by any unit of government OTHER THAN
If, during the precedn
ase list the name of such unut of government below:
CITY OF CHICAGO,
Yi Meade INCOME FROM CITY-RELATED BUSINESS
3. Please state the nzure of any profesional, business or other services rendered by you OR BY
YOUR SPOUSE, OR BY ANY ENTITY IN WHICH YOU OR YOUR SPOUSE HAS A FINANCIAL,
INTEREST, and the name and nature ofthe person* or entity (other than the City) to whom or to which such
services were rendered if during the preceding calendar year, (1) compensation in excess of $5,000 was
received for professional or other services by you, OR BY YOUR SPOUSE, OR BY ANY ENTITY IN
WHICH YOU OR YOUR SPOUSE HAS A FINANCIAL INTEREST™, and (2) the person* or entity was
doing business* with the City, or withthe Chicago Transit Authority, Board of Education, including the
Chicago Schoo! Reform Beard of Trustees, Chicago Park District, Chicago City Colleges, or the
Metropolitan Pier and Expssition Authority,
Nature of Service Rendered [Name and Nature of Person*
Anon Receiving Service
Wine
41, during the preceding calendar year, you hada financial inteest* in any person* doing business*
‘WITH the City, dent (athe name of such person(s)* and (b) your title or a description of any position you
tel with such prsont
(@) Name of Person (©) Ttl/Description of your position
A
BUSINESS OWNERSHIP
5, List the name an instrument of ovmership in any person® conducting business IN the City, im which
‘youhad a financial intrest during the receding calendar year. Ownership interest in publily bold
corporations need not be dicosed
Name of Business lestrument of Oomership
as CAPITAL GAINS
6 LIST the identity of ny capital asset, including the adress or legal description of rel estate, from
‘which you realized a capital gain of $5,000 or more in the preceding calendar year. DO NOT INCLUDE
‘ANY INCOME DERIVED FROM THE SALE OF YOUR PRINCIPAL PLACE OF RESIDENCE,
OO
REALESTATE
7. Ifyou havea Ginancil interest in eal estate located in the Cty of Chicago, OTHER THAN YOUR
PRINCIPAL PLACE OF RESIDENCE, identify the address ofthe propery, including zip code or, if none,
theegal desenption of the rel estate. Inch all forms of rector direct ownership such as partnerships
of trusts of which the corpus consists primarily of real estate. Trusts must be identified by the (a) trust
‘number; (b) name and address ofthe trustee; and (c) location of land by both street address and legal
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