.

.PAGE
, ,..
5 ""~AME:
;..
..
PAGE 5
' ,'

9. L i z ~each source of gifts, EXCLUDING campaign contributions, in EXCESS of $1,000, received during the reporting period for I
which this statement is filed by the reporting individual or such individual's spouse or unemancipated child from the same donor,
EX:I:LWDMG gifts from a relative. INCLUDE the name and address of the donor. The term "gifts" does not include
reSzzrbursements,
.. which term is defined in Item 10. Indicate the value and nature of each such gift.
P''
/SE$kSPOVSE
-
"NONE

o.l:knlLD
' , .iy !i'

"<
"
. NAME OF DONOR ADDRESS NATURE OF GIFT
CATEGORY OF
VALUE OF GIFT

....2..,<' ........... ........................................................................................................................................................................................................................................................

1.

I ,!

10. Idc~tifyand briefly describe the source of any reimbursements for expenditures, EXCLUDING campaign expenditures and
ex&nditures in connection with official duties reimbursed by the state, in EXCESS of $1,000 from each such source. For purposes
of'?-$isiten, the term "reimbursements" shall mean any travel-related expenses provided by non-governmental sources and for
ac: "kities *'elatedto the reporting individual's official duties such as, speaking engagements, conferences, or fact finding events.
Td*herm "leimbursement" does NOT include gifts reported under Item 9.

SI&<$CE
- DESCRIPTION
.-I

--
................................................................................................................................................................................................................................

*! ' T
. -: -

VALU$.&OUNT A - UNDER $5,000 C - $20,000 to under $60,000 E - $100,000to under $250,000

CATq:;4,PRIES B - $5,000 to under $20,000 D - $60,000to under $100,000 F - 5250,000 or over
PAGE7 NAME: PAGE 7

13. Li: i below the nature and amount of any income in EXCESS of $1,000 fkom EACH SOURCE for the reporting individual and such
individual's spouse for the taxable year last occurring prior to the date of filing. Nature of income includes, but is not limited to,
all income (other than that received from the employment listed under Item 2 above) £rom compensated employment whether public
or private, directorshipsand other fiduciary positions, contractualarrangements,teaching income, partnerships, honorariums, lecture
fer::., consultant fees, bank and bond interest, dividends, income derived from a trust, real estate rents, and recognized gains from
thc- ;ale or exchange of real or other property. Income from a business or profession and real estate rents shall be reported with the
sorzYceidentified by the building address in case of real estate rents and otherwise by the name of the entity and not by the name of
the individual customers, clients or tenant< with the aggregate net income before taxes for each building address or entity. The
reript of maintenance received in connection with a matrimonial action, alimony and child suppoi-t payments shall not be listed.

, . CATEGORY OF

--
SEI.F(SPOIJSC
/'
SOURCE NATURE AMOUNT
-..
.5ri.:2
.-- .a 3' ..........
5 L;. v$. .. LL L!6 . C L,. ""..
............................ ..... ................... ..........
.............................................

14. Lip: ihe sources of any deferred income (not retirement income) in EXCESS of $1,000 from each source to be paid to the reporting
in; vidual following the close of the calendar year for which this disclosure statement is filed, other than deferred compensation
reg :i-ted in Item 11hereinabove. Deferred income derived from the practice of a profession shall be listed in the aggregate and shall
idr-:tify as the source, the name of the firm, corporation,partnership or association though hhich the income was derived, but shall
no' *denti+ individual clients.

,ii;
. LJ,
NONE
CATEGORY b~
AMOUNT

V&UE/AMO.UNT -
A UNDER $5,000 -
C $20,000 to under $60,000 E - $100,000 to under $250,000
C.;,TEGOMES -
B $5,000to under $20,000 -
D $60,000 to under $100,000 -
F $250,000 or over
 PAGE 9

TYPE OF PERCENTAGE OF CORPORATE STOCK CATEGORY OF

ISSUING ENTITY SECURITY OWNED OR CONTROLLED ' M A R K E T VALUE ''

. -
'IF $:.:RE THAW 5% OF PUBLICLY TRADED STOCK. OR MORE THAN 10% OF STOCK NOT PUBLICLY TRADED, IS HELD.
= ,

"CATEGr::Y OF MARKET VALUE AS OF THE CLOSE OF THE TAXABLE YEAR LAST OCCURRING PRIOR TO THE FILING OF THIS STATEMENT.
...
....
.,.,.. .
~4:;;LEIAMBUNT
b
A - UNDER $5,000 -
C S20,000 to under $60,000 E.-$100,000 to under $250,000
C,$~TEGO~S B - $5,000 to under S20,000 D - $60,000 to under S100,OOO -
F $250,000 or over
PAGE 11 NAME: gb;5E 1 1
-- - --
t',
I.
,,.
19. List below all liabilities of the reporting individual and such individual's spouse, in EXCESS of $5,000 as of the date of filing of i:
this statement, other than liabilities to a relative. Do NOT list liabilities incurred by, or guarantees made by, the reporting individual -.
1 .

or such individual's spouse or by any proprietorship, partnership or corporationin which the reporting individual or such individual's
spouse has an interest, when incurred or made in the ordinary course of the trade, business or professional practice of the reporting
individual or such individual's spouse. Include the name of the creditor and any collateral pledged by such individual to secure
payment of any such liability. A reporting individual shall not list any obligation to pay maintenance in connection with a
matrimonial action, alimony or child support payments. Any loan issued in the ordinary course of business by a financial institution
to finance educational costs, the cost of home purchase or improvements for a primary or secondary residence, or purchase of a
personally owned motor vehicle, household furniture or appliances shall be excluded. If' any such reportable liability has been
-
guaranteed by any third person, list the liability and name the guarantor.

NONE

:!:
AMOUNT .:,

. .

z.... ............................... ............................................................................................. ................... .............

.... .... ..................................................................................................... . . .
.2.. ................................................................................ E'..:........
..................
.-1.1
.?-
-..-
,.I

D........: ....
. .

.L............................................................................. .................
.
IsI- :.,,;

S :
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i ]l

conduct or behavior w i l l be drawn merely from compliance with these requirements

REMINDERS:
Please review the Statement to ensure all questions have been answered, including both parts (a) and (b) for questions 3 , 4 , 5, 8 and 12.
Please remember to sign and date the Statement.
Please keep a copy of the completed Statement for your records.
Please be aware that any sheets attached to the Statement are also subject to public inspection.

VALWAMOUNT A - UNDER $5,000 -

C $20,000 to under $60,000 -
E $100,000 to under $250,000
CATEGORIES B - $5,000 to under $20,000 D - $60,000 to under $100,000 F - $250,000 or over