A. "Albert" Newy Scruggs, III

, NORTH CAROLINA STATE ETHICS COMMISSION [oe t & 2017 STATEMENT OF ECONOMIC INTEREST 1 IT RECEIVED APR 2 12017 NO CHANGE FORM Ad THIS ENTIRE FORM MUST BE COMPLETED TO | scanned Date. FULFILL YOUR ETHICS FILING OBLIGATION ai, ’ FILER'S NAME (FIRST, MIDDLE, LAST) Prefix | First Name Middle Name CT esteme suttix REASON FOR FILING (COMPLETE ALL THAT APPLY) N So ] STATE GOVERNMENT JOB (Specify Agency and Position) 'BOARD/COMMISSION (List the complete name of all State —— [EE boards on which you are serving or are being considered) | UNC —PEmReokd BoT JUDICIAL OFFICER (Spey Office) LEGISLATOR (Speciy House or Senate) AFFIRMATION N Information an N.C.G.5. 138-37 regarding providing fle miormaton Gicinary action under 6.5. 139A-45. § 1388-27. Penalty for flse formation G5 Tass. T hereby offirm that 1 have reviewed my most recently filed 2016 Statement of Economic Interest and that as of December 33, 2016, my responses continue to be true, Corre, and complete to he best of my knowledge and beter, IEE Hopi i7 Sars Bate ARBEPT ScvbaS ni” Printed Name Submit SIGNED, ORIGINAL documents only. Do not fax or e-mail this form. This entire document is a public record.

NORTH CAROLINA STATE ETHICS COMMISSION 2016 STATEMENT OF ECONOMIC INTEREST NO CHANGE FORM FILER'S NAME (FIRST, MIDDLE, LAST) Prefix First Name Middle Name Last Name Suffix Mr. Albert Scruggs III REASON FOR FILING (SELECT ALL THAT APPLY) STATE GOVERNMENT JOB (Please specify the agency for which you work or are being considered) BOARD/COMMISSION (Please list complete name of all State boards on which you are serving or are being considered) UNC Pembroke Trustees; JUDICIAL OFFICER (Please specify the office you hold) LEGISLATOR (Please specify House or Senate) The SEI and any attachments, excluding the Confidential Form, are public records. Page 1 of 2 AFFIRMATION I affirm that the information provided in this Statement of Economic Interest and any attachments hereto are true, complete, and accurate to the best of my knowledge and belief. I also certify that I have not transferred, and will not transfer, any asset, interest, or property for the purpose of concealing it from disclosure while retaining an equitable interest. I understand that my Statement of Economic Interest and any attachments or supplements thereto (with the exception of the Confidential Form regarding Unemancipated Children) are public record. I acknowledge that I have read and understand N.C.G.S. 138A-26 regarding concealing or failing to disclose material information and N.C.G.S. 138A-27 regarding providing false information: § 138A-26. Concealing or failing to disclose material information. A filing person who knowingly conceals or knowingly fails to disclose information that is required to be disclosed on a statement of economic interest under this Article shall be guilty of a Class 1 misdemeanor and shall be subject to disciplinary action under G.S. 138A-45. § 138A-27. Penalty for false information. A filing person who provides false information on a statement of economic interest as required under this Article knowing that the information is false is guilty of a Class H felony and shall be subject to disciplinary action under G.S. 138A-45. I hereby affirm that I have reviewed my most recently filed 2015 Statement of Economic Interest and that as of December 31, 2015, my responses continue to be true, correct, and complete to the best of my knowledge and belief. I Agree. It is my intention that this check box constitutes my electronic signature. By checking this box I certify that the information provided in this Statement of Economic Interest and any attachments hereto are true, complete, and accurate to the best of my knowledge and belief. Filed Electronically 3/30/2016 Signature Date Albert Scruggs, III Printed Name The SEI and any attachments, excluding the Confidential Form, are public records. Page 2 of 2

NORTH CAROLINA STATE ETHICS COMMISSION 2015 STATEMENT OF ECONOMIC INTEREST No-Change Form FILER'S NAME (FIRST, MIDDLE, LAST) First Name Middle Name Last Name Suffix Albert Scruggs III REASON FOR FILING (SELECT ALL THAT APPLY) STATE GOVERNMENT JOB (Please specify the agency for which you work or are being considered) BOARD/COMMISSION (Please list complete name of all State boards on which you are serving or are being considered) UNC Pembroke Trustees; JUDICIAL OFFICER (Please specify the office you hold) LEGISLATOR (Please specify House or Senate) The SEI and any attachments, excluding the Confidential Form, are public records. Page 1 of 2 AFFIRMATION I affirm that the information provided in this Statement of Economic Interest and any attachments hereto are true, complete, and accurate to the best of my knowledge and belief. I also certify that I have not transferred, and will not transfer, any asset, interest, or property for the purpose of concealing it from disclosure while retaining an equitable interest. I understand that my Statement of Economic Interest and any attachments or supplements thereto (with the exception of the Confidential Form regarding Unemancipated Children) are public record. I acknowledge that I have read and understand N.C.G.S. 138A-26 regarding concealing or failing to disclose material information and N.C.G.S. 138A-27 regarding providing false information: § 138A-26. Concealing or failing to disclose material information. A filing person who knowingly conceals or knowingly fails to disclose information that is required to be disclosed on a statement of economic interest under this Article shall be guilty of a Class 1 misdemeanor and shall be subject to disciplinary action under G.S. 138A-45. § 138A-27. Penalty for false information. A filing person who provides false information on a statement of economic interest as required under this Article knowing that the information is false is guilty of a Class H felony and shall be subject to disciplinary action under G.S. 138A-45. I hereby affirm that I have reviewed my most recently filed 2014 Statement of Economic Interest and that as of December 31, 2014, my responses continue to be true, correct, and complete to the best of my knowledge and belief. I Agree. It is my intention that this check box constitutes my electronic signature. By checking this box I certify that the information provided in this Statement of Economic Interest and any attachments hereto are true, complete, and accurate to the best of my knowledge and belief. Albert Scruggs, III Printed Name Filed Electronically 4/14/2015 Signature Date The SEI and any attachments, excluding the Confidential Form, are public records. Page 2 of 2