XGR Adams SFI

8/14/2019 XGR Adams SFI

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. '. . , .:NEBRASKA ." POSTMARK r x r & JATE 71:ACCOUNTABILITY AND 7900249ISCLOSURE COMMISSION STATEMENT MICROFILMNUMBER11th Floor, State Capitol OF.o. Box 95086 OFF~e-.~Qf'Il}t,

Lincoln, NE 68509 FINANCIAL !!H enl n "' : . : ' ;_L.,i Ii"', ' " 1 1 , n . I< "u(402) 471-2522 - '~ ,. ; ! , .,; " '~~ : ' o F L . . ; ~ \ .; } f\INTERESTS 2 0 0 9 f 1 A R - 3 M i lO : 0 6BEFORE COMPLETINGREAD FILING REQUIREMENTS N t : . M~(:nw ; iT~t & :NADC FORM C-1 D I S e L O S IS S IO N

Individuals listed under Sections 1-A & B of the General Information - FilingRequirementson page 5 must file this form. Dollar values need not be reportedfor any item, exceptfor Item 11. File with the Nebraska Accountability and DisclosureCommissionand with the election commissioner or clerk of the county of yourresidence. Persons who fail to file this reportor otherwise do not complvwith the renorfinn provisions of the law are subiect to penalties.ITEM 1 I YOUR NAME, ADDRESS AND PHONE NUMBERName Adams Greg lee Telephone No. 4023622153

LAST FIRST MIDDLEAddress 831 West 4th Street York NE 68467STREET ADDRESS OR RURAL ROUTE CITY STATE ZIP CODEITEM 2 IOCCASION FOR FILING (Check Appropriate Box)

oA candidate for elective office o left office or position~ Annual officeholder's or state employee's report oNewly appointed to office or positionITEM 3 IOFFICE HELD & TERM OF OFFICE (for incumbent elected or appointed officials and state employees)List the office or position you currently holdwhich requiresthis filing. Ifyou have leftoffice, list the office you held.Office or Position: State Senator Term: 1/3/07 1/1/11

BEGINS ENDSName of City, County, District, or State Agency: 24ITEM 4 IOFFICE SOUGHT ( for candidate only)List the office sought which requires this filing.Office: State legislatureName of City, County, District, or State Office: York County, 24th legislative DistrictITEMS IPERIOD COVERED BY THIS STATEMENTThis statement must cover all financial interests for the entire "preceding calendar year" and not just as of year-end. Ifyou haveleft office, this statement must cover all financial interests from the end of the calendaryear for which you previously filed up to andincluding the date you left office.~ This statement covers the preceding calendar year January1 through December 31, 20080 Left office, this statement covers the period January 1, to

(DATE YOU LEFT OFFICE OR POSITION)


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ITEM 6 ISOURCES OF INCOME OF OVER $1,000Income includes monev or anv other form of recompense const itut ing income under the Intemal Revenue Code. (See definitions)Name and address of any source" ( including an indiv idual, business, List the nature of the source's business and the nature of the services youbody of govemment, pol it ical subdivision or body corporate) from rendered or the circumstances under which income was received.whom income of over $1,000 was received.1.) 1a.)

2.) State Teacher Retirement - (Nebraska) 2a.) Retired teacher

3.) State of Nebraska 3a.) State Senator

4.) MidAmerica Investments 4a.) Early retirement separation pay

"NOTE: IF INCOME RESULTED FROM EMPLOYMENT BY, OPERATION OF OR PARTICIPATION IN A PROPRIETORSHIP, PARTNERSCORPORATION OR OTHER PERSON, LIST THE SAME AS THE SOURCE OF INCOME, BUT NOT THE PATRONS, CUSTOMERS, PATIENTS,CLIENTS THEREOF.ITEM 7 IBUSINESS ASSOCIATIONS (See definitions)Name and address of all businesses, organizations, or associations (profrt and non-profi t) w ith which you held a position of officer, director, limited licompany member, partner, or stockholder and any entity in which you held a position of trustee. Such reporting is required based on the position heldon whether income was received. You need not report business associations which are otherwise l isted under I tem 6.

Name and Address of Business or Organization Nature of Association1.) Nebraska League of Municipalities 1a.) Executive Board Member

1335 L Street Ended - 1212006Lincoln, NE 68508

2.) Nebraska Information and Technology Commission 2a.) CommisionerEnded - 4/2006

3.) Creekside Real Estate Trust 3a.) Beneficiary

4.) 4a.)

5.) Sa.)

6.) 6a.)

7.) 7a).


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~EM' 8 ' I R EA L PRO P ER TY O F rJF ILER I N NEBRASKA (R e a l p ro pe rty ~ : . l . t t le ss than $1,0 00 and yo urp ers on al re sid en ce n ee d not be repor ted .

List all real property in your name or in which you have a direct ownership interest. The description required must be sufficient to idethe location of the property. Exceptions: You need not report real estate owned by a business listed in Item 6 or 7, your persoresidence or real property valued at less than $1,000. Personal residence refers to your principal dwell ing-house and adjacent land ufor house-hold purposes, such as lawns and oerdens.

Location of Property Nature of Property(Description or Address (such as: agricultural, commercial, industrial, residential-rental)Creekside Estates, west 4'" street, York,NE 68467 ResidentialLot#16, Thunderbird Lake, Silvercreek, NE Residential(cabin)#25 Arbor Court, York, NE 68467 residential

','ITEM 9 I OTHER FINANCIAL INTERESTS AND PROPERTY HELD DURING THE PERIOD OF THIS STATEMENTWHICH EXCEEDED A FAIR MARKET VALUE OF $1,000 AT ANY TIME DURING THE REPORTING PERIO(a) List the names and addresses of the institutions in which you had checking and savings accounts and certificates of deposit.

Financial Institution AddressCornerstone Bank 6'" and LincolnAve., York, NE 68467Ameriprise Financial Advisors 218 West 6 th, York, NE 68467Leggett Company 612 GrantAve., York, NE 68467

(b) List the names of the issuers of all stocks, bonds, and government securities, not otherwise listed under Items 6 or 7.403(b) Annuity contract withAmeriprise FinancialAdvisors - 218West 6th Street, York, NE 68467. The annuity is invested in several various funds whinclude stocks andgovernment securities.

(c) Describe other property owned or held for the production of income not otherwise disclosed in Items 6, 7, 8 or 9(a)(b). Includeleaseholds and other interests in real estate, promissory notes and other obligations owed to you, beneficial interests in trusts andestates, cash value l ife insurance, IRAs, deferred income and reti rement 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 andother tangible personal property unless such property was held pr imar i l y for sale or exchange.


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ITEM 10 I CREDITORS TO WHOM $1,000 OR MORE WAS OWED OR GUARANTEED BY YOU OR A MEMBER OFYOUR IMMEDIATE FAMILY.Exception: Loans from a relative and land contracts which have been recorded with the County Clerk: or Register of Deeds need notreported. Accounts payable, debts arising out of retail instal lment transactions or loans made by a financial institution in the ordinarycourse of business need not be reported.

Name AddressCornerstone Bank 6t" and LincolnAve., York,NE 68467Tier One Bank Lincoln, NE

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 andDonor (See Key Below) Circumstances or OccasionGift

AChoose Value: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 theValue 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; m $1,000.01 or more.ITEM 12 I SIGNATURE OF FILER AND DATE.I hereby state tha~e used all reasonable diligence in the preparation of this Statement and that to the best of my knowledge it is trand comolete.

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XGR Adams SFI

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