Austin City Council Financials, 2009 - Mike Martinez

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P.O. Box12070

Texas Ethics Commission

(512) 463-5800

Austin. Texas 78711-2070

PERSONAL FINANCIAL STATEMENT

1 -800-325-8506

FORM PFS COVER SHEET TOTAL NUMBER OF PAGES FILED:

Filed in accordance with chapter 572 of the Government Code. For filings required in 2009, covering calendar year ending December 31 , 2008.

ACCOUNT *

Use FORM PFS--INSTRUCTION GUIDE when completing this form. 1

NAME

u.

nut

TITLE; FIRST: Ml

NICKNAME; LAST; SUFFIX

OFFICE USE ONLY Date Received

/TlMwt, 2

ADDRESS

rv>

era
522^

TV"**- Twl

fab, it | 3

TELEPHONE NUMBER

4

"» —q -,f

ADDRESS ; PO BOX; APT / SUITE »• CITY; STATE: ZIP CODE

[

-0

($\L)

_

_,

**"" —

o —-

wite

Receipt # HD / PM

(CHECK IF FILER'S HOME ADDRESS)

AREA CODE

~D

o >• (/> t— l^ cn

tZ4- ^\%l^

~-

^,-y O

_

2> -H

AmounJ.-'

Date Processed

PHONE NUMBER: EXTENSION

{ L >

Date Imaged

—}

™ o

J^

-H m

—^

~ ."J

*^J

j™ ^»

REASON FOR FILING

\~] CANDIDATE

(INDICATE OFFICE)

STATEMENT H(FI FCTFD OFFICER

(J> (j ^-U \

f^UwV*,

"

\{frl*ft,

*2-

(INDICATE OFFICE)

[~~l APPOINTED DFFICFR

(INDICATE AGENCY)

fl FXFOUTIVF HFAD

(INDICATE AGENCYl

D FORMER OR RETIRED JUDGE SITTING BY ASSIGNMENT PI STATE PARTY CHAIR

IINOCATF PARTY;

n OTHFR

(INDICATE POSITION)

Family members whose financial activity you are reporting (filer must report information about the financial activity of the filer's spouse or dependent children if the filer had actual control over that activity):

SPOUSE DEPENDENT C -in n 1

r> 3.

In Parts 1 through 18, you will disclose your financial activity during the preceding calendar year. In Parts 1 through 14, you are rpquirfid to disclose not only your own financial activity, but also that of your spouse or a dependent child if you had ctulual uunUul over that person's financial activity.

COPY AND ATTACH ADDITIONAL PAGES AS

NECESSARY Revised 12/01'2008

Texas Ethics Commission

P.O.Box12070

Austin. Texas 78711-2070

(512)463-5800

SOURCES OF OCCUPATIONAL INCOME

1-800-325-8506

PART 1A

NOT APPLICABLE

When reporting information about a dependent child's activity, indicate the child about whom you are reporting by providing the number under which the child is listed on the Cover Sheet.

INFORMATION RELATES TO

FILER

D SPOUSE

D DEPENDENT CHILD

NAME AND ADDRESS OF EMPLOYER / POSITION HELD

EMPLOYMENT

r~] (Check If Filer's Home Address)

EMPLOYED BYANOTHER

NATURE OF OCCUPATION

D SELF-EMPLOYED

INFORMATION RELATES TO

D FILER

D SPOUSE

D DEPENDENT CHILD

NAME AND ADDRESS OF EMPLOYER / POSITION HELD | | (Check If Filer's Home Address)

EMPLOYMENT

D EMPLOYED BY ANOTHER

NATURE OF OCCUPATION

D SELF-EMPLOYED

INFORMATION RELATES TO

D FILER

L] SPOUSE

[H DEPENDENT CHILD

NAME AND ADDRESS OF EMPLOYER / POSITION HELD

fj (Check If Filer's Home Address)

EMPLOYMENT H EMPLOYED BY ANOTHER

PI SELF-EMPLOYED

NATURE OF OCCUPATION

COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY Revised 1?/01/2008

Texas Ethics Commission

P.O. Box 12070

(512) 463-5800

Austin. Texas 78711-2070

RETAINERS

1 -800-325-8506

PART 1 B

OTAPPLICABLE

This section concerns fees received as a retainer by you, your spouse, or a dependent child (or by a business in which you, your spouse, or a dependent child have a "substantial interest") for a claim on future services in case of need, rather than for services on a matter specified at the time of contracting for or receiving the fee. Report information here only if the value of the work actually performed during the calendar year did not equal or exceed the value of the retainer. For more information, see FORM PFS--INSTRUCTION GUIDE. When reporting information about a dependent child's activity, indicate the child about whom you are reporting by providing the number under which the child is listed on the Cover Sheet. NAME AND ADDRESS

FEE RECEIVED FROM

NAME OF BUSINESS

FEE RECEIVED BY D FILER OR FILER'S BUSINESS D SPOUSE OR SPOUSE'S BUSINESS D DEPENDENT CHILD OR CHILD'S BUSINESS

FEE AMOUNT

D LESS THAN $5,000

D $5,000--$9,999

D $10,000--$24,999

D $25,000-OR MORE

NAME AND ADDRESS

FEE RECEIVED FROM

NAME OF BUSINESS

FEE RECEIVED BY D FILER OR FILER'S BUSINESS D SPOUSE OR SPOUSE'S BUSINESS D DEPENDENT CHILD OR CHILD'S BUSINESS

FEEAMUUNI

D LESS THAN $5,000

D S5.000-S9.999

D S10,000-$24.999

D $25,000-OR MORE

COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY Revised 12/01/2008

Texas Ethics Commission

P.O. Box 12070

Austin, Texas 78711-2070

(512) 463-5800

STOCK

1 -800-325-8506

PART 2

Q5[ NOT APPLICABLE

List each business entity in which you, your spouse, or a dependent child held or acquired stock during the calendar year and indicate the category of the number of shares held or acquired. If some or all of the stock was sold, also indicate the category of the amount of the net gain or loss realized from the sale. For more information, see FORM PFSINSTRUCTION GUIDE. When reporting information about a dependent child's activity, indicate the child about whom you are reporting by providing the number under which the child is listed on the Cover Sheet. 1

BUSINESS ENTITY

NAME

2

STOCK HELD OR ACQUIRED BY

D FILER

D SPOUSE

3

NUMBER OF SHARES

D LESS THAN 100

D 1 00 TO 499

D 5,000 TO 9,999

D 10,000 OR MORE

D LESS THAN $5,000

D $5,000-$9,999

4 IF SOLD

D NET GAIN

D DEPENDENT CHILD

1 ,000 TO 4,999 D

D 500 TO 999

D $10,000-424,999

D S25.000-OR MORE

D NET LOSS

BUSINESS ENTITY

NAME

STOCK HELD OR ACQUIRED BY

D FILER

D SPOUSE

D DEPENDENT CHILD

NUMBER OF SHARES

D LESS THAN 100

D 100 TO 499

D 500 TO 999

D 5,000 TO 9,999

D 10,000 OR MORE

D LESS THAN $5,000

D $5,000-$9,999

IF SOLD

D NET GAIN

D 310,000-424,999

D1 ,000 TO 4,999

D $25,000--OR MORE

D NET LOSS

BUSINESS ENTITY

NAME

STOCK HELD OR ACQUIRED BY

D FILER

D SPOUSE

NUMBER OF SHARES

D LESS THAN 100

D 1 00 TO 499

D 5,000 TO 9,999

D 10,000 OR MORE

D LESS THAN $5,000

D $5,000-49.999

IF SOLD

D NET GAIN

D DEPENDENT CHILD

D 500 TO 999

D 1 ,000 TO 4,999

D $10,000-424,999

D $25,000-OR MORE

D NET LOSS NAME

BUSINESS ENTITY STOCK HELD OR ACQUIRED BY

D FILER

D SPOUSE

D DEPENDENT CHILD

NUMBER OF SHARES

D LESS THAN 100

D 1 00 TO 499

D 500 TO 999

D 5,000 TO 9,999

D 10,000 OR MORE

D LESS THAN $5,000

D $5,000-49,999

IF SOLD

D NET GAIN

D $10,000-524,999

D1 ,000 TO 4.999

d $25.000-OR MORE

D NET LOSS NAME

BUSINESS ENTITY STOCK HELD OR ACQUIRED BY

D FILER

D SPOUSE

NUMBER OF SHARES

D LESS THAN 100

D 100 TO 499

D 5.000 TO 9.999

D 10,000 OR MORE

D LESS THAN $5,000

D $5,000-$9,999

IF SOLD

Q NET GAIN

D DEPENDENT CHILD D 500 TO 999

D S10.000-$24,999

1 ,000 TO 4,999 Q

G 525,000-OR MORE

D NET LOSS COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY 12/01/2008

P.O. Box 12070

Texas Ethics Commission

Austin, Texas 78711-2070

(512)463-5800

BONDS, NOTES & OTHER COMMERCIAL PAPER

1-800-325-8506

PARTS

NOT APPLICABLE

List all bonds, notes, and other commercial paper held or acquired by you, your spouse, or a dependent child during the calendar year. If sold, indicate the category of the amount of the net gain or loss realized from the sale. For more information, see FORM PFS--INSTRUCTION GUIDE. When reporting information about a dependent child's activity, indicate the child about whom you are reporting by providing the number under which the child is listed on the Cover Sheet. DESCRIPTION OF INSTRUMENT HELD OR ACQUIRED BY D FILER

D SPOUSE

D DEPENDENT CHILD

IF SOLD D LESS THAN $5,000

D NET GAIN

D S5,000-$9,999

D $10,000-$24,999

D $25,000-OR MORE

D NET LOSS

DESCRIPTION OF INSTRUMENT HELD OR ACQUIRED BY D FILER

D SPOUSE

D DEPENDENT CHILD

IF SOLD D LESS THAN $5,000

D NET GAIN

D $5,000-$9,999

D $10,000-$24,999

D $25,000-OR MORE

D NET LOSS

DESCRIPTION OF INSTRUMENT HELD OR ACQUIRED BY D FILER

D SPOUSE

D DEPENDENT CHILD

IF SOLD D NET GAIN

D LESS THAN $5,000

D $5,000-$9,999

D $10,000-$24,999

D $25,000-OR MORE

D NET LOSS

COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY Revised 12/01.2008

Texas Ethics Commission

P.O. Box 12070

Austin, Texas 78711-2070

(51 2) 463-5800

MUTUAL FUNDS |

1 -800-325-8506

PART 4

| NOT APPLICABLE

List each mutual fund and the number of shares in that mutual fund that you, your spouse, or a dependent child held or acquired during the calendar year and indicate the category of the number of shares of mutual funds held or acquired. If some or all of the shares of a mutual fund were sold, also indicate the category of the amount of the net gain or loss realized from the sale. For more information, see FORM PFS--INSTRUCTION GUIDE. When reporting information about a dependent child's activity, indicate the child about whom you are reporting by providing the number under which the child is listed on the Cover Sheet. NAME

1 MUTUAL FUND

2

SHARES OF MUTUAL FUND HELD OR ACQUIRED BY

3 NUMBER OF SHARES OF MUTUAL FUND

4

IF SOLD

D NET GAIN

;

/ ffl FILER

D SPOUSE

Ql LESS THAN 1 00

G 1 00 TO 499

D 5,000 TO 9,999

D 10,000 OR MORE

D LESS THAN $5.000

G DEPENDENT CHII n

G 500 TO 999

G $5,000-$9,999

G 1 ,000 TO 4,999

D S10,000-$24,999

Q $25,000-OR MORE

D NET LOSS NAME

MUTUAL FUND

flld'j SHARES OF MUTUAL FUND HELD OR ACQUIRED BY NUMBER OF SHARES OF MUTUAL FUND

IF SOLD

G NET GAIN

/KlAS5Axk^Wr5 JrwteTiAj)

I^FILER

D SPOUSE

D9-LESS THAN 1 00

G 1 00 TO 499

D 5,000 TO 9,999

O 10,000 OR MORE

D LESS THAN $5,000

G

h&VIVv. r^v^

nFPFNDFNTCHII D

Q 500 TO 999

G $5,000--$9,999 G $10,000-$24,999

G 1 ,000 TO 4,999

fj $25,000-OR MORE

D NET LOSS NAME

MUTUAL FUND

SHARES OF MUTUAL FUND HELD OR ACQUIRED BY

JJSJ/ILER

NUMBER OF SHARES OF MUTUAL FUND

IF SOLD

D SPOUSE 1

G LESS THAN 1 00

G

00 TO 499

Q 5,000 TO 9.999

G 10,000 OR MORE

G LESS THAN $5,000

G $5,000-89,999

G

nFPFNDFNTCHII D

Q 500 TO 999

|^1 ,000 TO 4,999

D NET GAIN G $10,000~$24,999

f j S25.000-OR MORE

D NET LOSS COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY Revised 12/01.'2008

Texas Ethics Commission

P.O. Box 12070

Austin, Texas 78711-2070

(512)463-5800

INCOME FROM INTEREST, DIVIDENDS, ROYALTIES & RENTS

1-800-325-8506

PART 5

NOTAPPLICABLE

List each source of income you, your spouse, or a dependent child received in excess of $500 that was derived from interest, dividends, royalties, and rents during the calendar year and indicate the category of the amount of the income. For more information, see FORM PFS--INSTRUCTION GUIDE. When reporting information about a dependent child's activity, indicate the child about whom you are reporting by providing the number under which the child is listed on the Cover Sheet. NAME AND ADDRESS

SOURCE OF INCOME

RECEIVED BY D FILER

AMOUNT

S500--S4,999

SPOUSE

D DEPENDENT CHILD

'$5,000-59,999

D $10,000-$24,999

D $25,000-OR MORE

NAME AND ADDRESS

SOURCE OF INCOME

RECEIVED BY D FILER

AMOUNT

D $500-$4,999

D SPOUSE

D DEPENDENT CHILD

D $5,000--S9,999

D $10,000-824,999

D $25,000-OR MORE

NAME AND ADDRESS

SOURCE OF INCOME

RECEIVED BY D FILER

AMOUNT

D $500-$4,999

D SPOUSE

D $5,000-$9,999

D DEPENDENT CHILD

[J $10,000-524,999

Q $25,000-OR MORE

COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY Revised 12/01/2008

(512) 463-5800

Austin, Texas 78711-2070

P.O. Box 12070

Texas Ethics Commission

1 -800-325-8506

PERSONAL NOTES AND LEASE AGREEMENTS

PART 6

LJ NOTAPPLICABLE

Identify each guarantor of a loan and each person or financial institution to whom you, your spouse, or a dependent child had a total financial liability of more than $1,000 in the form of a personal note or notes or lease agreement at any time during the calendar year and indicate the category of the amount of the liability. For more information, see FORM PFS-INSTRUCTION GUIDE. When reporting information about a dependent child's activity, indicate the child about whom you are reporting by providing the number under which the child is listed on the Cover Sheet. 1

2

PERSON OR INSTITUTION HOLDING NOTE OR LEASE AGREEMENT LIABILITY OF

l/flitfU&'TV I H *--\ FILER

3

Idttotl

U SPDIISF

CuJ-ti

\Jh.h^

~\ nFPFNDFNTr.HII D

GUARANTOR

4

AMOUNT

Ll^$1 ,000-54,999

D $5,000-39,999

D S10.000-S24.999

D S25.000--OR MORE

PERSON OR INSTITUTION HOLDING NOTE OR LEASE AGREEMENT LIABILITY OF D FILER

D SPOUSE

D DEPENDENT CHILD

GUARANTOR AMOUNT

D $1 ,000-54,999

D S5,000-$9,999

D $10,000-S24,999

D S25.000-OR MORE

PERSON OR INSTITUTION HOLDING NOTE OR LEASE AGREEMENT LIABILITY OF Q FILFP

D spnusF

D nFPFNnFNTnHii n

GUARANTOR AMOUNT

D Si ,000-54,999

D 85,000-59,999

D 510,000-524,999

D S25.000-OR MORE

COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY Revised 12/01/2008

P.O. Box 12070

Texas Ethics Commission

Austin. Texas 78711-2070

(51 2) 463-5800

INTERESTS IN REAL PROPERTY

1 -800-325-8506

PART 7A

NOT APPLICABLE

Describe all beneficial interests in real property held or acquired by you, your spouse, or a dependent child during the calendar year. If the interest was sold, also indicate the category of the amount of the net gain or loss realized from the sale. For an explanation of "beneficial interest" and other specific directions for completing this section, see FORM PFS-INSTRUCTION GUIDE. When reporting information about a dependent child's activity, indicate the child about whom you are reporting by providing the number under which the child is listed on the Cover Sheet. HELD OR ACQUIRED BY 2

D SPOUSE

D FILER

DEPENDENT CHILD

STREET ADDRESS. INCLUDING CITY, COUNTY, AND STATE

STREETADDRESS f~] NOT AVAILABLE r

CHECK IF FILER'S HOME ADDRESS NUMBER OF LOTS OR ACRES AND NAME OF COUNTY WHERE LOCATED

DESCRIPTION LOTS ACRES

NAMES OF PERSONS RETAINING AN INTEREST fj NOT APPLICABLE (SEVERED MINERAL INTEREST)

IF SOLD D NET GAIN

D LESS THAN 55,000

D $5,000-$9,999

D $10,000-524,999

Q $25,000--OR MORE

D NET LOSS

HELD OR ACQUIRED BY

D FILER

D SPOUSE

D DEPENDENT CHILD

STREET ADDRESS, INCLUDING CITY, COUNTY, AND STATE

STREETADDRESS f_l NOT AVAILABLE fj CHECK IF FILER'S HOME ADDRESS

NUMBER OF LOTS OR ACRES AND NAME OF COUNTY WHERE LOCATED

DESCRIPTION Q LOTS G ACRES

NAMES OF PERSONS RETAINING AN INTEREST D NOT APPLICABLE (SEVERED MINERAL INTEREST)

IF SOLD Q NET GAIN

D LESS THAN S5.000

D 55,000-59,999

D 310,000-524,999

D 525,000-OR MORE

[_] NET LOSS

COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY Revised 1 2/01.-2008

P.O. Box 12070

Texas Ethics Commission

(512) 463-5800

Austin, Texas 78711-2070

INTERESTS IN BUSINESS ENTITIES

1 -800-325-8506

PART 7B

NOTAPPLiCABLE

Describe all beneficial interests in business entities held or acquired by you, your spouse, or a dependent child during the calendar year. If the interest was sold, also indicate the category of the amount of the net gain or loss realized from the sale. For an explanation of "beneficial interest" and other specific directions for completing this section, see FORM PFS-INSTRUCTION GUIDE. When reporting information about a dependent child's activity, indicate the child about whom you are reporting by providing the number under which the child is listed on the Cover Sheet. HELD OR ACQUIRED BY

D FILER

D DEPENDENT CHILD

D SPOUSE

NAME AND ADDRESS

DESCRIPTION

(Check If Filer's Home Address)

IF SOLD D LESS THAN $5,000

D NET GAIN

D $5,000-39,999

D S10,000-$24,999

D $25,000-OR MORE

D NET LOSS

HELD OR ACQUIRED BY

D FILER

D SPOUSE

D DEPENDENT CHILD

NAME AND ADDRESS (Check If Filer's Home Address)

DESCRIPTION

IF SOLD D LESS THAN $5,000

D NET GAIN

D $5,000-S9,999

D S10:000-$24,999

D $25,000-OR MORE

D NET LOSS

HELD OR ACQUIRED BY

D FILER

D SPOUSE

D DEPENDENT CHILD

NAME AND ADDRESS [~"[ (Check If Filer's Home Address)

DESCRIPTION

IF SOLD Q NET GAIN

D LESS THAN $5,000

D $5,000-$9,999

D $10.000-$24,999

Q $25,000--OR MORE

CH NET LOSS

COPY AND ATTACH ADDITIONAL PAGES AS

NECESSARY Revised 12'01.'2008

P.O. Box 12070

Texas Ethics Commission

(512) 463-5800

Austin, Texas 78711-2070

GIFTS

1 -800-325-8506

PARTS

NOTAPPLICABLE

Identify any person or organization that has given a gift worth more than $250 to you, your spouse, or a dependent child, and describe the gift. The description of a gift of cash or a cash equivalent, such as a negotiable instrument or gift certificate, must include a statement of the value of the gift. Do not include: 1) expenditures required to be reported by a person required to be registered as a lobbyist under chapter 305 of the Government Code; 2) political contributions reported as required by law; or 3) gifts given by a person related to the recipient within the second degree by consanguinity or affinity. For more information, see FORM PFS-INSTRUCTION GUIDE. When reporting information about a dependent child's activity, indicate the child about whom you are reporting by providing the number under which the child is listed on the Cover Sheet. NAME AND ADDRESS

DONOR

RECIPIENT

D FILER

D SPOUSE

J DEPENDENT CHILD

DESCRIPTION OF GIFT

NAME AND ADDRESS

DONOR

RECIPIENT

D FILER

D SPOUSE

D DEPENDENT CHILD

DESCRIPTION OF GIFT

NAME AND ADDRESS

DONOR

D FILER

RECIPIENT

D SPOUSE

D DEPENDENT CHILD

DESCRIPTION OF GIFT

COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY Revised 1,?/0i '2008

P.O. Box 12070

Texas Ethics Commission

Austin, Texas 78711-2070

(512) 463-5800

TRUST INCOME

1 -800-325-8506

PART 9

[X. NOT APPLICABLE

Identify each source of income received by you, your spouse, or a dependent child as beneficiary of a trust and indicate the category of the amount of income received. Also identify each asset of the trust from which the beneficiary received more than $500 in income, if the identity of the asset is known. For more information, see FORM PFS-INSTRUCTION GUIDE. When reporting information about a dependent child's activity, indicate the child about whom you are reporting by providing the number under which the child is listed on the Cover Sheet. NAME OF TRUST

SOURCE

2

BENEFICIARY

EH FILER

INCOME

D LESS THAN 35,000

D SPOUSE

D DEPENDENT CHILD

3

4

D S5,000--$9,999 D $10,000--$24,999 D $25 OOO-OR MORE

ASSETS FROM WHICH OVER $500 WAS RECEIVED D UNKNOWN NAME OF TRUST

SOURCE

BENEFICIARY

D FILER

INCOME

D LESS THAN $5,000

D SPOUSE

D DEPENDENT CHILD

EH $5,000-39,999

D $10,000-$24,999

D 325,000-OR MORE

ASSETS FROM WHICH OVER $500 WAS RECEIVED D UNKNOWN NAME OF TRUST

SOURCE

BENEFICIARY

D FILER

INCOME

D LESS THAN $5,000

D SPOUSE

D $5,000-39,999

D DEPENDENT CHILD

D $10,000-324,999

D 325,000-OR MORE

ASSETS FROM WHICH UVER $500 WAS RECEIVED D UNKNOWN

COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY Revised 12:01'2008

Texas Ethics Commission

P.O. Box 12070

Austin, Texas 78711-2070

(512)463-5800

BLIND TRUSTS

1-800-325-8506

PART10A

[)Q, NOT APPLICABLE

Identify each blind trust that complies with section 572.023(c) of the Government Code. See FORM PFS-INSTRUCTION GUIDE. When reporting information about a dependent child's activity, indicate the child about whom you are reporting by providing the number under which the child is listed on the Cover Sheet. 1

NAME OF TRUST

2

TRUSTEE

3

BENEFICIARY

NAME AND ADDRESS

G Fll FR

4

FAIR MARKET VALUE

D LESS THAN $5,000

D SPOUSE

G nFPFNDFNTnHll D

D S5,000--$9,999

G $10,000--$24,999

D $25,000--OR MORE

' DATE CREATED

NAM EOF TRUST NAME AND ADDRESS

TRUSTEE

BENEFICIARY G Fll FR

FAIR MARKET VALUE

G LESS THAN $5,000

G SPOUSF

G S5,000-$9,999

G nFPFNDFNTr.HII n

G $10,000-524,999

Q S25.000--OR MORE

DATE CREATED

NAME OF TRUST NAME AND ADDRESS

TRUSTEE

BENEFICIARY G FILER

G spnnSF

G nFPFNDFNT HHil n

FAIR MARKET VALUE G

LESS THAN $5,000

Q S5,000-$9,999

G $10,000--$24,999

G S25,000--OR MORE

DATE CREATED COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY Revised 12/01,2008

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