XGR Howard SFI

of 4

  • date post

  • Category


  • view

  • download


Embed Size (px)

Transcript of XGR Howard SFI

  • 8/14/2019 XGR Howard SFI








    \ Ik A propriate Box)ITEM 2 OCCASION FOR FILING (Chec P

    oA candidate for elective office I rt\ E l Annual officeholder's or state employee s re p oo Left o ffic e o r p o s itio n . . " .o N e w ly a p p o in te d t o o ff I c e o r p o s I tI O n

    \Name of City, County, District. or State Agency:ITEM 4 OFFICE SOUGHT (Candidates only. See 1A of instructions)List the office sought which requires this fil ing.Off i ce :

    ITEM 5 PERIO D CO VERED BY THIS STATEM ENTThis statement mustcover all financial interestsfor the entire "preceding calendar year" and notjust as of year-end. If you haveleft office, this statement must cover all financial interestsfrom the end of the calendar year for which you previouslyfiled up to andincluding the date you left office.~ This statement covers the preceding calendar year January1 through December 31, / g

    ~~~---------o Left office, this statement covers the period January 1, to---- (DATE YOU LEFT OFFICE OR POSITION)I RevisedAugus t 2007

  • 8/14/2019 XGR Howard SFI


    "\ l J . . .. ..ITEM 6 I SOURCES OF INCOME OF OVER $1,000Income includes money or any other form of recompense constitutinq income under the Internal Revenue Code.7See definitionS)Name and address of anysource* (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: Dowhom income of over $1 ,000 was received . list the amount of the income.1.) (f {p ITiAn .II.~ .::J7liff tKl A 1,.i.....N ~h 1a.)


    2.) 2a.)

    3.) 3a.)

    4,) 4a.)

    'NOTE: IF INCOME RESULTED FROM EMPLOYMENT BY, OPERATION OF OR PARTICIPATION IN A PROPRIETORSHIP, PARTNERSHCORPORATION 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, organizations, or associations (prof it and non-profit ) with which you held a position of off icer, director, limited licompany member, partner, or stockholder and any entity in which you held a position of trustee. Such report ing is required based on the position heldon whether income was received. You need not report business associat ions which are otherwise l is ted under Item 6.

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

    2.) 2a.)

    3.) 3a.)

    .~~-. .--~.-4.) 4a,)

    5.) 5a.)

    6.) 6a.)

    7.) 7a).

  • 8/14/2019 XGR Howard SFI


    ,.. ! 1 f ~ITEI'Vi8 . 1 . REAL PROPERTY OF THE' . LER IN NEBRASKA (Real property valu't,~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 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 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 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 certi ficates of deposit.

    Financial Institution Address

    (b) List the names of the issuers of all stocks, bonds,-and government securi ties, not otherwise listed under Items 6 or 7.2:~~~./)~P~

    (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 teal estate, promissory notes and other obligations owed to you, beneficial interests intrusts andestates, cash valuelife 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 tanqlble personal property unless such property was held primarilvfor sale or exchance.

  • 8/14/2019 XGR Howard SFI


    ,\ }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 installment transactions or loans made by a financial institution in the ordinarycourse of business need not be reported.

    Name AddressHhli- ! J ? c nff-JdiJ d t i A t f ~

    Gvtin:vn - licJ-71A frL~ (. rM~/!~dJ)~~~-itJdt;~~ e fw ~oe)CIiC4 f- C - a J -Clf~- C 3-~ /f< ?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 gif t. 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.

    ~1Ntuf L/~)-()9(Signature of Filer) (Date)