RECEIVED WAR 16 2012 CANDIDATE REEIVED NORTH CAROLINA STATE ETHICS CO} 2012 STATEMENT OF ECONOMIC INTEREST, ee 19 2¢ 9192715207) warwathcseommssionacgos WAR 12 2012 CLEVELAHE CO 8D CLECTION STLUIESCnmins USAR SEER CRATER, ADEE Me 0 TIME, av FLFR NAME GIRST MIDDLE LAST) " ~ Fa ie ce - some Tinoiy wot Ni Ai ADDRESS, GY, STATE, 2 - . Address: City State aa 308 Fast Kings St ~ Kings Mountain INC "28086-0000 — t ‘i OME ADDRESS, ITY, STATE, Pes [Cisane As Mailing Addces . ‘aves Gs Sawe [a 1457 Mertimont Drive: Kings Mountain Inc 280-0000 |canaair camcoweR - Testi (Soieotne Sie Repesetse ~ DAYTIME PHONE NUMBER: ~ JALTERNATE PHONE NUMBI 1 [Oi 7A3-ARR - - 704-730-1221 ~ E-MAIL ADDRESS. ~ ~ ~~ tim moore(@neleg net —_ ~ ~ ~ STATE eae oe mages This entire document and any attachments are public record, Page tof 12[REASON FOR FILING (GFLECT ALL THAT APPLY) {CISTATE GOVERNMENT JOB (Please specify the agency for |CIBOARTYCOMMISSION (Prease list all boards on which you ‘which you work) are serving) LBIUDICIAL OFFICER (Please specify the office youbold) | LEGISLATOR (Please specify the legislative branch - House ‘or Seite} House of Representatives Pio other immediate family members reside in your household? 2 ves No FULT NAME, RELATIONSHIP | EMPLOYER: ‘JOB TITLE, NATURE OF _ BUSINESS lice McRae Moore [wife Kings College Part Time Recruiter [education Frimerhy MeRar Mowe [soo ‘one [none none ~ Witson Bryon Mosse {sen ‘none [nove ‘none. 1. $10,000 PLA have ascets oHabilsies with a market value ofa! Yeast $10,000 in the Fhe preceding year unless anather tine period he you, your spouse members of your inne fs following categories lence preside he requested information as of December 3° ss specified inthe questi * De mor tist te value of those ansets or liste > Do nor lis asses of baits held in a bed must esblished by ¢ fur dhe benefit of you or an tmmrediae fanny member 1 Do yo, your spouse, or members of your icanedin family hans an owerabiy nirct in Nowth Caroling real ext with @ maker! ‘value of $10,000 or more? | Ye CNe _ a Owner of Real Estate % Ownership Laterest Location by City, | Location by County Thon Moore & Juli Meare tae ‘Kings Moontain Cleveland "Fin Moore & Juli Moore 100 ‘Kings Mouniana oveland 2..Do you. your spouse or members of your shetty lease or rent oot fom he State reel estate with market valab of | 510,000 oF more? tive xe | Name of Lestor Nanve of Lessee (eater) entire document and any attachments are public record Page 2.of 123. Within the preceding two years, have you, your spouse, or members of your inmediote family sold to or bought from ihe State personal property with «market vile of $10,000 or more? Ye 2No Ae ‘ame of Purchaser Name of Seller Type of Property 4. Do you yur spouse, or metsbes of your imme. family cure lie of et oo Fgm the State persons propery witha ‘market value of $10,000 oF more? i ye Bano a t ‘Name of Lessor ‘Name of Lessee (Renter) ‘Type of Property Sa). Do you, your spouse, or members of yeu iimediatefanily own inuerstsfprnerally stock) valued at § 10,600 or more ins bly owned campaity? | yee CINo * Di not list ownership interests in widely held investment fund (including mutual finds, eewalated investment companies, ‘or pension or deferred eompensation plans) if (the fand is publoly raed or is assets are widely diversified nd til) neithee you ner an imesediateFurily momer are ble 10 conte the assers held in the esstual fund, investment company. oF pension or deferred compensation plan ‘Owner of Interest Fall Name of Company (Bo not use a ieker symbol) Tim Moo ~ [Atiiance Bank & Trust Tim Moore ~ [Wells Farge Company TimMooe OT tewtote Packet _ XO) Do you, your spouse, oc merabers of your immediate family hold stock options valued at $10,000 or more ina cornpusy or bostaes? : ives FiNo “Owner of Stock Option ‘ull Name of Company (Do not use a Heker symbol) ‘This entire document and any attachments are public record, Page 3 of 12‘a9, o you, i spouse, or members of your immediate fay Have Baancilntrcts valued $10,000 aoe ina nan pb owned compaty or bisines entity chiding interests in ote propritorshps,panwersips, (nied partteships, teat cps mie by ue ny capt? ves Uno ‘Owner of Interest | ‘Name of Business Entity [Tim Moore Tim Moore, Atorney at Law ‘by, Forsch of those nor: publicly wed compan a business coe en i pein 69 te “primary compat", plesse fst the names of any oir companies in which the primer’ comity owns secures ey ioteress valued a over $10,000, know, Be i ‘oe-Publicly Owned Company (he Primary Company) | Other Companies in which the Primary Com Ll Security or Equity Interests 4 None or Not Krew ‘Name of Company or Business Entity T Description of Business Activity with the Stare (None oF Not Known “Tim Moose. Auomey at Law ‘court appointed legal services 1. ave you. your spout, or embers of yon tien th ener seeds wa a S000 that is created, established, o¢ controlled by vos? i Gye ENo 5 . eg > Do not Hist blind trusts, Name and Address of Trustee Description of the Trust ‘Your Relationship to the Trust This entire document and any attachments are public record. Page 4 of 12'. Do you, your spouse, os members of your imimediate family have a liabihty (debe) of $10,000‘or more, excluding indebiediess (momgage an sour primary persal residence? Examples inch creditcard debts, auto oan, and stdent fans lOve @ xo ; ‘Name uf Der (Vou, Spouse; Immediate ‘Type of Creditor (Commercial Bank, Credit Union, Individual. ee} I OTHER DISCLOSURES >), During the preseing calendar year; were you, your sponse oF mets of you? immediate Rinilyo dnetor, officer, goveming board meinber employee, nJeyendent contacto, of restive bbbyist ofa wenproft corporation or organiza Speratng in the Site primarily for religins charitable, scent, trary, public heath an safety, or educational purposes? ‘ Byes CINo > Do nat list State boot oF entities, or entities created hy 4 politcal subdivision ofthe State > Doo not list cryanizations of which you area mere member orsubserber Name of Person “isiHier Postion Name of Nonprofit Nature of Business or Purpese| oruilon oF Cepanization of Organteation Tint Moone [sonmactettooney Counly Community community action newwork ne Services ne 1 ‘{b), IC the listed nonprofit corporations or organizations do business wk the State or reosive Stale funds, pleass provide brief | _deserption of thematic ofthat husines, if Gown, o¢ with which dé diiense could veasouably be ke Name of Nonproft Corporation or Organization Describe State Busineys or State Fonding ~ Fonding for commonity tasca programs ‘This entire document and any attachments are public record. Page Sof 1210, List all sources of income (no spec arn of ore than $5,000 received by you Jour spouse, ar members of your mediate family duvng the precedir calendar year. Uncude salary, wage staielocal retirement. piofestonalfes, \bonoraria, interest divideuds, rental come, and busines ison ‘Do no clue incorne received from the following sources: > Capita gains > Federal government eetiement > Miley reurement ___Soeialsccucity income/SSDE | Name of Sovrce Type of Business/tadustry “Type of Income Recipient of Income IL had no repoable encore over $5,000 in the preceding caleulr yout [Tim Moore FTim Moore, Attomey ar Law [law fier Salary and dividends Tim Moore enral prapersy ‘enbl property rental income Dan Moore ‘Kings College college salary - 11. Are you a practicing anorney? © Yes CNe Ci Jadiciat Officer State atiricy. IFVes*, check each category of legal representation in swhich you or the law fim: with which yau are associated fas earned leyal fees of $10,000 or more during the preceding ealendar year. IE Administrative DiAdmiratty corporate Crieninal 1 Decedent's Estates Cnvitenmernal Dnsurance tabor Local Govermant Real Proseny Useentes Ow |B Tor gation fnciuding — L{Ulities Regulation Other category not listed or didnot earn legal Fees of $10.000 regligence) 6 noe daring te preceding ends _ 12, Are you (1) a loensod profes father than an amore) a do you provide consul srviees ‘ndiviiay or asa member of 9 profesional association an (2d you charge or were you oid over $10.00 ,forshone servers daring the preceding calendar yeu? yes @No Type of Business ‘Nature of Services Rendered ‘This entire document and any attachments are pubsic record. Page 6 of 12[ae yo yor employes you spi or nee of yours aly oir emplye: |+ Licensed by the State board or employing eatin with which you ar or wil be asinted or Regulated by the State board or employing eotity wih which you are or will be associated oF | sts tnt Su ero ho eer tm? [Yes CINo i LegistucriJudicial Officer - You are nex required fo complete this question if you are fling because you are a legislator ora judicial officer or you ae (iling as an appointee to those offices. ‘Name of Person ‘Name of Employer GF applicable) ‘Type of Relationship (Licensing, jp _ Regulatory, Business) f 14. During che preceding calendar year, were you, your spouse, or mershers of your siniédie Family'adirecear,afMice, oF leoverning board member of any society, organization, of advocacy group which has un interest pertaining to subject matter areas lover which your ageecy or hoard may have jurisdiction? [Ves CINo © Legislator/iudicial Orficer - You are not required 10 complete this question if you are filing because you are a legislauot ora judicial officer of you are filing a8 an appoinune to those offices. + Do nat list organizations of which you are only a member (cota lextership re). ‘Name of Person ‘Nawte of Society, Organization or | Leadership Postion Director, OMicer, ‘Advecacy Group ‘Boned Member) 15. Have you ever been convicted ofa felony for whieh you have not ceckived either (i) panion of innocence or (if) an arder of ‘expongement cegarding tha cinvition? ‘Cyes BNo ‘Offense Date of Conviction | County of Conviction | State of Conviction This entire document and any attachments are public record Page 7 of 12“16. Daring any calendar quarter inthe preceding year (bi only the time period after you were appoieted, employed or fled or were Jpominated as a candite, did you + recive any Us) exceeding $200 per quarter fiom aperson or group of persons ating iether, and + when both you and'hose persons) were lide Novth Carohe he ime you aveepted the pits), il “the gifs) were givea under circumstces sha would lead a teasanable person to conclude that they were given for lobbying? Iraves No : > Donor eepor iis piven by snembers of your extended family > Denar senor its that have previously beea reported by you fo the Department af the Secretary of State an the “Exsonse Report for Exerpledl Persons.” ‘Date em Received Name and Address of Deseribe Item Received | Estieated Market Value Donoris) 17 Daring the receting yer (ut ont the ie paid afer you were al ni fd or were nominated a a lcandidate) have you 5: j | acted "schoo xoeting $20 aa pena ros poe egies and + those persons} were ouside Non Carona and | the scholarship was slated to your public position? A “scbsiarshfp” és a grant-in-ald to a(téad:a conference, meeting, oF similar eveat. ce [Iver No Clings Oftver- You are notemuisedto ciple Bis ued Ifyou aa juicer oF you a king us 8 judicial officet appointee. | % Darotespo gist ave previo beer repos by out the Deparment of he Secretary af Slats an he “pen Report for Exempted Persons.” > Legislator are not regotred to report scholarships paid by 3 nonpartisan legislative organization of which the Fepistator or the General Assembly da meraber or participact or ‘Name and Address of Donors) nails af that ofganization, "Bstintated Market Valne ‘This entire document and any attachments are public record. Page 8 of 1218. Are you ora member of your immediate fly cca reseed ‘bys roby principe or wr go reper as such wathin the preceding 12 months? yes Ro Name of Lobbyist Lobbyist’s Principal Date of Registration Registration 18), List the name of each bsingss with which you are associated where yoo member oyu immediate family isan “employee, director, officer, parmer, proprietor, of ment or i pe ‘Name of Peeson Relationship to Filer ‘Name of Company Role of Person TDNo Business Associations Tim Moore Ter [Tim Moore. Attomey at Law, [President - sole shareholder L [p.A. Wl Moore — Kings College recruiter 1910) 1Fyou keel eny company or buses ety ited (2) abowe has any mae bsiness dealings oF bases conics ‘ofthat business stiviy. wit the State, of i regulated by the Ste, provide a bret Name of Company or Business Entity Description of Business Activity with the State OW apticale (No emis sted on #192) CINo elaionship / Not known ‘Tim Moore, Attomey'at Law, PA. This entire document and any attachments aro public record. Tes apne afc es Page 9 of 4220. iid a Council of State memiser appoint you to or recommend you far sppoiniment to a board covered by the Bthios Act? Couneit [or Se momber are + Govemee + Govern = Seti of Sine +See Aue + Sue Teaaer = bupenntendent of Public tition + Asorney General + Comisinier of Apricas + Commissiner of Labor | + Gomis of fnrance ‘ ye @No : me ives ‘tal contributions you (0% iniediat family members) made dating the preceding calendar year with a cumulaive toa la rofe than $1,000 tothe Council of State raember ho appointed you, (Contributions are defined in NEG. 163-278 6(6) and inchude, bul ate not limited 0, “any advance, vonveyance, deposi ution, transfer of funds, lean, payment ft, pledge or subscription of money or anything of vahie whatsoever” ‘Amount ” ‘Contributed to ~ This entire document and any attachments are public record. Page 10 of 12[>i Are wou not or ace yea prospective dente to 1a. the head of a prieipel state department (eg. cabinet secretary) appointed by the Govemer; [Yes & No b. a Nowth Carolina Supreme Court Justice, Court of Appeals, Superior ur District Cour Sedge, c. amember of any ofthe following beards + ARC Commission * Cons Resorts Comision + Sine Boar of Education + Sine Roar nf eters : * inplyinen Scour Consison + Environment Management Commasion + Ingstna Commision + Ste Peronnel Commision “Rules Review Comarsion * oar of Tnsporation + UNC Boat of Govemors = Ulies Commision + Wildlife Resources Commission | U:Tfs0, wore you appointed to, or are you being considered for, apoiatment to your public |T1ves “No position by a Count of State Member (Governor, L Govemar, Secretary af State, State “Auditor. State Treasucer, Superintendent of Publis tnstaction, Attorney General, raynissioner of Labgr, or Commissioner of Jasur Commissioner of Agriculture, «-If's9, you mast indicate whether during the preceding caleudar year you (ho mediate [LJ Yes. FINO. ities with cespeet to oF on behelf of the Family members) engaged in ony ofthe following candidate or campaign commitee ofthe Council of State member who appointed you © your public position | {Collected contibutons from mile coneibtars, (oak possesion of such mule aoe ead tanaierred or dlwered tose collected contributions to tHe cand dae contre *Contbunions are detines in N.C.GS. 165-278.6(6) and ince. OH 9 | ooo. any advance, conveyance depos, aistibution, trunsfer of funds, oan, wr met Bl pledge cr suiwerignion of money anythiigof value whalsoey =r _ 4 ! i, Howe a tndraser at your esience oF place of business? loves No TVatumoocd fo campaign eelated activities, which inci, hut wre sot ime 0, vo 2No ‘phone banks, event assistariee, mailings, Can¥ ASS". ‘surveying, or any other activity that 0 ances the campaign of scandals” ‘This entire document and any attachments are public record. Page 11 of 1222. Ase you aware ol any other information that you believe may mssist he SiateEthice Commision in advising you concerning your compliance with the Staxe Goveinment Ethics Act? ‘Ver @No In aeson tha the snformation povided i this Statement of Beancmic Interest andl any aachwnens rete ate tue empl, wad lncourate tothe best of my knowledge and belie Faso certify that} ave not transfered, and will nar transter, any asst, iterest, or propeny For the pumpose af concealing ft front Liselowuee while reining an gauitable ierest understand that avy Statement of Eemnorni Interest and dey attachments or supplements thereto are public record, __.____| a | acknow edge thot {have read and understand N C.GS, V3RA-26 regarding concealing o filing 0 Jd N.CGS.13KA.27 ceasing providing fle information ose material information 6 1384-26. Conceatiny or farting to aisclase material baformation i A filing pecson who keowingly corceats or knowing fails to disclose mformation tha i eequired 19 be disclosed on a Matement af economic interest under this Aicle shall be guilty ofa Class T mslemmaror and shall be subject to disciplinary petion under GS, 138-49, (2006-201.5 1) © 1988-27, Penalty for fale information. A files person who provides false information on g statement of economic interest as required ardor this Article know ine that the nforination i false ts sult ef a Class H Felony and shall be subjee: to diseiptinary astion unger G.S. T38A-45. (2008-201 fangs | | Fimathy Keith Moore **Notarization is na lomger required” * | titan ae BAY 2 Signature Dare | Ln . 1 This entire document and any attachments are public record. Page 120f 12