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XGR Dubas SFI

XGR Dubas SFI

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Published by nebraskawatchdog

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Published by: nebraskawatchdog on Dec 19, 2009
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12/18/2009

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I
1
,
-
NEBRASKA
-(
)
1
jPOSTMARK
cjJJ!j
,
-
ACCOUNTABILITYAND
DATE
!
DISCLOSURECOMMISSION
STATEMENT
MICROFILM
796(}09~j
11
th
Floor,StateCapitol
NUMBER
OF
.o.
Box95086
OFFICEilf~-Q~~
y,,.."-
Lincoln,
NE
68509
FINANCIAL
L.!NGo'LT!,
Yii'tt~\Si{l
(402)471-2522
INTERESTS
7°00
',ll
0,)
I
BEFORECOMPLETING
10-1..\)-1
fU-inv,
PH2:
15
READFILINGREQUIREMENTS
'
.
D'i~CC'
i.fNi/i~'
I;:.,
JITY
t.
NADCFORMC-1
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;
CandidatesfordesignatedofficesandholdersofdesignatedofficesandpositionsmustfilethisstatementSeeSections1Aand1Boftheinstructions.Candidates(includingincumbents)subjecttothisfilingrequirementmustfilewiththeCommissionandwiththeappropriateelectionofficial(SeeInstructions).DesignatedofficeholdersandholdersofdesignatedpositionsmustfilethisstatementwiththeCommissionannually.Dollarvaluesneednotbereportforanyitem,exceptItem11.Personswhofailstofileasrequiredissubjecttoacivilpenaltyofupto$2,000.ITEM1
I
YOURNAME,ADDRESSANDPHONENUMBERName
Jjuba.S
A
r\
Yl
e.tte...
Marie-
TelephoneNo.
3D8'-
5
310-
d.O
g
a
LASTFIRSTMIDDLEAddress
54-Cicio
N
iso
AVE
J:"u.,\
e.r+un
NE
b~b3X'
STREETADDRESSORRURALROUTECITYSTATEZIPCODEITEM
2
I
OCCASIONFORFILING(CheckAppropriateBox)
o
Acandidateforelectiveoffice
o
Leftofficeorposition~Annualofficeholder'sorstateemployee'sreport
o
NewlyappointedtoofficeorpositionITEM3
I
OFFICEHELD
&
TERMOFOFFICE(Incumbentelected/appointedofficialsandstateemployees.SeeIBofinstructions)Listtheofficeorpositionyoucurrentlyholdwhichrequiresthisfiling.Ifyouhaveleftoffice,listtheofficeyouheld.OfficeorPosition:
J)
i
tr
i
c
t
3L.\-
Stll.te.~
Term:
dDo1..
d.o4D
BEGINSENDSNameofCity,County,District,orStateAgency:
TJ;
+
3t.1--
_,IS'
ITEM4
I
OFFICESOUGHT(Candidatesonly.See1Aofinstructions)Listtheofficesoughtwhichrequiresthisfiling.Office:NameofCity,County,District,orStateOffice:ITEM5
I
PERIODCOVEREDBYTHISSTATEMENTThisstatementmustcoverallfinancialinterestsfortheentire"precedingcalendaryear"andnotjustasofyear-end.Ifyouhaveleftoffice,thisstatementmustcoverallfinancialinterestsfromtheendofthecalendaryearforwhichyoupreviouslyfileduptoandincludingthedateyouleftoffice.
!Xl
ThisstatementcoverstheprecedingcalendaryearJanuary1throughDecember31,
;)..OO~
0
Leftoffice,thisstatementcoverstheperiodJanuary1,to(DATEYOULEFTOFFICEORPOSITION)
I
I
I
I
I
f
!.
I
I
RevisedAugust2007
 
ITEM6
I
SOURCESOFINCOMEOFOVER$1,000
IncomeincludesmonevoranvotherformofrecompenseccnstitutinqincomeundertheInternalRevenueCode.(Seedefinitions) Nameandaddressofanysource*(includinganindividual,business, Listthenatureofthesource'sbusinessandthenatureoftheservicesyoubodyofgovernment.politicalsubdivisionorbodycorporate)fromrenderedorthecircumstancesunderwhichincomewasreceived.NOTE:Donot whomincomeofover$1,000wasreceived. listtheamountoftheincome.1.)1a.)
Fllm;I~
wmMcl
Ranc.h
rl>h"\m~d;h
St...\9<'
I
2.)
5to..te.
of
t-lwrosko..
2a.)
lll\i514.ti\l'~
Ec..1Al"\l
<oJ
/
3.)
3a.)4.)4a.)*NOTE:IF.INCOMERESLJLTEDFROMEMPLOYMENTBY,OPERATIONOFORPARTICIPATIONINAPROPRIETORSHIP,PARTNERSHIP, CORPORATIONOROTHERPERSON,LISTTHESAMEASTHESOURCEOFINCOME,BUTNOTTHEPATRONS,CUSTOMERS,PATIENTS,OR CLIENTSTHEREOF.
ITEM7
T
BUSINESSESWITHWHICHYOUAREASSOCIATED(Seedefinitions)
Nameandaddressofallbusinesses,organizations,orassociations(profitandnon-profit)withwhichyouheldapositionofofficer,director,limitedliability companymember,partner,orstockholderandanyentityinwhichyouheldapositionoftrustee.Suchreportingisrequiredbasedonthepositionheld,not onwhetherincomewasreceived.Youneed
not
reportbusinessassociationswhichareotherwiselistedunderItem6.NameandAddressoflBusinessorOrganizationNatureofAssociation1.)1a.)2.)2a.)
5-
3a.)
.)
-
4.)4a.)
5.)
5a.)
6.)6a.)7.)7a).
 
·
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rrEM
J
8
I
REALPROPERTYOFT~_)ILERINNEBRASKA(Realpropertyvdl,jdatlessthan
$1,000
andyourpersonalresidenceneed
notbe
reported.)....
Listallrealpropertyinyournameorinwhichyouhaveadirectownershipinterest.Thedescriptionrequiredmustbesufficienttoidentifythelocation.oftheproperty.Exceptions:YouneednotreportrealestateownedbyabusinesslistedinItem
6
or
7,
yourpersonalresidenceofrealpropertyvaluedatlessthan$1,000.Personalresidencereferstoyourprincipaldwelling-houseandadjacentlandused forhouse-holdpurposes,suchaslawnsandqardens.
NIP.
NatureofProperty(suchas:agricultural,commercial,industrial,residential-rental) LocationofProperty(DescriptionorAddress
ITEM9
I
OTHERFINANCIALINTEREST.$ANDPROPERTYHELODURINGTHEPE.RIODOFTHISSTATEMENT WHICHEXCEEDEDAFAIRMARKETVALUEOF
$1,000
ATANYTIMEDURINGTHEREPORTINGPERIOD
(a)Listthenamesandaddressesoftheinstitutionsinwhichyouhadcheckingandsavingsaccountsandcertificatesofdeposit.FinancialInstitutionAddress
J30
=rt
Fu.((v1b-n.
4-11b
Bl"OA.ciWIl.1'
fu.11u-h"h
~1d.1
Arc..her
R.l)
A-rc..htr,
NE
(b)Listthenamesoftheissuersofallstocks,bonds,andgovernmentsecurities,nototherwiselistedunderItems6or7. (c)DescribeotherpropertyownedorheldfortheproductionofincomenototherwisedisclosedinItems6,
7,8
or9(a)(b).Includeleaseholdsandotherinterestsinrealestate,promissorynotesandotherobligationsowedtoyou,beneficialinterestsintrustsandestates,cashvaluelifeinsurance,IRAs,deferredincomeandretirementplans.Exception:Donotincludeaccountsreceivable, inventory,fixturesandequipmentownedorusedbyabusinesslistedinItems6&7orhouseholdgoods,personalautomobilesandothertanolblepersonalpropertyunlesssuchpropertywasheldprimarilyforsaleorexchance.
NJA

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