Xgr Harms Sfi

8/14/2019 Xgr Harms Sfi

1/4

. , . .,~EBRASKA \ r I I POSTMARK 'AID.J- DATEACCOUNTABILITY AND 7940175ISCLOSURE COMMISSION STATEMENT MICROFILM11th Floor, .State Capitol NUMBEROF.o. Box 95086 OFFICE USEONLY

Lincoln, NE 68509 FINANCIAL L: n e e u E T . / X t i / , : i \ : . ~ ~ ;(402) 471-2522 INTERESTSBEFORE COMPLETING ? P i1 Q ~/i~P;; :

{~ i;j Q. 1 8EAD FILING REQUIREMENTS LUUJ i ~nil L!.-~ .J .-NADC FORM C-1 : n : . A c e y . ' \ ' / iT'1 ">r- 'jS "" L c : ( ) t ' l f ; i i ; : ~ ; (t Candidates for designated offices and holders of designated offices and positions must file this statement. See Sections 1A and1B of the instructions.

Candidates (including incumbents) subject to this filing requirement must file with the Commission and with the appropriateelection official (See Instructions). Designated off iceholders and holders of designated positions must file this statement with the Commission annually. Dollar values need not be report for any item, except Item 11. Persons who fails to file as required is subject to a civil penalty of up to $2,000.ITEM 1 IYOUR NAME, ADDRESS AND PHONE NUMBERName j-+o.(~$ - = r Q ~ Y \ ;\I Telephone No. G:og) /'3!:'--/'-/1 PLAST FIRST MIDDLEAddress I q L E ~ ~ X " f : ! J . s .:h -,., ..~ J - < :: : : : : , (Ixf t.e:.. . h I , .1..L N F . I e r t_ ~c ISTREETADDRESSOR RURALROUTE CITY ""VI..> STATE ZIP CODEITEM 2 IOCCASION FOR FILING (Check Appropriate Box)

DA candidate for elective office DLeft office or positionI ) ? J ' Annual officeholder's or state employee's report DNewly appointed to office or positionITEM 3 I OFFICE HELD & TERM OF OFFICE (Incumbent elected/appointed officials and state employees. SeeIB of instructions) /List the office or position you currently hold which requires this filing. If you have left office, list the office you held.Office or Position: S e - . ' " " Y \ . . . : ; ( . . . t o ' r Term: J ~ : /)'1BEGINS ENDSName of City, County, District, or State Agency: f) ;St - I - ,1 , 4 . ' J . . '- I g,

.

ITEM 4 I OFFICE SOUGHT (Candidates only. See 1A of instructions)List the office sought which requires this filing.Office:

Name of City, County, District, or State Office:

ITEM 5 IPERIODCOVERED BY THIS STATEMENTThis statement must cover all financial interests forthe entire "preceding calendar year" and not just as of year-end. If you haveleft office, this statement must cover all financial interests from the end of the calendar year for which you previously filed up to andincluding the date you left office.~ This statement covers the preceding calendar year January1 through December 31. ~oog0 Left office. this statement covers the period January 1, to

(DATEYOULEFTOFFICEOR POSITION)

Revised August 2007


2/4

(' !4',

ITEM 6 I SOURCES OF INCOME OF OVER $1,000Income includes money ot any other form of recompense constituting income under the Intemal 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 govemment, political subdivision or body corporate) from rendered or the circumstances under which income was received. NOTE: Do nwhom income of over $1,000 was received. list the amount of the income.1.) ' s tm - t e o S - - ' lJ 1 3 1a.) S.e."'fJ h,.... tv", "g .t: .

2.) U s. Go 0PX-e- , =pc .f ''' ''--t- 2a.) -So e.-i n I 5:.P '" :1I3.) ,If:)$ ~ Qir~ 3a.) R p -j.. ~"' ''' >M..e t F :'vlJ~es, So,


3/4

~r .'-~.,." \ J ~ ~ - ~ - ~ ~ ~ ~ ~ ~ ~ - - - - - - .ITEM 8 I'''RE,AL PRO,P~R,TV: c ,HE FILER INNEBRASKA (Real property valued at less than $1,000 and yourIpersonal resldenceneed-nor be reported.)

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

~/t) e /It{>S < !. .t> + fs b I C - l J J IN 6

Nature of Property(such as: agricultural, commercial, industrial, residential-rental)Location of Property(Description or Address

ITEM 9 I OTHER FINANCIAL INTERESTS AND PRO,PERTYHELD 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 certif icates of deposit.

Financial Institution AddressP . &. 13D '( J ';l .( . ,7 ) ~cpf-f-s b I ! . L : . f - s { f l J t 3 L" y 3 t,3-- rsf. (J. .B " t .;L ~o~ ~ ~Hsbl - :1 .. s( )pt r S 4 -( ) I t{. - f l - e

~tCL1- e B 4 . " " " I(U c",. lky N ed: O'1.Q{ t3ct v../(

(b) List the names of the issuers of all stocks, bonds, and government securities, not otherwise listed under Items 6 or 7.Tr!J1L e't-ef'7 30 . .3A ; ! > p'v eI V ew y o , < - / - ( { L IY

e " . ' ' f l & .po ....!F il1.rtYLc. l . . . ( (J...IrIJU-P'7 11 J .1 i'1h stDeiYY lotV le s ~ Il ~o3CJ;;'-OOD(

(

(c) Describe other propertyowned.or held for the production of income not otherwise disclosed in Items 6,7,8 or 9(a)(b). lncludeleaseholds 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, 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 exchanqe.fr-il'\~ifd ril1.~'Y\e.ZtL-{ c 3 - r .. , ..f'71l U i? h ~fD e .~ lY \.o ~ Y I c . ~ ,I a . 5 0 03 q ') ..000 (

t. i 'r\ C - D I y. t U l L - + ' / / . _ 3 fcp .(.C .. s., 8 '-1 1~ /)h-iy\e..61-.-. fl)[ &1t;bl-


4/4

, ,I " ) )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 retail installment transactions or loans made by a financial institution in the ordinarycourse of business. need not be reported.

Name AddressP I C \,+f e , \ ) ~k'( N c c f ' t fja . . -Y1 {( Bo~ o.-305?/~~ b lu . . Y j - , . t I e I... :> c t3 /;] - ~ ~ o J '

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 forGift

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; D) $1,000.01 or more.ITEM 12 I SiGNATURE 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 complete.

(\I,JL ~ ~ 3/S~/o/l /L; : : :: " . -(Signat'f Filer) \...-/ (Date) '/

Xgr Harms Sfi

Documents

Transcript of Xgr Harms Sfi