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NEBRASKA
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I, .1 POSTMARK
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ACCOUNrABlLrrY AND
DISCLOSURE QQUMISSION
STATEME,NT MICROFI.M
NUMBER'
" 11930164
11th Floor; Stale capitol
P.O. Box 95086
OF OFFICE USE ONLY
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Uncaln, HE 68509 ' FINANCIAL .,

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(402) 471-2522
INTERESTS 7 'In
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BEFORE COMPlETING
REAO·AUNG REQUIREMENTS HADC FORM C-1
INS (: Lee: LlHE C C/j"·j h ll'~ ~;:!:5'1!!
-Individuals listed ooder Sections I-A & B of the GenemlInformaIiorrFiI Requirements ori page 5 must file 1hisform.
• Dollar values need not be reported for any item. except for Item 11.
• File with the NebraskaAcooun1abilily and Disclosure Commission and with the election oornmissioner or clerk of the county of your residence.
• Persons whO fail to file 1his report or oIheJwise do not comply with the repoelilg provisions of the law are subject to penalties.

ITEM 1 I YOUR NAME, ADDRESS AND PHONE NUMBER

Name 1- o ade. /\
lAST
j .a:
. FIRSI" I
\J
MIDDLE
Telephone No. (.JCtf) "7t7- S'03 6
' 11, a,dev & s: ' ,E / ISuiOI- -rli, lU.e-) j- 6' 9)'1'0
Address Sl"REEr ADDRESSOff FlUAALROI1TE CITY SOO'E ZlPCOOE
.,

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I OCCASION FOR RUNG (Check appropriate
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,.

0 A cand!date for eIectiv8 Office .0 .l.efloHice or position

~ Annual officeholder's or state employee's report 0 Newly appointed to office or position

ITEM 3 I OFFICE HELD & TERII OF'OffiCE (for incumbent

.r
elected or appointed officials and state employees) ,

List the office or position you currently hOld which requires this filing. If you have left office, list the office you held •

Office or Position: :SeFJqTtJ) .n /sb,'c.{=

)
/d
'19 Term: rfS!b-> -- 1.70/ht> ;
ENOS

Name of City, County, District, or State Agency: U" ,. "am e» s I' I.

ITEM 4 I ·OmCE SOUGHT (for carididates only)
",

List the office sought which requires this filing.

OffICe:

Name of City, County. District. or State Office:

.
ITEMS I PERIOD COVERED BY mISSTATEMENT
This statement must cover aDfinancial inteIesIs for the entire •••• eceding calendar year" and not just as of year-end. If you have left office, this
statement must cover aH fiI'IanciaI interests from the end of the calendar year for which you previously filed up 10 and including the date you left
office.

QI This statement covers the preceding ~I

calendar year January 1 through December 31, £ ()

0 left OffICe, this statement covers the period January 1, --'--' to

(DAlEYOULEFTOfFICE (lfI POSmON)

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 J
ITEM 6 I SOURCES OF INCOIIE OF OVER $1,000
Income includes rIlOOOY or any oIher fonn Of recompense CClI'isiibJting incOOle under the Internal Revenue COde. (~ definitions)
Name and address of any source. ••flllCluding an inc:iviclJaI. business; , list the nabA'e d the source's business and the nature of the services
body of govemment, pollicai suIxIvision or body corpor.de) from you rendered or the cireumstances ooder which income was
whom income dover $1,000 was received. received.

1.) .5-e/{ ern JlJ/oVett

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!l Cf, nv ;. .e;.. 1a.) bWl)~'"
,

2.} ..
If-cde pf JIt/~/J r-ftS /t« 2a.) S e.-PlA/l of-
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3.) 50 c /9 I ~ e, c. 14. fo/ 'Iv

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380) /3e-ne F,: r.s

4.) 4a.)

• NOTE:FINCOIE 1$A1B)RfOM EIiII"I.OYMENTSY. OI'EIIIUJOIfOF~PJIIRIlCII>II1IIVAPH)f'HIEIQJ$f" FffR11IERSIIF.CCJRIIafIfTIONOROIIER I'ERSa'(. LJSrTHE SAME AS

THE SOl.'IIa OFSUCH~ BUTNOTTHE ~ CUSI'I::IUER$. RIf1JEN1S. ORCUEN1S 7HEREDF.

ITEM 1 I BUSINESS ASSOCIATIONS (See deIiniIiOns)

Name and address of aI businesses, ~ or assoc:iaIioilS (profit and I1OI1-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 associalioIlS Which are oiIher'wiSe IisIed under Jtefu 6.

Name and Address of ~ or Organization , NaUe of Association

' ,
- ,

1.) -£,-1--1+ .f'.a er (J

)
Y ,
C 01-:4 1a) Jto '-k holder

2.) £eI we"J ,ta

• ne 5 28.) L/J (/'-l?s 1-0;,

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3.) 38.)
,
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4.) 4a.)

S.) 5a.)

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6.) Ga)

7.} 7a)

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REAL PROPERlY oF'THE ALER IN NEBRASKA (Real propeny vawea 81 leSS man ~Uuu anu your
~J
I personal residence need not be reported.)
List all ~ property in .;;. ~ orin wtjQ)you helve a drect ownenIhip ~ The description required must 'be ~t to ~ the
location of the property. ExceptioIIS: You need not report real esIaie owned by a business listed in Item 6 or 7, your petS(lt'8 residence or real
property valued at less than $1000. PeJsonaI residence refers to your principal dweIing-hotJse and aqacem land used for flouse-hoId purposes,
such as lawns and gardens. ,-' ,

Location of Property" , Nature of Property

(Description or Address) (such as: agricuIIuraJ, commercial, industrial, residentiaI-ren)

T J.l 11«s / r cJ5-- If ,/1- IT;£'1 If!to/; t~31i 11:J

/ t /,H)-(l ~ (fa/1 "h J Do 1/ if "" 5 heN ri&v" ¥-

Gc~,.tJe-'1 GOf.VI,+/-e S

/3 ()C 6 -5T r..e of .r

!. (~Il U,C> / I') ,,veL/J-

rrEM 9 • OTHER RNANCIAL INTERESTS AND PROPERTY HELD DURING THE PERIOD OF THIS STATEMENT
WHICH EXCEEDED A FAIR MARKET VALUE OF $1.000 AT ANY TIllE ,DURING THE REPORnNG
PERIOD
(a) list the names and addiesses of the instIutions in which you had checking and savings accomts and ceetificates of ~
FmnciallnstiIution Address

(b) List the names of the issueIs of au stocks, bonds, and government securities, not otherwise Iisled under Items 6 or 7.

(e) Describeother properly owned or heldfor1he production of income not oIheIwise disdose<i in Items~1.8 or 9(a)(b).lncIude~,~ "
other interests in real estate. promissoIy notes and oIher Obligations owed to' you, beneficial' ideiesls' i1 trusts and estates; Cash value ,life
insurance,lRAs;defened income andieliren1ent'pIans. Exception: DOriot inclUde ~'~' inventOry, fixtures arid equipffient
owned or used by a business IisIed in Items 6 & 7 or househokI goods, ,person8I'~' and Other ~ peIsonaJproperty unleSs
such ~ ~ tJeJdPrii'n8J:ilrfoi'SaJe Of. exchange. , " .1. -, ' "
. '

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fIJ~'w f01-1, j.. : -f 1/ S lk r().rn-c.....e

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 ITEM 10 CREDITORS TO wtIOlII-l1,OOO OR MORE WAS OWED OR ~ BY YOU OR A MEMBER OF
YOUR IllllEDlATE FAMILY. .
exception: l..clans from a relative and land c:onIrads which have been recorded with the ColBy CIeIk or Register of qeeds need not be repo~.
ACcounts payable. ~ ari5itig out ofret8il iI1sIaJIment1ransacIiOns. Or Ioarl::> made by a fiilanciaI instiIlJtion in the .~ course of ~ness
need nOt berepdrted. "', . . . .
. ' "':' '.' , ,:'
. , ~. .~~
Name Address

ITEM 11 SOURCES OF GIFTS OF A VALUE OF MORE TlfAN· $100 ReCEIVED EXCEPT' Gli=TS FROM
RELAllVES. (See definitions)
Name and address of Donor OQa!palion or nature of buSiness Value of Gift 0escripIi00 of Gift and
of Donor (See Key Below) Cin::umstances or Occasion for
Gift

'.....

.~.,", -.: . 'If.: , ..~.

~-------- ~ -L ~ -II.
The monetary value of each ~ shaI be categolized based on the good faiIh estimate of the filer. For each reported gift insert in the Value
~ the ~ wIlichconaspoIlds to the -..e category or the gift The vaIue.categories are:.
A) $100.0ftO $200; El)$2()O.01to $500;. C) $500.01
" ": ~.: '.:\; ;",;-".-:.
," . .... '." . r .
to $1,000;0)$1,000.01
. '. " -. .
or more.
...
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iTElii12
. .. ' -, ," ; SIGNATURE
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OF FILER AND
- ..
DATE. . . ,.... r::.', ". ~.,1. . ,;', ~ ..~.. ' ,':

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