XGR Christensen SFI

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    ~ r: ~jk .( 1 A l( .;;. ': ..".:- a e ,-~ "NEBRASKA POSTMARK ?OOATEACCOUNTABILITY ANDDISCLOSURE COMMISSION STATEMENT MICROFILM 7 R f i 0 1 1 L fUMBER11th Floor, State Capitol OFP.o. Box 95086 OFFICEIJ,SIf'!t1lr:-(,Lincoln, NE 68509 FINANCIAL I """1

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    ITEM 6 I SOURCES OF INCOME OF OVER $1,000Income includes money or any other form of recompense consti tut inq income under the Internal Revenue Code. (See definitions)Name and address of any source* ( including an individual, business, List the nature of the source's business and the nature of the services youbody of government, political subdivision or body corporate) from rendered or the circumstances under which income was received. NOTE: Do nowhom mcorne of over $1,000 was received. l ist the amount of the income.1.) AgW~st Commodities 1a.) commoditiy brokerage,POB 1098- ,

    Holdrege NE 68949

    2.) Farming 2a.) grain sales! hay salesPOB 1058Imperial NE 69033

    3.) Crows Hybrid Seed Corn Company 3a.) seed sales

    4.) 4a.)

    *NOTE: IF INCOME RESULTED FROM EMPLOYMENT BY, OPERATION OF OR PARTICIPATION IN A PROPRIETORSHIP, PARTNERSHIPCORPORATION OR OTHER PERSON, LIST THE SAME AS THE SOURCE OF INCOME, BUT NOT THE PATRONS, CUSTOMERS, PATIENTS,CLIENTS THEREOF.ITEM 7 I BUSINESSES WITH WHICH YOU ARE ASSOCIATED (See definitions)Name and address of all businesses, organizat ions, or associations (profi t and non-prof it) with which you held a posi tion of of ficer, director, l imi ted liabicompany member, partner, or stockholder and any entity in which you held a position of trustee. Such reporting is required based on the position held,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 Nature of Association1.) AgWest Commodities 1a.)

    POB 1058Imperial NE 69033

    2.) R&A Christensen Farms INC. 2a.) farming

    Edison, NE 68936 secretary

    3.) Cross roads Wesleyan Church 3a.) Lay Director1510 wesley driveImperial NE 69033

    4.) SW NE corn Growers 4a.) Vice Pres

    Imperial NE 690335.) 5a.)

    6.) 6a.)

    7.) 7a).

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    ~ ,ITEM 8 I REAL PROPERTY OF THE FILER IN NEBRASKA (Real property valued at less than $1,000 and yourpersonal residence need not be reported.)List all real property in your name or in which you have a direct ownership interest. The description required must be sufficient to identithe location of the property. Exceptions: You need not report real estate owned by a business listed in Item 6 or 7, your personresidence of real property valued at less than $1,000. Personal residence refers to your principal dwelling-house and adjacent land usefor house-hold purposes, such as lawns and qardens,

    Location of Property Nature of Property(Description or Address (such as: agricultural, commercial, industrial, residential-rental)e1/2 of sw1/4 sec 29 t-4n r-22w ag land5~ c r - f f . . ~ / ' i J .-f S.W, I / & . . ~ ~, J..l- ~~ , ,

    .W"l(~ sw r I t . . \ ~'-S-~~Scz. . ' h o o t ~') s ~?.z.~ * " - b0( CO, I ? J "'5~- se:tv '/~ of-II)W l/~.

    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 PERIOD(a) List the names and addresses of the institutions in which you had checking and savings accounts and certificates of deposit.Financial Institution AddressFirst State Bank Imperial NEFirst state Bank Holbrook NE 68948Adams bank and Trust Imperial NE 69033w e A L s . ';"'0 L.\,,(o(~ : ,"'SCi.Pinnacle Bank Imperial NE 69033

    Homefederal Holdrege NE 68949Lincoln Federal Holdrege NE 68949(b) List the names of the issuers of all stocks, bonds, and government securities, not otherwise listed under Items 6 or 7.Phares Fiancial11"LU~ f laM.

    (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 obl igations owed to you, beneficial interests in trusts andestates, 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 andother tangible personal property unless such property was held primarily 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 not bereported. Accounts payable, debts aris ing out of retail installment transactions or loans made by a financial institut ion in the ordinarycourse 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 andDonor (See Key Below) Circumstances or Occasion forGiftChoose Value:Choose Value:Choose Value:Choose Value:Choose Value:Choose Value:

    Choose Value:Choose Value:

    ~. ---The monetary value of each gif t shall be categorized based on the good faith est imate of the filer. For each reported gif t 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; D) $1,000.01 or more.ITEM 12 ISIGNATURE 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 trueand comolete.

    ~t cL~.~ l-/1 - o c r(Signature of Filer) (Date)