Amygayle Law Womble

NORTH CAROLINA STATE ETHICS COMMISSION 2018 STATEMENT OF ECONOMIC INTEREST NO CHANGE FORM FILER'S NAME (FIRST, MIDDLE, LAST) Prefix First Name Middle Name Last Name Suffix Ms. Amygayle Law Womble REASON FOR FILING (SELECT ALL THAT APPLY) STATE GOVERNMENT JOB (Specify the agency for which you work or are being considered) BOARD/COMMISSION (List complete name of all State boards on which you are serving or are being considered) Principal Fellows Commission; JUDICIAL OFFICER (Specify the office you hold) LEGISLATOR (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 2017 Statement of Economic Interest and that as of December 31, 2017, 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 3/30/2018 Signature Date Amygayle Law Womble Printed Name The SEI and any attachments, excluding the Confidential Form, are public records. Page 2 of 2

NORTH CAROLINA STATE ETHICS COMMISSION 2017 STATEMENT OF ECONOMIC INTEREST NO CHANGE FORM FILER'S NAME (FIRST, MIDDLE, LAST) Prefix First Name Middle Name Last Name Suffix Ms. Amygayle Law Womble REASON FOR FILING (SELECT ALL THAT APPLY) STATE GOVERNMENT JOB (Specify the agency for which you work or are being considered) BOARD/COMMISSION (List complete name of all State boards on which you are serving or are being considered) Principal Fellows Commission; JUDICIAL OFFICER (Specify the office you hold) LEGISLATOR (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 2016 Statement of Economic Interest and that as of December 31, 2016, 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 2/7/2017 Signature Date Amygayle Law Womble Printed Name The SEI and any attachments, excluding the Confidential Form, are public records. Page 2 of 2

Fyn SSIs Sion Soli sSooit oR ETHICS COMMISSION USE ONLY RE Gate Received: 2!" &° 2016 STATEMENT OF ECONOMIC INTEREST ANGE FORM No cH 0 creck for compieion Dlr THIS ENTIRE FORM MUST BE COMPLETED TAU [45,27 Fl 3: 28, SELF GATION FULFILL YOUR SEI FILING OBLI: ees non] Loy KS FILER'S NAME (FIRST, MIDDLE, LAST) _ Prefix First Name Middie Name Last Name Suffix MS | Ruyaayle Law Womble oo REASON FOR FILING (SELECT ALL THAT APPLY) — [J STATE GOVERNMENT JOB (Please specify the agency for | (4BOARD/COMMISSION (Please list complete name of ail which you work or are being considered) State boards on which you are serving or ae being a considered) NC Principal Lellovis _— LTV SC CI UDICIAL OFFICER (Please specty the office you hold) _| [J LEGISLATOR (lease specity House or Senate) APFRMATION — Yalfim that the information provided in this Statement of Economic Interest and any attachments hereto are tre, complete, and accurate to he best of my knowledge and belle. Taio cert that 1 have not transferred, and wil not transfer, any asset, interest, or property for the purpose of canceling i from disclosure whie retaining an equitable interest. understand that my Statement of Economic Interest and any attachments o supplements thereto (with the exception of the Confidential Form regarding Unemancipated Chien) ar pubic record. 1 acknowledge that 1 have read and understand 1... 1384-26 regarding concealing o falling to disclose material information and N.C.G.S. 138A-27 regarding providing tise information: 5 1384-26. Concealing or ailing to disclose material information. A fling persan wha knowingly conceals or knowinly fails to disclose Information that is required to be disclosed on 2 statement of economic interest under this Aric <hal be guity of Class 1 misdemeanor and shal be subject to discipimary action under G.5. 136A 45. § 1388-27. Penalty for fase information Ailing person who provides fale information on a statement of economic interest as required under tis Article knowing that the information is false is Quy of lacs 1 felony and shall be subject to dcipinary action under GS. T30A45. 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 cantinue to be true, correct, and complete to the best of my knowledge and betieT. Clngaacfe Fon, le =.= 14 Sage ET — ypayle bo Wounb le a Submit SIGNED, ORIGINAL documents only. Do not fax or email this form.