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NEBRASKA ACCOUNTABILITY AND DISCLOSURE COMMISSION

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MICROFILM NUMBER

STATEMENT OF FINANCIAL INTERESTS

11th Floor, State Capitol P.o. Box 95086 Lincoln, NE 68509 (402) 471-2522

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;POSTMARK DATE

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799C092

Fl'F C F~fit::1QaUSE ONLY r'J e-r NEf:'F"\ :-! ;C (;1 '.'

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20ng APR 20 At'! 9: 09

BEFORE COMPLETING READ FILING REQUIREMENTS

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NADC FORM C-1

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• 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). • Designated officeholders and holders of designated positions mustfile this statementwith the Commissionannually. • Dollar values need not be report for any item, except Item 11. • Persons who fails to file as requiredis subject 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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FIRST

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I OCCASION

FOR FILING (Check Appropriate

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CITY

STREET ADDRESS OR RURAL ROUTE

ITEM 2

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ZIP CODE

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D A candidate for elective office ~nnual officeholder's or state employee's report

o Left office or position o Newly appointed to office or position

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OFFICE HELD & TERM OF OFFICE (Incumbent elected/appointed officials and state employees. IB of instructions) List the office or position you currently hold which requiresthis filirig. If you have left office, list the offlce you held, ITEM 3

Office or Position:

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Term:

01/(

Ol/()C} Bi!GINS

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

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ENDS

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ITEM 4

I OFFICE

SOUGHT (Candidates

only. 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

This statement must cover all financial interestsfor the entire "preceding calendar year"and not just as of year-end. If you have left office, this statement must cover all financial interestsfrom the end of the calendar year for which you previouslyfiled up to and including the date you left office. .

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This statement covers the preceding calendar year January1 through December 31, Left office, this statement covers the period January 1,

:;;"'008

to (DATE YOU LEFT OFFICE OR POSITION)

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Revised August 2007

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ITEM 6

I SOURCES

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OF INCOME OF OVER $1,000

lncorne includes money or any other form of recompense constituting income under the Infernal Revenue Cope. (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 whom income of over $1,000 was received. list the amount of the income.

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·NOTE: IF INCOME RESULTED FROM EMPLOYMENT BY, OPERATION OF OR PARTICIPATION IN A PROPRIETORSHIP, PARTNERSHIP; CORPORATION OR OTHER PERSON, LIST THE SAME AS THE SOURCE OF INCOME, BUT NOT THE PATRONS, CUSTOMERS, PATIENTS, OR. CLIENTS THEREOF.

ITEM 7

I BUSINESSES WITH WHICH YOU ARE ASSOCIATED (See definitions)

Name and address of all businesses, organizations, 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 ofAssociation

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.ITENiS .. REA~.PROPEFtT\ ~~" rlE FILER IN NEBRASKA (Real p!Operty'Val~ed at les~ than . 'lJ~rsonal residence ne.ed notb~-reported.). .,.; ; , ..•.

$~,000 and your '.

Ltst all r~alpr'op.ertYih·.yQ(jr Jiatii~. or in o/hich you have a direct ownership interest: Thedescrlption required must be sulflclent to identify the location ofthe.propsrty.' 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 ,ooci.Personal residence refers to your principal dwelling-house and adjacent land used. for house-hold purposes, such as lawns and gardens. Location of Property Nature of Property ... (Description or Address (such as: agricultural, commercial, industrial, residential-rental)

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'ITEM9

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OTHER FINANCIAL INTERESTS AND PROPERTY'HELI)OURING THE PERIOQ OF THJS 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 you had checking and savings accounts and G~rtificates 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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'. (c) Describe other property owned or held forthe production of income not otherwise disclosed in Items 6; 7, 8 or 9(a)(b),lnclude leaseholds and other interests in reat estate, promissory notes 'and other obligations owed to y6'u, beneficial interests in trusts and' estates, cash value life insurance, IRAs, deferred income and retirement plans. Exception: Do not include accounts receivable, inventory, fixtures and equipment owned or used by a business listed in Items 6 & 7 or household goods, personal automobiles and other tangible personal property unless such property was held primarily for sale or exchanqe .

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ITEM 10

'I CREDITORS TO WHOM $1,000 OR MORE WAS OWED OR GUARANTEED BY YOU OR A MEMBER OF YOUR IMMEDIATE FAMILY.

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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

Address

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ITEM 11

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SOURCES OF GIFTS OF A VALUE OF MORE THAN $100 RECEIVED EXCEPT GIFTS FROM RELATIVES. (See definitions) , ,

Name and address of Donor

Occupation or nature of business of ' Donor

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, Value of Gift (See Key Below)

Description of Gift and Circumstances or Occasion for Gift

Choose Value: Choose Value: Choose Value: Choose Value: Choose Value: Choose Value: Choose Value: Choose Value:

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) $100.01 to $200; B) $200.01 to $500; C) $500.01 to $1,000; D)

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or more.

ITEM 121 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.

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(Signatur{( of Filer)

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