XGR Cornett SFI

XGR Cornett SFI
XGR Cornett SFI
XGR Cornett SFI
XGR Cornett SFI
XGR Cornett SFI
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Transcript of XGR Cornett SFI

  • 8/14/2019 XGR Cornett SFI



    Lincoln, NE 68509 FINANCIAL L Ii {~;l~'-.~. t u : E ; F1I\~)t { j~.;(402) 471-2522 INTERESTS 'If nO i;~O /) IL . i : fit:\ ~ F y i 2 : 22BEFORE COMPLETING ) L ~ ( ,t.~i\~",.:;; ' . : : :, L 1 T '/ f LEAD FlUNG REQUIREMENTS NADC FORM C-1 0;') ,,1 flC:~1:.h_ C"I":lc!,'t::'~I"'", '~""".-'---')\,

  • 8/14/2019 XGR Cornett SFI



    ITEM 6 , SOURCES OF INCOME OF OVER $1,000Income includes money or any other form of recompense constitutinq 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 income of over $1,000 was received. list the amount of the income.1.) State of Nebraska ta.) As legislator

    PO Box 94604Lincoln, Ne. 68509

    2.) City of Omaha 2a.) Service Pension1819 Farnam Street Husbands IncomeOmaha, Ne. 68102

    3.) 3a.)

    4.) 4a.)

    'NOTE: IF INCOME RESULTED FROM EMPLOYMENT BY, OPERATION OF OR PARTICIPATION IN A PROPRIETORSHIP, PARTNERSHICORPORATION 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 al l businesses, organizations, or associations (profit and non-profit) with which you held a position of officer, director, l imi ted liabcompany 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 reoort business associations which are otherwise listed under Item 6.

    Name and Address of Business or Organization Nature of Association1.) Plasma Alliance 1a.) Chairwomen

    1100 New York Avenue Suite 630Washington, DC. 20005

    2.) Bellevue Chamber of Commerce 2a.) Board Member1102 Galvin Road SouthBellevue, Ne. 68005

    3.) 3a.)

    4.) 4a.)

    5.) 5a.)

    6.) 6a.)

    7.) 7a).

  • 8/14/2019 XGR Cornett SFI


    ;; . ( i.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)

    ITEM 9 I OTHER FINANCIAL INTERESTS AND PROPERTY HELD DURING THE PERIO D O F 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 AddressSAC Federal Credit Union Hwy 370 and 36'" Street Bellevue,Ne. 68123Omaha Police Federal Credit Union 3003 S. 82nd Avenue Omaha, Ne. 68124Bank of Nebraska 923 Galvin RoadSouth Bellevue,Ne. 68005

    (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). Includeleaseholds and other interests in real estate, promissory notes and other obligations 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, f ixtures 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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    " .Whole Life American Family InsurancePension[sj from City of OmahaDifferred Comp-State of Nebraska

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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 arising out of retai l instal lment transactions or loans made by a financial institution in the ordinarycourse of business need not be reported.

    Name AddressCountrywide Homeloans 4500 Park GranadaCalabasas, California91302Visa P.O. Box 84078, Columbus,GA31908-4078HSBC PO Box 60102 City of Industry, CA91716-0102Nelnet P.O. Box 786 Jacksonville, FL 32201-0786

    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 forGiftHanns-Seidel Foundation Conservative Government 0 Foreign legislative exchangeLazarettstrasse 33 Foundation to NATO and Germany80636 MunichGermany

    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; D) $1,000.01 or more.ITEM 12 ISIGNATURE OF FILER AND DATE.Ihereby state that Ihave used all reasonable diligence in the preparation of this Statement and that to the best of my knowledge it is trueand complete.

    /$~d4.~ '3 1 (Y"I A-R :: lC !J0 J(Signature of Filer) (Date)