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STATEMENT OF FINANCIAL INTERESTS

11th Floor, State Capitol P.O. Box 95086 Lincoln, NE68509 (402) 471-2522

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POSTMARK DATE

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MICROFILM NUMBER

79'4010'8

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BEFORE COMPLETING READ FILING REQUIREMENTS

!!E.,f1.CCOUfHr\fHLlTY &. ufSCl.OSUR£ CQr'IMISSION

NADC FORM C-1

• Candidates for designated offices and holders of designated offices and positions must file this statement. See Sections 1A and 1B of the instructions. • Candidates (including incumbents) subject "to this filing requirement must file with the Commission and with the appropriate election official (See Instructions). I • Designated officeholders and holders of designated positions must file this statement with the Commission annually. • Dollar values need not be report for any item, except Item 11. • Persons who fails to file as reauired is subiect to a civil penalty of up to $2,000. ITEM 1 I YOUR NAME, ADDRESS AND PHONE NUMBER

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Name

LAST Address

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STREETADDRESSORRURALROUTE ITEM 2

I OCCASION

FOR FILING (Check Appropriate

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~ndidate for elective office Annual officeholder's or state employee's report

o Left office or position D Newly

appointed to office or position

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See OFFICE HELD & TERM OF OFFICE (Incumbent elected/appointed officials and state employees. IB of instructions) , List the office or position you currently hold Whzequires,this filing. If you have left office, list the Offi:,e:U held. ITEM 3

Office or Position:

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Name of City, County, District, or State Agency: ITEM 4

I OFFICE

SOUGHT (Candidates

only.

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Term:

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ENDS

See 1A of instructions)

List the office sought which requires this filing. Office: Name of City, County, District, or State Office: ITEM 5

I PERIOD

COVERED BY THIS STATEMENT

7

This statement must cover all financial interests for the entire "preceding calendar year" and not just as of year-end. If you have left office, this statement must cover all financial interests from the end of the calendar year for which you previously filed up to and 9the date you left office. This statement covers the preceding

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calendar year January1 through December 31,

Left office, this statement covers the period January 1,

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to (DATEYOULEFTOFFICEORPOSITION)

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Revised August 2007

-,.. ITEM 6 I SOURCES OF INCOME OF OVER $1,000 Income includes money or any other form of recompense constitutinq income under the Internal Revenue Code. (See definitions) List the nature of the source's business and the nature of the services you Name and address of any source' (including an individual, business, rendered or the circumstances under which income was received. NOTE: Do not body of government, political subdivision or body corporate) from list the amount of the income. whom income of over $1,000 was received. 1.) 1a.) ...--, .Po ."<~A'J

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'NO~ ~~gME ~~~ Fto~CLO~~~, CORPORATION OR OTHER PERSON, LIST THE SAME AS THE SOURCE CLIENTS THEREOF.

ITEM 7 I.BUSINESSES

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OF OR PARTICIPATION IN A PROPRIETORSHIP, OF INCOME, BUT NOT THE PATRONS, CUSTOMERS,

WITH WHICH YOU ARE ASSOCIATED

PARTNERSHIP, PATIENTS, OR

(See definitions)

Name and address of all businesses, orgariizations, or associations (profit and non-profit) with which you held a position of officer, director, limited liability company member, partner, or stockholder and any entity in which you held a position of trustee. Such reporting is required based on the position held, not on whether income was received. You need not report business associations which are otherwise listed under Item 6. Name and Address of Business or Organization Nature of Association 1.)

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'ITEM

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8

R,EAL PROPERTY 0 .,~~ FI.LER IN NEB~SKA personal residence need not be reported.) -.

"~Iued at less than $1,000 and your .

(Real propert~ '.'

List all real property in yourname or in which you have a direct ownership interest. The description required must be sufficient to identify the location of the property .. Exceptions: You need not report real.estate owned by a business listed in Item 6 or 7, your personal residence of real property valued at less than $1,000. Personal residence refers to your principal dwelllnq-house and adjacent land used for house-hold purposes, such as lawns and oardens, Nature of Property Location of Property (such as: agricultural, commercial, industrial, residential-rental) (Description or Address

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ITEM 9 .

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OTHER FINANCIAL INTERESTS AND PROPERTY HELD DURING THE PERIOD OF THIS STATEMENT WHICH EXCEEDED A FAIR MARKET VALUE OF $1,000 AT ANY TIME DURING THE REPORTING PERIOD

(a) List the names and addresses of the institutions in which Y9u had checking and savings accounts and certificates of deposit. Address

Financial Institution

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(b) List the names of the issuers of all stocks, bonds, and government securities, not otherwise listed under Items 6 or 7.

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ITEM 1

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\i CREDITORS TO WHOM $1,000 OR MORE WAS OWED OR GUARANTEED YOUR IMMEDIATE FAMILY.

BY YOU OR A MEMBER OF

Exception: Loans from a relative and land contracts which have been recorded with the County Clerk or Register of Deeds need not be reported. Accounts payable, debts arising out of retail installment transactions or loans made by a financial institution in the ordinary course of business need not be reported. Name

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Address

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(!!O /U"~R SOURCES OF GIFTS O~ (See definitions)

Name and address of Donor

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VALUE OF MORE THAN $100 R~IVED

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Occupation or nature of business of Donor

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Value of Gift (See Key Below) Choose

Value:

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Description of Gift and Circumstances or Occasion for Gift

The monetary value of each gift shall be categorized based on the good faith estimate of the filer. For each reported gift insert in the Value column the letter which corresponds to the value category of the gift. The value categories are: '.

A) $100.Q1 to $200; B) $200.01 to $500; C) $500.01 to $1,000; D) $1,000.01 or more.

ITEM 12

I SIGNATURE

OF FILER AND DATE.

I hereby state that I have used all reasonable diligence in the preparation of this Statement and that to the best of my knowledge it is true and complete.

~~xWttj2 (Signature OfFiler)

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