! .

• NEBRASKA ()-r-----------{ POSTMARK

DATE
ACCOUNTABILITY AND
DISCLOSURE COMMISSION STATEMENT MICROFILM
NUMBER
I' 9 2 0 1 0 8
t t" Floor, State Capitol
P.O. Box 95086 OF OFFICE USE ONLY
Lincoln, NE 68509
(402) 471-2522
FINANCIAL
INTERESTS
BEFORE COMPLETING
READ FILING REQUIREMENTS
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).
• 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 required is subject to a civil penalty of up to $2,000.
ITEM 1 YOUR NAME, ADDRESS AND PHONE NUMBER

Name

Address

ITEM 2 OCCASION FOR FILING (Check Appropriate Box)

D A candidate for elective office D Left office or position

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

ITEM 3 OFFICE HELD & TERM OF OFFICE (Incumbent elected/appointed officials and state employees. See
IB of instructions)
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: ~ ~e.~ Term: \.A.W\.aJ~..J.-U!lol...~WJUo!!~

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

ITEM 4 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 PERIOD COVERED BY THIS STATEMENT

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
including the date you left office.

~ This statement covers the preceding calendar year January1 through December 31,

D Left office, this statement covers the period January 1, to

---- (DATE YOU LEFT OFFICE OR POSITION)

RevisedAugust2007
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ITEM 6 SOURCES OF INCOME OF OVER $1,000

Name and address of any. source.' (including an individual, business,

body of government, political subdivision or body corporate) from
I
Income includes monev or anv other form of recompense constituting income under the Internal Revenue Code. See definitions)
List the nature olthe source's business and the nature of the services you
rendered or the circumstances under which income was received. NOTE: Do not
whom Income of over $1,000 was received. list the amount of the income. "
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• ~ TE: ~nNC5ME Cl~1 n :11" t1mM" E'MPLOYMENT
BY, OPERAT~N OF OR PAR'TI~ATION INA PROP~RIETOllsAfF':"):>ARf~ER~HI~
CORPORATION OR OTHER PERSON, LIST THE SAME AS THE SOURCE OF INCOME,.BUT NOT THE PATRONS, CUSTOMERS, PATIENTS, OR
CLIENTS THEREOF.
ITEM 7' 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 I Nature of Association
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4.) 4a.)
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5.) ___ --.,. ~_ 5a.)

6.) __________________ 6a.)

7.) _-'-- 7a).

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ITEM 8 REAL PROPERTY OF THE FILER IN NEBRASKA (Real property valued at less than $1,000 and your·
ersonal residence need not be re orted.

List all real property in your name 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 dwelling-house and adjacent land used
for house-hold ur oses, such as lawns andardens. .
Location of Property Nature of Property
(Description or Address (such as: agricultural, commercial, industrial, residential-rental)

Financial Institution Address

~l8 N\.U\~.~
~.o.~~Lfa9
L<Wt~li\eJ ~ ~/6037

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

(c) Describe other property owned or held for the production of income not otherwise disclosed in Items 6, 7, 8 or 9(a)(b). Include
leaseholds and other interests in real estate, promissory notes and other obligations owed to you, beneficial interests in trusts and
esta.tes, 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 tan ible ersonal ro ert unless such ro ert was held rimaril for sale or exchan e.
 ..,
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ITEM 10 I YOUR
CREDITORS TO WHOM $1,000 Of, MORE WAS OWED OR GUARANTEED
IMMEDIATE FAMILY. -f\. '~\f\e_
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 Address

ITEM 11 I 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 Value of Gift Description of Gift and
Donor (See Key Below) 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) $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.

~~_Q
(Signature of Filer)
.. ~~AA~

(Date)
:s-/o-cCf .