Professional Documents
Culture Documents
, I
A~Nl,)ALSTJ\TEMENT OF
Flr-JANCIAL DISCLOSU.RE
2. 5l0\5
LitVELJ.~~FFI.E8S, .8fiJIPLl()YEI;$,,;A~D.APPQINTEPOFFIGIALS
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'f(~~Titl~~ol'.Ohon9E~9a Couocy:Posltion:
. (b)bciunty Department, County Agency, or other County Goverrtrn<3nt Affiliation:
:0~.5.~0:;!::74.:22=---___,.-'-------'----+--.,--~
(a) YourJ?fi:r.S,ffnf;M~ritat Status: If married, .pie~se.:ghrespouse's Jull. name, inclu~ing maiden name
wli.i;ir~ ;~PJ?.ttca,~t~:
. (pj:t]$t.the .names t=1hd a.ges of any child. For p).ltpqses o.fcqh'\plefing thiscstaternent"chi!d;; is4~'1j
d~l{ghter, {StePson or stepdaughter under tSyears of a.9eror a dependent
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Name
3
5 months
4.
,(~) 'rR~po.ftir19 Qat~g\:>ry;'; For the purpose: of ompl~tli19 the $l~tement: ot:fin;:tncial 1is1o~ure., .n. exact doll'at
<:;~te.gory.; ~o,,$t(),OoO
oategof1:8,$Ad'001..,$5tr:ooo
o~t~~on;
$!5.o,ooo
g; over
(b)l.,istfb~J()cation of any real :pr,qper;ty Wi~hiO #JEtP<>unty, orwlfhiii.flve miles qf:t~e county.in~wfnd: he'Pr $h, <)r
t)is.:Qr h~r;~pouse;
.or,hls ore her d~pncte.nt child, ~as.
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. an ow~etspip prc;;t~erfJn~ncial interest:
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Famiti{Member
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Location
oanrwand Kimb~rly
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Oth\~,qf'h~r:.$p9u5~. Of his other depl\lnd(:!ht?(;hi!l:fr is.!3 member; offjqetor.~lJ1ployee;,. br iQ,Which h~or She;. rhis or her
spo\J~e~~.po~ition; orhTs or'hera~p:enq~li('ghik!l~.position,.if:aJ1Y;, withthe;p~.Ftoership; association,. or bllsilt. s:
Position
(o):l,.istthe n;an'le:of any corporation .of Which he or she, or his or her spouse, or his or her dependent child, s an officer;
dJre(;,tpr,,ot empi()yee, orotwbich:he;drsn:e,. othis,orl:l:er spoQ~e; o.t)bJ:~. ()rl)er dependentchild, leg;ally q beneficially
,qW~~~ ~r cqp,~\BI~~me>re othary fi\ie, g~rc~Of()f tl)e :putstandin9 's.toc;:k; a'odJ1is or her position, and his or. er spouse'-s
Position
Name:andAadress.ofOrqanizatic:)!1.
{e.) List th!Sl name and description of any outside employmentJrom which he or she, or' his or tier spause1 or his or her
depend,l=!nt child, has derived, during the previous calendar year, gross income in excess of twa tho sand dollariS
($2;QQQ):
Famii{Member
. Kimberly
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Name.andAddressofOrganization
SYn:ic,us~
City $ohools
Position
Teacher
:~a~~~ .
.SXec~.tive
Jh.t.,i$.t . e9!;:H.'sc;Jrce or~ifts1 :,$icJuoi6Q c~ftip~ig.rft;d~tri'~utidtrs, Jn.$xc:e~$.,of$1 ;oo6;:r~ceived ,during th~.re . ortih9'JJetiqd .
for WJ1iql:f \tilis statement~ ls .filed; b,y the tepoctipg Jndi.\lidu91 ,pr such irt9lvJtiuaU.~ spp!J,l;~ or dependent:. bild fr()m the
sam~donor <excluding gift'sfr<?m a. rela,tive: .tncti:tde. the . nafilei ~.it~ E~?:J~ress ot'(he. donor, The te:rm}r ifts" d.oes not
i;,ciude reimbursements, which term is defined in iti:lm (9Yhere1h. Indicate 'the value: and nature of each su ifgift
Name and Address of Organization
Position
(g) idel;\tity. and briefly descripe th~st)Urc,e of a.QY reimbursements tor eX,pendityre,s,. excluding C~ITlR<lign ~ pndltures
aqd ~);ip~nditures in coonectiop With. officl:;~,l.;;l!ties reimbursed :by ttie politlcflls!Jbciivision, .for which thi~.~t. emeot has
.b,~~fl'flle,~J i.n.~peps"of,$1 ,009 fr.qmeacnsU~t\:sourc~' For purp6$esofti:iis item, the term "reirnbursemE)nts' shaU.mean
aJ5y Jra\?et,rera'te<f .expenses provided l:)y nPn~goveromental sQUrc~s aoq for ~ctivities related to the eporting of
inl:llV.idutWs offiif:ll dutie.s . such... ~s. speaking engagements, . corif~rences, or fact.,finding events. The term
''teimburs$rtu:mts';;cioesnot include gifts reporteel unqeritem (f) herein:
Soyrce
$.
Reporting Cate:g ry
oescription
lf~reporl,ing .officer, . emplqy_ee :q( ~PPC!int~~iqffiqialls n(?t ~bl~.;;aft.~rcte<1l~on,~PI9eff()rt5, .to pbtain,:s.om . ~r . ~!l~of!th~
ihformationrequire.d by p~r~grap,h fpqr pfthis section,. wh1htelates'tQ his or her.spouse or liousel'lbld rnernber,he
6; . tf<a .r'~pqftir:t!l()fflcet,_em.pibyee or app!Jlnted .official pr~\':ltiqes taw;; is llcensed~y th~[)ep$rtm:ent of.S ate. as:~. real
. est.~t l;>r9.~ef'.ol' ~gent; or practices.a professiQJ:l li~n~ed qy theQe,p~i1i'ne.nt ofEq~ca.tiqn, his rher allnual
dl~~~o~s,vr~ statement shan ir191u(ie ~9.~neral:<;tespriP,tign. oftM printiipal ~~.oJe~t ~r~~$9f . m~tter .u derta~C3f1 py
$l!?h ;b,fflqe,r;.,er:nployee or;:tl:WPintett. offi.~it:l! Jn hlsPrcfler':lip~n~edpratt~. Jf:E>l.l9hpffieP;,,e11jplpye.e, or: app;giht:d,.
pffio.ial
JIJ~:firrQ cmBp,r:poratlon; 'his i,or :her ~i:II)t;Jaf 9(~clo~\Jre stat~m~;nLs11alJ ib.cli.Jd~ag$O~rgl ~descniption
p. 'th~p,r~n.1pa.l
..~J.!j:iJ\:lM ~re_a~j,)fr:patters ondertaken:py. s\JqhJii-OO .orcorpor~fiorl. The?:Qi))plO:sure 'reqpJr:edhy:tnls se tibn .sn~ll: not
in!::)!J~~t~~ npmes-.oHndividuatcli~nts; :custPrn.ers or-patientS,
I hereby certify llhderpenallyofperjury, that the information disclosed on this form is:trueand cor:npletf3
.KIMBERLY A. MEMORY
Quatlfl!~Jn On9orJ.agaf'/u['y ..
~ycom)lltsstoo)xpir~s.. .~~ri.