ONONDAGA COUNTY ,

llR I 7 2015
ETHICS BOARD
&\'l'tcLI YI:U. FoRMS
The annual etatem.nt of fJnanclal dJeoloeu~e ehall be in .ubltantJa11y the
!ollcwi119 fot'll: AHNUAL ST:'TIMIH'l' OP FIIf~ DI8Ct08UU FOR OHOHOAGA ClUR'l'T.
For eallndar rer
40 I~ - s~ 15
.

tAl Level I Offlcert, !!R!oxeef !ftd AP29intd Off1c1al1:

1.

2.

(bJ O.partnt. AteftCJ or otta.r

GmtrtiNrlt lri

Ln( z Le = t.v g e

(c:) Add!l'est of rreent: Office

Co

<...A...

6\

~0~ ~
(cl) Offtc:e Tel.,tton lfullber

3.

(a)

(b)

~let

Mill

~ V-S -~

tiJ

~~~..e
S/ ff '/. 'S S .0 ;z()

M.r!tal StetuaS\1"\,t;\sz...

n - lncludlnt Nic!en

ttr__________

!.3<.,/

If ..l'ried. plea.. vtweepou' full

whn appUc:able.

the n...a Qf all children.

~one...

..

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- - - : . ;.._
4

An..,.r aeeh of the follaw.lnt qu"Uon COII!pletalr.

(a) Lbt the location of any nal Pl'OPil'tt within the Countr or within
flve llea of the Countr ln which he or tile, Ol' ltla or hel'
or
children, haa en ownerthip or other flnanclel lnteret:

lfPGU

(b) Llat the n.Me of ant partnerahlp, unincorporated oclatlon, or other

unincorporated buelne of which he or the, or hit or her 1pou1e, ia
~r. officer or ..ploy.. , or ln which he or ~. or hla or her tpouee,
hae proprietary lntereet. end hla or her: podt1on, IUid hb or her
podtlon, lf anr, with the partnerahip, acJaUon, or buJne11:

IJO'l'

Cc) Lilt the n - of enr corporation of which he or 1h1, or hla or her

spouae, le en officer, cllrec:tor, or stii(Jloyee, or of whlch 1\tJ or she, or hi1
or hu qouaa, l..,aUy or e.neflc:lally own or controla 110re than flya
percent of the outetandlng toe~. and hle or her poeltlon, and hit or her
spoue'a liOdtlon, U "''' with th corpoll'atlonJ ancl
(dt

L.lat

the

n - and ntcr.lptlon ot any lfetploJ'Iftlnt r~ whlc:h he or

ahe, or hl 01' her 111'0'1 h derl"" durlnt the prevl011a c:alenclar reu,
tro.. lnCOM ln oc: of two th<Naancl c!ollart.

(e) Llat each 1aurca of tift, exclucllng ca.pa.ltn contrlbutlon, 1n excesa

of $1,000, reea1Yed dudnt tu nportlnt period for whlch thl etat...nt la
Uled by the reporUnt 1ncUv1dual or euc:h tndlvldual '
or child fr011
the ,._ ckmor, exclud.lnt tlfta f~ relative.
Include tfe Mille end
adck of the aa..or. The ta&'ll "t!fta" dcMe not inoludt relMblraeeanta,
which terM l lefJnad ln lt. . (f) herein. Indicate the value end nature of
each aueh 91ft.

I'C'a

t f)

Identify and brleflv dl!''- ..... ---- - --- --

connection wlth official dutlee ~~~~ed br the political aubdivieion for

which thle tat1111111nt be bftn filed, in nee of u.ooo be~~~~ .ach IIUCh
eource. ro~. Jlllf'POII of tht.
the ten~ "~eiftluniiMtnte" ehall Nan
any travel-related ellp41n p~!ded by nonIJO'Qrn~Wntal eaurcee and for:
ect1Ylt1. rlat,.S to the ~:epol'tint lndi'lldual' offlclal dutl weh
epe11Jc.l119 1198CJ...nb, canferenc:es, or fact .. f!ndlnt e'lente. 'l'he tara
"re!Mbur...nta" does not include tlfts reportad under tt.. (e) herein.

tt...

s. If reportlnt officer, ~~~~ployH or eppoint.llll ofticlal ie not olble, after

reaaonllbt. effort.a, to obtain 1011e or all of the lnfor~~~~t.lon r~q~.~lred br
paratraph four of thl1 aectlon which relata to hi or her 1pou1e or household
~r, ha or 1h1 hall ao tate, pert of the tnnual dlscloture 1tatem.nt.
If report1n9 offlcer, etr~ployae or JIIIO.tnt~ official prac:t.lcea lu, il
llcented by tiM depart.ant of atate real tate broker or acJnt or
practice a profe.. ton Ucenaed by the depert.lnt of education, hlt or her
annual dl1cloture atat...nt thall include a veneral daacrtptlon of the principal
subject areaa of Ntter umlertiiJcen by tuch officer, -.loyee o~ appointed
ofUdal in hi o~ her UceniM ptac:tla.. If auch offlc:er, tll'lployee . or
appointed offlclal p~actic:ea with partnerlhlp, un~nc:orporeted Uloclatlon or
corporation and 11 a partner or ahareholc!er of the fiN or co.t"pOratlon h.t. or
her annual dllcloaure atat-nt ahall include pneral c!e1cript1on of the
prlncil"tl wbject are.. of ttn undartiiJcen bf t~~c:h firM or carporatlon. The
dladonre required br t.llla aec:t1on ahall nat lnclucl the ~~- of lndi'lldual
cllenta, cultaMerl or patlanta.
fi.

{8) L!Y!l II Oftlcert, l!!plgyeel

..

!uf !PPOlgt!!l OCflgl!lt:

"--------------------------------------------------(a) title of Podt1on,_ _ _ _ _ _ _ _ _ _ _ _ _ _ __

(b) Depart.-nt, Agancr

or oth!r Go'IICMent lntity - - - - - -

(c) Adclr of Preeent Office - - - - - - - - - - - - - - - - -

(d) Office telephone lfllllber - - - - - - - - - - - - - -

2.

Pl var.lff the fotlowift9 stat...nt:

I have received and read a copy of th! Local Law ~toJ.Z.. of 1990 of the
County of Onond8CJI eatlbllahlnt coct. of ltblc:e, creat1119 1 IJOU'd of lthlc.
and requidll9 f1n1111c:ial dllc:lonn. All deflnecJ under that law, I know of no
conflict which exlata concerning -r ~ition wtth the COUnty except for _____

SWorn to before

a4it~
110 ary PllbUo

OIANE M. DWIRe
llolary Public, State of New Yor1<

No. 010W6096998
c.Qualifled in Onondaga Count\'
tommisslon Expires Aug, 11. 2Ci.(..$""

!!Uq.l IX. flLJ.t!G

Annual

etate~~~nt

of flnuclal d.t1aloaurJ fllintJ uc:ept1on1 encl eatenlione.

1. Anf person required to file an annual etat..ant of flnencial dlleloure

purauant to thll chapter ahall aw.J.t tuch GOI91eted fon on or hfon the
fifteenth dat of May of eeeh rar to th ao.rcl of lth!c:a.

Margaret Anne Chase RN EdD

Property in Onondaga County

440 Ridgewood Dr
Syracuse, NY 13206
2717 East Lake Rd
Skaneateles, NY 13152

I Serve on State Education Nurse Board, no salary but they do

pay for travel expenses. I have been a member for 15 years.