UNITED STATES SENATE PUBLIC FINANCIAL DISCLOSURE REPORT [a “Ths form contains two cover pages, ten sections for reporting certain items held by you, your spouse, or your dependent child, and detailed instructions for completing the form. COVER PAGE: Choose the cover page which covers the type of report which you are fling. Annual and Termination filers use one cover Rage New Employees and Candidates use the other page. These pages are clearly marked a the top Ifyou do not choose the correct cover page, the questions ‘asked on that page will not correspond fo your required reporting. PARTS I-X: After you have read the instructions at the back of this booklet, you must determine whether you fave items to fepor’ on each of the Parts must be completed and attached, answer the questions on the appropriate cover page. For each question ‘complete and attach that Part h the instructions. For each question checked “NO,” no further report is required. If you ddo not check either "YES" or "NO" for each applica . your form may be deemed incomplete. nce your form is complete, sign and date your form at the bottom of the cover page. Make sure you have ‘completed the information regarding your fling status at the top of the cover page. “The due date for annual reports is May 18. The due dates for new employee, candidate, and termination reports are described on Te atk tons. In the event that May 15 or other fling date falls on a weekend, or other holiday, the fling deadtine shall be on the next business day. Requests for extensions of fi to 90 days beyond the due a the Committee. {or fling must be in writing and sent to the Committee at the address below. The Committee may grant an extension Up eg Mate may not fie ther first report later than 30 days before the election regardless of any extension granted by Before fling, separate the pages and fle only those required. Be sure you have completed each applicable section on the cover page including filer information and status. Please contact the Commitie ifyou need additional assistance in completing this form, or you are unsure of your fing requirements. If you have been Fequested to complete this form and believe this request isin error, you must notify the Committee in order to determine ‘whether this report is required. 'A'$200 late fling fee shall be assessed against any individual who files more than 30 days after the due date ofa report or the due dote of any extensions granted by the Committee. ‘Your completed form (and any subsequent amendment) must be filed with the ‘Secretary of the Senate Office of Public Records 232 Hart Senate Office Building Washington, D.C. 20510 Office of Public Records 9.0. Box 2517 Alexandria, VA 22301-0517 OR “Additional forms may be obtained from the Select Committee on Ethics at 220 Hart Senate Office Building, United States Senate, Washington, D.C. 20510. Telephone: (202) 224-2981. Frevius Eaivone Cannot Be UsedUNITED STATES SENATE FINANCIAL DISCLOSURE REPORT FOR NEW EMPLOYEE AND CANDIDATE REPORTS ales ae ae Kelly A Sait Os Teena See wih ua aca /0| Charles or (,03) 232-Mee Mas chester, W4_ 03101 New Hampshire AFTER READING THE INSTRUCTIONS - ANSWER EACH OF THESE QUESTIONS Did you or your spouse have eared income (@.., salaries or fees) or non- investment income of more than $200 from any reportable source in the ‘Did you hold any reportable positions during the reporting period? reporting period? ItY¥es, Complete and Attach PART Vill IWY¥es, Complete and Attach PART Il ‘Did you, your spouse, or dependent child hold any reportable id you have any reportable agreement or arrangement with an outside entity on the filing date? IW¥es, Complete and Attach PART IX, ‘worth more than $1,000 at the end of the period or receive uneamed investment income of more than $200 in the reporting period? ‘Yes, Complete and Attach PART IIA and/or IIB. Did you, your spouse, or dependent child have any reportable lability Did you receive compensation of more than $5,000 from a single source (more than $10, in the bo prior years? ind Attach PART VI Yes, Complete and Attach PART X Each question must be answered and the appropriate PART attached for each “YES” response. this report and any amendments with the Secretary of the Senate, Office of Public Records, Room 232, Hart Senate Office ing, U.S. Senate, Washington, DC 20510. $200 Penalty for filing more than 30 days after due date. This Financial Disclosure Statement is required by the in Government Act of 1978, as amended. The statement will be "FOR OFFICIAL USE ONLY made available by the Office of the Secretary of the Senate to any requesting person upon written application and will be feet bens reviewed by the Select Committee on Ethics. Any individual who knowingly and wi falsifies, or who knowingly and wil fails to fle this report may be subject to civil and cr TCERTIFY that the statements rave mace on this fom ad al attached schedules ae true, Complete and correc fo the best of This the Opinion of the reviewer that Signature of Revewng Oficial the statements made inthis form fae m compance with Tale of the Enhics n Government Act.CONFIDENTIAL DISCLOSURE OF CANDIDATES HOME ADDRESS Ayotie Kelly A qa] 07 Y Tuckerwood Ct, Nashua M1 03064 | 603-886-6778 EL STE fol Charles St Mander, e3jol bo3 - 232 -N1be Who Must File: Any candidate who files a public financial disclosure report with the Senate Select Committee on Ethics must also file this confidential report. Where to Fil 20510. File this report with the Select Committee on Ethics, Room 220, Hart Senate Office Building, U.S. Senate, Washington, DC When to Within 30 days after becoming a candidate for nomination or election to the office of Member of the United States Senate, or by May 15 of that calendar year, which ever is later, but at least 30 days before the election, and on or before May 15 of each succeeding year an individual continues to be a candidate. A candidate who currently holds an elected position in the United States Congress is not Tequired to file a Candidate Report. Contents of Reports: List your home and office address and phone number. Please sign your report certifying that your report is complete and correct. Penalty Provisions: Any in Cee estar extension is granted, more than 30 days after the last day of the filing extension period, shall be subj feo Waivers of this fee may be granted by the Committee in extraordinary circumstances if requested in witng, Fal this report may result in the imposition of civil and criminal sanctions. (See 2 U.S.C. 701 et seq. and 18 U.S.C. 1001.) dual who is required to file this report and does so more than 30 days after the date the report is required to to a $200 penalty Review of Reports: These reports will be reviewed by the Committee along with the corresponding public reports within 60 days of the filing Gate. These reports will be kept confidential by the Committee in accordance with the Ethics in Government Act 1978, as amended. (Centicaton ‘Signature of Reporting Individual Date (Month, Day, ¥ ‘complete and corect othe best of / ny knoweage and belie. Seeseetiem ess billy a gl was/Topanga Nar Tae Ayote Kalk h PART Il. EARNED AND NON-INVESTMENT INCOME ) Report the source (name and address), type, and amount of eared income to you from any source aggregating $200 or more during the reporting period. For your spouse, report the source (name and address) and type of earned income which aggregate $1,000 or more during the reporting period. No cor yeit needs to be specified for your spouse. (See p.3, CONTENTS OF REPORTS Part B of Instructions.) Do not report income from employment by the U.S. Government for you or your spouse. Individuals not covered by the Honoraria Ban: For you and for your spouse, report honoraria income received which agoregates $200 or more by ‘exact amount, give the date of, and describe the activity (speech, appearance or article) generating such honoraria payment. Do not include payments in lieu of honoraria reported on Part |. Name of Income Source Address (City, State) Type of Income Amount Tame oar tenho Tarps cay Zong | fra000 OS) ‘Aiton. VA Crono Slay Zrampie | Over $1000 1] State of New Hampshire Contoh , NH Salary + einvand (9F, 500 2[Daley Qutdlir Sevices (Sparse) NerCimack, NH ners Daw er (000. 3[Mass_ ANG Westficl, MA Sl ler /,c00.~ ’Tepang vanes a Ao: “ ‘BLOCK A Identity of Publicly Traded Assets ‘And Unearned Income Sources Report the complete name of each publicly traded asset held by you, your spouse, of your dependent child, (See p.3, CONTENTS OF REPORTS Part 8 of Instructions) for production of income or income during the reporting pe Include on this PART IIA a complete identification of each public bond, mutual fund, publicly traded partnership interest, nk excepted investment funds ‘accounts, excepted and qual trusts, and publicly traded assets of a retirement plan. = TBM Corp. (stock PARTIIIA. PUBLICLY TRADED ASSETS AND UNEARNED INCOME SOURCES "None (or less than $1,007) $1,001 - $16,000 '$45,001 - $50,000 150,001 - $100,000, BLOCK B Valuation of Assets Alte close of reporting period it None, of less than $1,001 None (or las tan includes "Check the fist column. “$100,001 - $250,000 15250 001 - $500,000 "$500,001 ~ $1,000,000 ‘Over $1,000,000" Type of Income “$000 004 - $6,000,000 '35 000,001 - $25,000,000 “$25,000,001 - $50,000,000 ‘Over $50,000,000, None | Dividends Excepted Investment Fund Excopied Test Interest ‘Captal Gains Rent BLOCK C ‘Type and Amount of Income received cr accrued to the benefit ofthe indvua “Amount of Income other (speci Type) $1,000,001 - $5,000,000 ‘Qualified Bind Trust ‘None (or less than $201) | $201 - $1,000 51,001 - $2,500 12,501 - $5,000 135,001 - $15,000 '$15,001 - $50,000 '$50,001 - $100,000, "$400,001 - $1,000,000 ‘Over $7,000,000" ‘Over $5,000,000 ‘Bane is Checked, no other entry is needed in Block C for that ter. This bei [iS Keystone Fura FE Row Pre Hath Sciowe Ford Banpie | x INH Rekrarment Sastre 2 (5) Fedeatel Kuwtirwn Tod “fe aula Eyal Food ) \ SAY] kane Bice, Plone Beryet Food 6(S) eile tgp Mow Mie Tavs 7B) Well Faye Gaol Tow Fond 1 #15) Wovbw Rad Cay By i 815) Arar in 1 ston Wane poh) Oe Raed TXEMPTION TEST (266 ntructons before marking bor) you ome any eset peceuse meats he three-part test for exemption doscrbed i EXEMPTION TEST (ee rane ast vas Pos repende oe apse pera CM, ease ven ete Pe PS TAS OF the instructions, pease checkbox to the rht [Dri eld use he cer categories of vale, as appropriatePapa aaa nae ¢, Kell BLOCK A Identity of Publicly Traded Assets ‘And Unearned Income Sources Report the complete name of each publicly traded asset held by you, your spouse, of your dependent child, (See p.3, CONTENTS OF REPORTS Part B of Instructions) for production of income or investment which: (1) had a value exceeding close of the reporting (2) generated over $200 income during the reporting period. Include on this PART IIIA a complete identification of each public bond, mutual fund, publicly traded partnership interest, excepted investment funds, bank accounts, excepted and qualified blind trusts, and publicly traded assets of a retirement plan. PARTIIIA. PUBLICLY TRADED ASSETS AND UNEARNED INCOME SOURCES ‘BLOCK B BLOCK. ‘None (or less than $7,001) 1,001 - $15,000 '515,001 - $50,000 Valuation of Assets [At tne close of reporting perio. ‘Type and Amount of Income IW-None (or ess than $201 4 $s Checked, no other entry is needed in Block C fr that tem. This None, of less than $1,001 includes Income received of accrued 1o the benefit ofthe individual "Check the frst cob '$50,001 - $100,000, $100,001 - $260,000 $250,001 - $500,000 x Type of Income ‘Amount of Income i il = $5,000,000 ‘None (or less than $201) 15,000,008 - $25,000,000 '$25,000,001 - $60,000,000 “Over $60,000,000 ‘None Excepied Investment Fund "$500,004 — $1,000,000 Excepted Trust ‘Over $1,000,000" '$400,00% - $1,000,000 ‘Qualified Bind Trust 151,001 - $2,500 135,001 - $15,000 '515,001 - $50,000, 350,001 - $100,000, ‘Over $1,000,000" $2,501 - $5,000 151,000,001 Dividends Capital Gain | Rent Interest ™ | $201 -$1,000 i ‘Actual Amount Required i “other Specified '37,000,001 - $5,000,000 (Over $5,000,000 a aoe TBM Corp. (S103) toed [6S)_ Keystone Fund Trak Lowston Maine i Eero 1[00) 4s feuouwt ancy Beak Leyistis Ware Sasnss Boigewt 10} SUP TION TEST sv neurone bf: aig be) youre ny asst ecaune Xmen ete pa ine yarn deeb Pe OS Pe ter tothe roht EXEMPTION TEST oe erase van No meee ye s86 Sopdet cd We anal vas eee ne of PY MA ins ine oer entegores of vale, a8 aprons OoPARTIIIB. NON-PUBLICLY TRADED ASSETS AND UNEARNED INCOME SOURCES ) BLOCK A BLOCKB BLocKG jentity of Non-Publicly Traded Valuation of Assets Type and Amount of Income and Unearned income Sources les han $201) is Checked, no other entry is needed n tock C for that tem. This Report the name, address (city, state and includes Reame received or accrued fo the beneft of the individual description) of each interest held by your spouse, or your dependent child (See sooo] p.3, CONTENTS OF REPORTS Part B of Instructions) for the production of income cr investment in a non-public trade or iness whi ) had a value exceeding $1,000 at the close of the reporting period; and/or jenerated over $200 in “unearned” income during the reporting period. Include the above report for each underlying asset, which is not incidental to the trade or business. Publicly traded assets held by non-public entity may be listed on Part IIA. S| uP computer Sofware Desan, x Example: DC, | Wash DC. od Type of Income “Amount of Income ‘Actual ‘Amount i ‘None (or less than $201) $201 - $1,000 Required] (specity Type) other’ Specied '$5,000,001 - $25,000,000 '$25,000,00% - $50,000,000 ‘Over $50,000,000, None ‘Excepted Investment Fund '$4,000,004 - $5,000,000 ‘Over $5,000,000 ‘None (orless than $1,007) Excepted Trust $3,001 - $15,000 '515,001 - $50,000 '350,001 - $100,000, "$100,001 - $250,000 $5250 001 - $500,000 '$500,00% — $1,000,000 ‘Over $1,000,000" '1,000,00 - $6,000,000 Dividends Rent Interest Capital Gains ‘Qualified Bind Trust 54,001 - $2,500 ‘$2,501 - $5,000 $5001 - $15,000 {$15,001 - $50,000 ‘$50,001 - $100,000 '$100,001 - $7,000,000 ‘Over $1,000,000" | ; i and Dae a aries Mert red 5 2 i 3 4 9 ba Jii jt) i) it rene TION TEST ce bacon befor raring bar you onted ony esc because it eats ha free par wtf exertondescbdin he wrucons. plese chah none RSP EXEMPTION TEST (se tr sno reperdet tye poe or operant GMB, the snl vase ety fee ooh nee oes Segoe Sf Ne oS MONSnn all PART VII. LIABILITIES atte, (dell Category of Amount of Value (x) Report liabilities over $10,000 owed by you, your spouse, or dependent child (See p.3 CONTENTS OF REPORTS Part B of Instructions), to any one creditor at any time io lg during the reporting period. Check the highest amount owed during the reporting zlel3 e| |8/8ls erica. Exclude: (1) Mortgages on your personal residences unless rented (2)loans | 5 | g gle/8). |slals secured by automobiles, household furniture or 3|% | Is\3 gslslslilelsigis certain relatives listed in Instructions. See Instructi £|/ #] <= /8/Slsjglsjelajals 818 accounts. gB/2] = el8lele|2]2iglelelals =) Feeley elels/Sislslsie ® Je}sla/8/8|8/2/3]3/2|3 Name of Creditor Address Type of Liability 2l2ls|e g B\ale Blglé = [Fists Bank | Wash, 0G saaraoge on ndeveopedand | 1001 | 13% | 25s xLTelxtalm|P [cle example: 06, “2 orj | (J) John Jones Wash., DC Promissory Note 1999 | 10% | omg xleE|x|A;M/P|LIE Ta) GE Money unk Onando , FL Equig Lean 2007 | & ‘hb | Oren 2 (5) Bawk of WH Manchest, WH _[Favipmat Loa ost | | +t 33) Bank of WH Dandesten, WH [Eviytmort Laan ax [75 4 4 2[3)TD Praknowk NA [Manclestw NH NF, viprent Lon + |b 5 a 33/1 trukwat, WA [Marcle WH [Tuck Loan + |b45| 5 2[35TD Byukroih WA Whauhede, MH [Trak bean 2 [635 |S is 75) fod Credit F Laws, Mo | Tanck Lean oot |.75 |S” #43) Yuk of WH Dwrbedar BH [Truck (1am Zoot] |S she) CAM Gptel hi Envi peer Lean os |S |S oh) Wels Favgo buswess Petty Carel Strain FL (yuck bien Pot 4% | 2 J 3) (hws Biss Card Wi dwinfor, OF Fayalp Low 2008 [3.94 |Z | rel) CyykWerrs —— quella, WH [bine of (rele of LES ae xeurTion TEST (ne inscons before rng box) Mau ote any asst bacauee trate ee-pt st forearpien Sos see oe it please check box othe right EXEMPTION TEST (on arc eects hd sopendey bye poie or ependent Ms, Wr met in ahr Pel by He Oe PANY NO tse the other calagoes of ale, 38 approprateTapa aware ane Tate Ny volte I, A PART VIII. POSITIONS HELD OUTSIDE U.S. GOVERNMENT ie Report any positions held by you during the applicable reporting period whether compensated’ of Tol Positions include, but are not limited to those of an Aeon dieetor, trustee, general parner, proprietor, representalive, employee, or consultant of any corporation, firm, partnership, or other business enterprise or any non-proft organization or educational institution. Both the year and month must ‘be reported for the period of time that the position was held. Exclude: Positions with federal government, religious, social, fraternal, or political entities, and those solely of an honorary nature. Name of Organization ‘Address (City, State) Type of Organization Position Held ory meee Treo | Ratna Asso Fok Coleco | NEY EXAMPLE Thorp edacaion President 3790 Present Pr [ones & Smith Hometown USA__ EXAMPLE ‘Law Fem Parner 7195 __| 1170x 1] Babson Colkeg-e- Wellesly mM Clleye Dead of (esters Zor _|Ho4 Se Ansel tun wy Byer Om af Neco Colge Powbetey, WA Caley ss GT Anes [315 [Rennt 3 4 5 6 7 8 Compensation in excess of $200 from any position must be reported in Part