XGR Louden SFI

of 4

  • date post

    30-May-2018
  • Category

    Documents

  • view

    218
  • download

    0

Embed Size (px)

Transcript of XGR Louden SFI

  • 8/14/2019 XGR Louden SFI

    1/4

    . c ,"I I, .1

    ~EBRASKA . . POSTMARKDAlEACCOUN rAB lL rrY AND STATEME ,NT MICROF I.M " 11930164I SC LOSURE QQUMISS ION NUMBER '11th Floor; Stale capitol OF O FF IC E US E O NLYP.O . B ox 9 50 86 FINANCIAL , ~ U Ij. " e-,i'{ f.1 " if L)Uncaln, HE 68509 ' . C : L ~ ! ': ~' r'~' ;1.t(402) 471-2522 , ' ",~INTERESTS 7 ' I n Il'1n r\ r:L.\..; iu- LOBEFORE COMPlETING H A D C F O R M C - 1EAOAUNG REQU IREMENTS I N S ( : L e e : L l H E C C / j " j h l l '~ ~ ; : !5 ' 1 ! !

    - Ind iv idual s l is ted oode r Sec ti ons I-A & B of the G enem lInform aIiorrF iI R equirem ents ori page 5 m ust file 1his form . D o lla r v alu es n ee d no t be repo rt ed for any item. except for I tem 11. F ile w ith th e Ne br as ka A co ou n1 ab ilily a nd D is clo su re C omm is sio n a nd w ith th e e le ctio n o ornm is sio ne r o r c le rk o f th e c ou nty o f y ou r re sid en Pe rs ons w h O fail to f ile 1h is report o r o Ih eJwis e d o n ot c omp ly w ith th e re po elilg p ro vis io ns of th e law are subject to penalt ies.ITEM 1 IYOUR NAME, ADDRESS AND PHONE NUMBERName 1 - o ade. /\ j .a: \J T elephone N o. (.JCtf) "7t7- S'03lAST . F IRS I" I MIDDLE

    lU.e-) j- 6 '9)'1'0Address ' 1 1 ,a,dev &s: ' E / ISuiOI- -rli,Sl"REEr ADDRESSO f f FlUAALROI1TE , CITY SOO'E Z lPCOO.,

    rrEM2 IO CC AS IO N F OR RUNG (C heck appropriate boX ).. / "0A cand !da te for eIectiv8 Office .0l.e flo Hic e o r p os itio n ,~ A n nu al o ffic eh old er's o r s ta te emplo ye e's re po rt 0New ly appo in ted to o ff ice o r posit ionITEM 3 IOFFICE HELD & TERII OF'OffiCE (for incumbent elected or appointed officia ls and state employees)

    .rList the office or position you currently hOld which requires this filing. If you have left office, list the office you held O f fic e o r P o sitio n: :SeFJqTtJ) .n /sb,'c.{= /d '19 Term: r f S ! b - > - - 1.70/ht>) ; ENON am e of C ity, C ounty, D istrict, or S tate A gency: U " ,. "am e I's I .ITEM 4 IOmCE SOUGHT (for carididates only) ",List the office sought which requires this filing.Of f ICe:N am e of C ity, C ounty. D istrict. or S tate O ffice:ITEMS IPERIOD COVERED BY mISSTATEMENT .This statement must cover aD f inancial inteIesIs for th e e ntire e ce din g c ale nd ar ye ar" a nd n ot ju st as of year-e nd . I f y ou h av e le ft o ffic e, tstatement must cover a H fiI 'I anc ia I i nteres ts fro m th e e nd of th e cale ndar yea r fo r which you p rev iousl y f il ed up 10 a nd in clu din g th e d ate y ouoffice.QI This statement c ove rs th e p re ce din g c ale nd ar y ea r J an ua ry 1 th ro ugh Decembe r 31,()~I0 left OffICe, this statement c ov ers th e p erio d J an ua ry 1, --'--' to (DA lEYOULEFTOfFICE (lfI POSmON)

    .

  • 8/14/2019 XGR Louden SFI

    2/4

    JIT EM 6 I SO U RC ES O F IN C O IIE O F O VER $1,000In com e includes rIlOOOY or a ny oIh er fo nn O f r ecompe ns e CClI'isiibJting in cOO le under the Internal R evenue C O de. (~ defin itions)Name and add re ss o f a ny sou rc e. flllC l ud in g an in c:iviclJaI. business; , lis t th e nabA'edth e s ou rc e's b us in es s a nd th e nature o f t he se rv icesbody of govemment, pollicai suIxIvision or body corpor.de) from you re nd ered or th e c ire um sta nces oo de r w hich income waswhom incom e dover $1,000 was received. received.1. ) .5-e/{ ern lJ/oVett !lC f, nv;.. e ; . . 1a.) bWl)~'"J r ,2. } ..f-cde pf JIt /~/J r-ftS /t 2 a . ) S e.-PlA/l of-

    / I') , , v e L / J -

    rrEM 9 OTHER RNANCIAL INTERESTS AND PROPERTYHELD DURING THE PERIOD OF THIS STATEMENWHICH EXCEEDED A FAIR MARKET VALUE OF $1.000 AT ANY TIllE ,DURING THE REPORnNGPERIOD(a ) list the nam es and addiesses of the instIutions in w hich yo u h ad ch ec kin g a nd sa vin gs a ccomts a nd ce etific ate s o f ~

    FmnciallnstiIution Address

    (b) List the names of the issueIs of au s tocks, bonds, an d government securi t ies , not otherwise Iis led under Items 6 or 7.

    (e)Describeother proper ly owned or he ld fo r1he p roduc ti on of income not o Ihe Iw ise d isdose

  • 8/14/2019 XGR Louden SFI

    4/4

    ITEM 10 C RE DIT O RS T O w tIO lII-l1 ,O O O O R MORE WAS OWED OR ~ BY YOU OR A MEM BER OYOUR IllllE D lA T E FAM IL Y . .exception: l..clans from a re la tiv e a nd la nd c:onIrads whic h h av e b een re co rd ed w ith th e Co lBy C I eI k o r R e gis te r o f qeeds need not be repo~A C counts payable. ~ ari5itig ou t o fr et 8i l iI 1s Ia JImen t1ransacIiOns.O r Ioarl::>made by a fiilanciaI instiIlJtion in th e .~ courseo f ~ ne ssneed nOt berepdrted . " ', . . .. ' "':' ' , ,:'

    Name Address . ,~. .~~

    IT EM 11 SOURCES OF GIFTS OF A VALUE OF MORE TlfAN $100 ReCEIVED EXCEPT' Gli=TS FRORELAllVES. (See definitions)Nameandaddressof Donor OQa !p alio n o r natureo f buS iness Valueof Giftof Donor (See Key Below) 0escripIi00 of Gift an dCin::umstances or OccasionGift

    . . . .' .

    ~-------- ~ -L ~T he mone ta ry v alu e o f each ~ shaI be categolized based on th e good fa iI h e stim a te o f th e filer. F or e ach re po rte d g ift in se rt in th e V alu e~ the ~ wIlichconaspoIlds to th e -..e categoryo r th e gift T he v aI ue.ca tegories a re :.A ) $ 1 00 .0 f tO $ 20 0 ; E l)$ 2( )O . 01 to $ 5 0 0 ; . C ) $ 50 0 .0 1 t o $1 ,000 ;0 )$1 ,000 .01 or more."": ~: '.:\;;",;-"-:." . .... '." .r . .'. " -. . ...

    .~.", -.: . 'If.: , ..~.

    . . .:: .. ",

    iTElii12 ," ; S IGNATURE O F F I L E R AND D ATE . .. .. ' - , ,'. ., - - ..

    I

    . , . . . . r : : . ' , ". ~.,1. .,;', ~ ..~..' ,':

    Dale