Andrew "Drew" G. Moretz

For Saf se Only GR STATE ETHICS COMMISSION PE He fi A] Ey 2020 STATEMENT OF ECONOMIC INTEREST This entire form must be completed to fulfill ree SYORCH ft umplations Your ethics filing obligation. —Saanad __oate Tocomplete Qs __ __ _ __ Supp. ene asts 3 Supp. recabed we Emerecndstabese by [orotic Jisthame Twisdlotame — Tiastame Tou | [ foonis [Cee | poe] | Current Employer Sob Ti (Vins. 7Y + 80kTH_(azscinn WP of Splc Enernmed Reletios Nature or Type of Business a [= Reson for Fling (Complete oll tat 39ply) State Government 105 (Speci agency and postion.) | Boord/ Commission (Uist the complete names of a State oy boards on which you are serving or are being considered.) Judicial Ofice (Spey office) Legislator (Speaty House or Senate.) A. Do other immediate family members reside in your household? Wes Oto On tis form, “immediate family” includes your spouse (unless legaly separated). It aso Includes members of your extended family (your and your spouse's chidren, arondehiren, parent, grandparents, and slings, and the 3015s of e3ch of those persons) who reside in your household. st the ful name of al adults and emancipated minors in your household. Minors are children under 18. They are emancipated by marrage, enlistment in the US mitary, o court order for emancipation. ST Emancipated Minors + Spore | wf Nan aE ‘The SEI and any attachments, excluding the Confidential Form, are public records. Page tof 10 ee SES Ly EL [En Jes ae TE a, [Fn [af T 7 penis [Ff (0 [eee hee | ert mE 1. As of December 31, 2015, did you or any members of your immediate family: iss wad ory Wl owner arse re | nrg rt pr Sp —————————— EL eT er TE TT oe a TI, 2. At any time during 2018 or 2019, did you or any members of your immediate family sell © o buy from the State of Tm LL OYes Kho rt SY TR eR AR STR Speer) emt 3. sof December 33, 2019, id you or any members of your Immediate family on ony of the folowing financal interests ‘valued at $10,000 or more? List each company individually. A Stockin publicly owned compony? Rves One > Do not st interests in 3 widely hed investment fund (incading mutual funds, regulated Invesimert. companies, or pension o deferred compensation plans) i: 1. the fund s publicly traded or 5 asets are widely diversified; ond 2. neither you nor an immediate family member oe abi to control the undertying assets. Owner of Interest Ful Name of Company or ticker symbol Avrew De vom &Is MFT _UTx Laci a Buk of ration Dobe Cuergy, Enbridge tne Grm sco 8. Stock options in a company or business? mE Ove tgno Full Name of Company (Do not use a ticker symbol) C. interests n 2 non-public owned company or business eniy? These Include interests in sole propretorships, Partnerships, ad Dornersis, Jom venture, led abit Companies, Imited aby porinersnps, and Closely held corporations. (Res No- 1F"No,” proceed to question 4. Owner of Interest T Name of Company or Business Entity boner MATZ paris wiliansers Gots CLE Proton Myddz Rows gn: Duchtn “ATF LLE C1). For cach company or business entity Identifed in question 3.C. (the “Primary Company’) please ls the names of any other companies or business entities In which the Primary Company owns securities or equity Interests vated a over $10,000, know. ‘Non-Publicly Owned Company or Business Entity | Other Companies in which the Primary Company (the primary Company) ‘Owns Security or Equity Interests (Xf None or not known The SEI and sny attachments, excluding the Confidential Form, are pubic records. Page30f10 Tein rE I ie er a PES ee Ee FL D0 not list assets held In blind trusts. Oves one | ame soa are ar remee | pesciptm ore re | vous neon tore rs 7 a ‘the mortgage on your primary personal residence? Examples include credit card debts, auto loans, student loans, ET yn faves Ono aE or Fired Chis fmt | indidua, etc) 6. List each source of income (not spedific amounts) of more than $5,000 received by you or any members of your ET a SB oie, i Solos pis WSs mn REGIS eal SE na AH ps » an SRL v SEE > oa a Rr Yor Sina C71 had no reportable income over $5,000 in 2019. pth Stocks | Presse Pivioeror FT ma | = TO IE A Red aire wae Professional and Civic Relationships To Pn TE Su oo pes Ce er Sn Be Toh oes [Yes FINo- IF*No,” proceed to question 8. ee SR TE = I LTA DB EEE I——— PE Ta eT Br Name of Nonprofit Corporation or Organization | Describe State business | TTT PT, 0 2 non Dives BfNo [J Legistator/udicial Officer - You are not required to complete this question if you are fing because ——— Name of Person Name of Society, Organization, Leadership Position rr a Pr i BR dn 9(a). List the name of each business with which you were associated where you or a member of your immediate family WEEE a, omeoireon | tomtonmiptorie | omeorcamoun | lestrenmn Tas = I LL SE fo ee SSE ER RR a [oy a, 1 nn {not applicable (No entities listed on #92) TE RAR BREE hi Se Pee ETE ahi a A tases Tres a ri [J] Decedent's Estates [J Environmental insurance [Labor [0 Local Government [J Real Property [0 Securities. Ovex fv § Too fuguien (including [) utilities Regulation {J Other category not listed TT EDIE ne ne —— ] et as 12. Are you or your employer, or any members of your immediate family, or their employers currently: HE ives [flo (Legislator uc Officer You are not required to compete this question if you ar fling because Ee aT 13. Have you or member of your immediate family been registered as a lobbyst or lobbyst principal wkihin the 12 Oves No Lobbyists Principal Date of Registration | -_ TT DEES ARR. ir ms isl Sn inne including tuition, travel, lodging, meals, and other similar expenses. 1 Dives [RNo []3udical Officer - You are not required to complete this question If you are a Judicial officer or you Te a top ts | oateot Name and Address of Donor(s) Describe Event Estimated Market rr) FR | » State Auditor » State Treasurer » Superintendent of Public Instruction Oves [No Aa aA is e200 0 Rah I es oir oan cms re IS ate A TA, SME ERE os LL Een TTT 3. the head of 2 principal state department (e.g., cabinet secretary) appointed by Ra ES os i A Som So © a member of any of the following boards: Oves (RN by Be an, et a EE eT Tr ; pees me pi a yi ith 4.1 30, were you appointed or are you being considered for appointment to that | (Yes (No TET EE VR Be a TE TT Sy Ta SR a ns ‘multiple contributions, and transferred or delivered those collected [[JYes [INo boy EE TT assistance, mailings, canvassing, surveying, or any other activity that | (Yes [INo ey I TTR TATE TET ove Fm [or comin | yeoman | sem comico | re RE RE OYes No If yes, please provide that information below. oR ns SR a mie sigpires Affirmation The information provided in this Statement of Economic Interest and any attachments are true, complete, and accurate £0 the best of my knowledge and bef. Ihave no transferred, and wil not transfer, any asset interest, o property for the purpose of concealing it from disclosure while retaining an equitable interest 1 understand that my Statement of Economic Interest and any attachments except for the Confidential Form regarding Unemancipated Children are public records. have read and understand the following statutes: N.C.G.S. § 1384-26. Concealing or falling to disclose material information. A filing person who knowingly conceals or knowingly is to disclose information tht is required to be disclosed 03 statement of economic interest. shall be guiy of Class 1 misdemeanor and subject to disciplinary action under G.5. 138-45. H.C.G.5. § 1384-27. Penaity fo aise information. fling person who provides aise information on a statement of economic interest... knowing that the Information 1s folse is uit of 3 Class H felony and shall be Subject to dscplinary action Under G.5. 138A-45. Taffiem under penalty of perjury that the foregoing is true and correct. 7 dl Yo 20 Signature Sate Aaotin CG. Mo eT Printed Name ‘Submit signed, original documents only. Do not fax or e-mail this form. The SEX and any attachments, excluding the Confidential Form, are public records. Page 1001 10

Vita} pRECEIVED (Bh) STATE ETHICS COMMISSION MAR 15 2019 lr 5) 2019 STATEMENT OF ECONOMIC STATE ETHICS COMMISSION INTEREST rn Checked for completion This entire form must be completed to fulfill 42 scanned Aefone Your ethics filing obligation. incompleie as 0 __ Supp. sent date br Supp. received dre entered in coabase or L272 R= Fr FS W_STOTE Gurarinr_asraes State Government ob (Speci agency and position.) on which you are serving or are being considered. Legsator (Specty House or Senate) A. Do other immediate family members reside in your household? ves Oo On this form, "immediate family” includes your spouse (unless legally separated). It also includes members of your extended family (your and your spouse's chidren, grandchicren, porent, grandparents, and sibings, and the spouses. ofeach of those persons) who reside fn your household. ist the full name of ll adults and emancipated minors in your household. Minors are chidren under 16. They are emancipated by marrage, enlistment in the US miltary, or court order for emancipation mite ree | oe Emancipated Minors ee a NS The SEI and any attachments, excluding the Confidential Form, are public records. Page 10f 10 Unemancipated [gem | ke [wf | [sem [=~ 7 - KYes [No waee Oves [®No 3. As of December 31, 2018, did you or any members of your Immediate family own any of the folowing financil interests valued at $10,000 or more? List each company individually. A. Stock in a publicly owned company? Hives Oto > a0 lst Interests in 3 widely held investment fond (including muta funds, regulated Investment companies, or pension or deferred compensation pans) If: the fund s publicly traded or is assets are widely diversified; and 2. neither you nor an immediate family member ara abl to control the underlying assets. [ ownrotmmeew | rulNameof Company or icker symbol fron uretr Dis, Yom, CI. Fr, ut 5. Stock options n 2 company or business? Oves Wo ‘Owner of Stock Option Full Name of Company (Do not use a ticker symbol) C. Interests in a non-publicly owned company or business entity? These include Interests In sole proprietorships, partnerships, imited partnerships, ont ventures, limited iabilty companies, Imited liabilty partnerships, and Closely held corporations. Yes [INo- If “No,” proceed to question 4. Owner of Interest Name of Company or Business Entity rsa liq Corky re [rosin ote; AEH Durnin RTE (ee C (1). For each company or business entity Identified in question 3.C. (the “Primary Company”), please lst the names of any other companies or Business entities in which the Primary Company ours securiles or cquity Interests valued at over $10,000, f known. Non-Publicly Owned Company or Business Entity | Other Companies in which the Primary Company (the Primary Company) ‘Owns Security or Equity Interests. The SEI and any attachments, excluding the Confidential Form, are public records. Page 3 of 10 ee Eo Do not list assets held in blind trusts. See 2019 SEI Helpful Tips for the definition of "Vested Trust” and “Blind Trust.” Oves no Yes Ono Campane Croyle weemantot ams. ama of source pr Er Ll sroces TEE U lomteg raistt [Hotes gfe loin Lec fil ton] vated | Professional and Civic Relationships 7(0). During 2018, were you or any members of your immediate family a directo, officer, governing board member, Srmloyee, independent contractor, ar registered abbyis of a nonprofit corporation or organization operating in orth Coola marty fo Tegious, charkabie, Scenic, teary, pUSIE health and safety, o educational purposes? Yes [iNo- If "No, proceed to question. > Do not st State boards or entities. > Do not lt organizations of which you are a mere member. | Donot Ist organizations of whch you are a mere member. | Name of Nonprofit Nature or Corporation or Organization | Purpose of Organization 706). 1 the nonprofit corporations or organizations sted above do business with the Sate of forth Carolina or receive State funds, biel describe the nature of that busines, if known o with due lence coud reasonably be known. Name of Nonprofit Corporation or Organization Describe state Business Cone or Not Known [& During 2016, were you or any members of your Immediate arly a drecir, Ofer, or Governg board member of any society, organization, ar AGvocacy rou wih an Interest n matters over Which your agency ar board may have Sonsdiccon OYes No Ctepisiator/iudicial Office - You are not required to complete this question f you ar fing because Vou are legislator or Juda office o you ar fing 95 an appaintee to one of those affces. 00 not st organization of which you are ony a member and do not serve in a leadership role. Name of Society, Organization, Leadership position or Advocacy Group (Director, Officer, Board Member) The SET and any attachments, excluding the Confidential Form, are pubic records. Page sof 10 | ameotron | nestoniptorier | wemeotcompny | saeotraren | I EE EE I EE EE I EE EE EE rr" © rr I I 10. Are you a practicing attorney? = Oves [No [judicial Officer/State Attorney [J Administrative 0 Admiralty 0 Corporate Criminal [0 Decedent's Estates. J Environmental [Insurance [0 tabor 0 Local Government [J Real Property 0 Securities OTax Tort litigation (including [J utilities Regulation [0 Other category not listed EE EE 12. Are you or your employer, or any members of your immediate family, or their employers currently + licensed by the State board or agency with which you are or will be associated or + regulated by the State board or agency with which you are or willbe associated or + in 2 business relationship with the State board or agency with which you are or will be associated? Dives [No []Legilotor/udicl Officer You ae not required to complete this question you are fling because you are a legislator or a Judicial offcer or you are fillg as an appointee to ane of those offices. Name of Employer Type of Relationship (if applicable) (Licensing, Regulatory, Business) 13. Have you or a member of your immediate family been registered as a lobbyist or lobbyist principal within the 12 months preceding your filing of this form? Oves ono Name of Lobbyist Lobbyist's Principal Date of Registration Registration Expiration Other Disclosures 14. During 2018, after you were appointed, employed, or filed or were nominated 5 a candidate, did you + receive any "gif(s)" exceeding $200 per quarter from a person or group of persons acting together, + when both you and those person(s) were outside North Carolina, + under circumstances that would lead a reasonable person to conclude the gifts were given for lobbying? To answer Yes, al three conditions must apply. Oves Nino Do not report gifts given by members of your extended family. > Do not report gifts you have previously reported on the “Expense Report for Exempted Persons.” [oe eam rca Name and Address of Donor(s) | Describe Item Received | emmgppener | The SEX and any attachments, excluding the Confidential Form, are public records. Page 7 of 10 we + when those person(s) were outside North Carolina? | |] I I RE Council of State members are: | Oves ho 17 Are you sn spines or prospective spots a: a the head of principal tate department (e5, cabinet secretary) apponted by he fbn 5. 3 North Carolina Supreme Court Justice, Court of Appeal, Super or District Son uager or . a member of any of the flowing bores A8C Commission PR — * Stoe Board of Education Oves (go ~ State Board of locuons ~ Owiion of Employment Securty I Nos procesd to ~ Envranmental Management Cammision Question 18, Mip—— ~ Human Resources Commision ~ Rules Reviw Commission Bardot Transporation UNC Board of Governors ~ Vitis Commission Wide Resources Commission oT sm, were you spplnted or ae you btng considered for apparent to that | ves DING Soon oy Counc of State momoer? De et Bo ston 18. «22, you must Indicate whether during 2018 you engaged in ry ofthe allowing ies wi 145560 to oh bea oth candat campaign commie of oe Coun of Se marer whe sppormed you I Collced contbutions fram mule contriutors, took posgssion of such | (Ives [IN ie Comtinaions, and wansared or dead tose caected onrpeians fo the condo o comme? Hosted a fndrtser a your residence or ac of une? Wh Vlunteered fo ampalg-related act, inducing phone Barks, ever Sean, maloge, Caan: Tew, o an Sr ety Sok avATCES oe compion f 3 contones To, Hove you evr been cnvited of a elany or which you have nt receved oer, (0 a pardon; ar 1 a order of bmi Oves fgho | omews | owteof Conviction | County of Conviction | _ State of Conviction 15. Are you ware of any ovr formation tat you belles may 355 te ihc Commision In a6wng You Concoing You COmpYaRG wih the Kate Goverment Snes Act Dves NoNo 1fyes, please provide that information below. The Sex and any attachments, excluding the Confidential Form, ae public records. Pages or 10 he formato provide inthis Statement of Economic Interest and any atachments ae true, complet, and accurate ne ek of my knowin ond per ave nt tansered, and wil no ranstr, any ase, tres, o rapety forthe purpose of concealing rom Gstionre wave rami a equate aren. understand that my Statement of Economic Interest and any atachments xcept for the Confidential Form regarding Urmancraes Coven oe pose recor. hav read and understand th following statutes: NCGS. § 1638-191. Concealingo falling t disclose moter formatin. A fing person who knowingly concels or knowingly fal to disclose formato thats required to be dilosed On Senemant of Emo aretha bs uly of 3 ies 1 idemavoar ond Sbset 1 Benen Seon under 6.8, Seams. NCGS. § 1630-192. enaty for tse information. A fing person who provides false formation on a statement of scanamic res... knowing that the amon 5 ss. Buty of Coss los ai Sh pe ofc 0 scr acon under G5: LED-415. Laff that ave reviewed my mst recently fled 2018 Statement of Economic Interest and tha as of December 31, S016, my responses continue 10 be ues Comrech and complete to th pet of my lode and pete Xfi under ganalty of perjury that the foregoing is true and correct. py 2/28/15 Sigmar ad fro06w € tuety EE Submit signed, origina documents ony. Do not fox or e-mail this form. EE | The SEX and any attachments, excluding the Confidential Form, ae public records. Page 100110

/7#%y NORTH CAROLINA STATE BOARD OF FOR COMPLIANCE UNIT USE ONLY ZR’): ELECTIONS AND ETHICS ENFORCEMENT Date Received: G44 2018 STATEMENT OF ECONOMIC INTEREST 919-814-3600 van. ncsbe.gov/Ethics/SET AY EHR 14 PARI TX checked tor completion THIS ENTIRE FORM MUST BE COMPLETED TO FULFILL [<= ames 28 Bee YOUR SEI FILING OBLIGATION FRTPRIY ee me Supp. Sent oe [C— Supp. Received Date entered in gouvose SAI or A SN Unity of sett Cptssutn SYats Vb, Sth Gonconenr Lécrmns "NATURE OR TYPE OF BUSINESS Linsan "REASON FOR FILING (COMPLETE ALL THAT APPLY) boards on which you are serving or are being considered) [owe wysmom | VP A Stare Cuucenmer peer JUDICIAL OFFICER (Specify Office) LEGISLATOR (Specify House or Senate) A. Do other immediate femily members reside in your household? Kes Ono When used throughout thi form, the term Immediate family includes your spouse (unless legally separated). t aso includes members of your extended family (your and your spouse's Chidren, granachidren, parents, grandparents, and Siblings, and the spouses of each of those persons) who reside In your household. List the full name of all adults and emancipated minors In your household. A minor fs a chid under 16 years old. Minors re emancipated by marriage, enlistment in the US miltary, or court order for emancipation, FULL NAME OF ADULTS & [ Reusmonswre | EMPLOYER [ osmme | NATURE OF _ EMANCIPATED MINORS BUSINESS € Lavesey 1. tse — The SEX and any attachments, excluding the Confidential Form, are public records. Page 10f10 Note: You must list the full name of each minor child on the Confidential Form available at the ot to mun fo [Cw | ow [ ] from Tomer |] [sen 1 mews | [| ves Ono 5. Lease or rent realestate or personal property £a.ar from the State of North Carolina with a market value of OvYes [No am ter ET. RTT — AT pn ‘State of North Carolina personal property with a market value of $10,000 or more? Oves no eT Er CT FINANCIAL INTERESTS 3. A of December 31. 2017, did you, your spouse, or members of your immediate family own any of the following financial interests valued at $10,000 or more? LIST EACH COMPANY INDIVIDUALLY. | A" stock na puicly owned company? Yes [Ino +50 nat list ownership interests In 5 widely heid investment fund (incuding mutual funds, reguated Imvestent Companies, or pension or ferred compensation pans) I: () the fund 5 publcly traded or 5 assets are wily iversiiod; and (1) neRher yo nor an mmedate family member ars abe to CHI the asses held n she mutual fund, | investment company. o pension or defered compensation plan: Owner of Interest |_Full Name of Company (Do not use a ticker symbol) I Apres potest | Diswey mmm “ | lennl mls | btimtond Bross smnnes (8) _ : Micas sor . Geitd Teckusloyn Gtr. I = yy oF hoc: Dus ory Cubed Po ©. Stock Optians In company or business? GRA iy Oves no ‘Owner of Stock Option Full Name of Company (Do not use a ticker symbol) C. Interests in 2 non-publicly owned company or business entity (including Interests in sole proprietorships, partnerships, Imied parnerships son ventures, ime abity companies, mited labity partnerships, and Cosel neld corporations? Yes CINo- 1 *No,* proceed to question 4. Owner of Interest Name of Company or Business Entity Law tere bighoay 48 «st. Stepher (ech 2d Lic Fuotow_flonere RHE Wie #ASe Gon te Paneer _[hrtere, hisien- Dulane 1? tic (1). For each non-publcy owned company or business enty (the "primary company’) entiied n question 3.C above, please lst the names of any other companies or business entites In which the primary company owns securities or equity interests valved at over $10,000, 1 known. ‘Non-Publicly Owned Company or Business Entity | _ Other Companies in which the Primary Company (the Primary Company) ‘Owns Security or Equity Interests The SEX and any attachments, excluding the Confidential Form, are public records. Page30r10 4. As of December 31, 2017, were you, your spouse, or members of your immediate family the beneficiaries of a vested Do not list assets held in blind trusts. See 2017 SEI Helpful Tips for the definition of “Vested Trust” and "Blind Trust.” | ove gr | Name and Address of Trustee Description of the Trust Your Relationship to the Trust I RE 5. As of December 31, 2017, did you, your spouse, or members of your immediate family have liabilities of $10,000 or ‘more, excluding the mortgage on your primary personal residence? Examples include credit card debts, auto loans, student ves to 6. Uist each source of income (not specific amounts) of more than $5,000 received by you, your spouse, or members of | Do not include income received from the following sources: Freese eons Sn —— [poten Acts | Sui of we Jaret fone 2 I RY PO ITY PROFESSIONAL AND CIVIC RELATIONSHIPS 7(a). During 2012, were you, your spouse or members of your immediate family a director, officer, governing board member, employee, Independent contractor, or registered lobbyist of nonprofit Corparation of organizaten operating in the State of North Carolina primary for religious, choabl, scent, erary, public health and safety or educational purposes? Yes [§iNo - If “No,” proceed to question 8. Do na st State boards o entitles, or antes created by a poical Subamision of the State. > Do no lst organizations of which you are a mere member. Ro not lt organiaions Of WAC you ate ere eer His, Mer Position Name of Nonprofit Nature of Business or Corporation or Organization | Purpose of Organization 7(0). 1f the nonprofit corporations or organizations sted above do business wih the State of North Caroling or receive State funds, please provide 3 brif description of the nature of that business, If known of with which due digence coud reasonably be known. Name of Nonprofit Corporation or Organization Describe State Business or State Funding None or Not Known ©. Dulin 2017, Were you, your 90use, or members of your [IEIALE family 3 Grector, oficer, or governing board member of any society, organization, or advocacy Group With an Interest In matters over which your 2gency or board may Hove jurisdiction? OYes No [)Legislator/iudical Office - You are no required to complete this question f you are fling because ‘ou are a legislator or judicial officer or you are fing as on appointee to hose offices. D0 not lst organiztions of which you are anly a member (Ro serving in a leadership ole). Name of Person Name of Society, Organization Leadership Position H or Advocacy Group (Director, Officer, Board Member) The SEX and any attachments, excluding the Confidential Form, are public records. Pages or 10 Te ee BT Ce Des Id No [Judicial Officer/State Attorney [0 Administrative [Admiralty 0 Corporate 0 Criminal [J Decedent's Estates. [J Environmental OJ Insurance 0 tabor [0] Local Government [J Real Property Securities. Ovax Dyes Rho owt Snes [erm + Regulated by the State board or employing entity with which you are or will be associated or + Have a business relationship with the State board or employing entity with which you are or will be associated? Oves R No [J Legislator/Judicial Officer - You are not required to complete this question if you are filing because ‘you are a legislator or a judicial officer (“judicial officer” is defined in the SEI Helpful Tips) or you were you registered as such within the 12 months preceding your filing of this form? OYes [3] No + when both you and those person(s) were outside North Carolina at the time you accepted the gift(s), and | + the gii(s) were given under circumstances that would lead 2 reasonable person to conclude that they were given = + those person(s) were outside North Carolina and ves Re [Judicial Officer - You are not required to complete this question If you are a judicial officer or you are | Dateot Name and Address of Donor(s) Describe Event. OvYes ¥ No If “Yes”, list all contributions you (NOT immediate family members) made during 2017 with a cumulative Er I RS B= TR 17. Are you an appointee or prospective appointee to: 1 a. the head of a principal state department (e.0, cabinet secretary) appointed by he Governors or 5. 2 Noth Carolina Supreme Court Justice, Court of Appeas, Superior or District Court Judge: or . a member of any of the folowing boards: + ABC Commission | + Coastal Resources Commission + State Board of Education |Oves Kino + State Board of Elections | + Division of Employment Security |1f “No,” proceed to + Environmental Management Commission Question 15. + Industrio Commission + Human Resources Commission © Rules Review Commission + Board of Transportation + UNC Board of Governors + Utites Commission + vidio Resources Commission 4.1050 were you appointed or are you being considered for appointment to that | (J¥es (INo public positon by 3 Counc of State member? Council of State members are I5ted | 17 wpe,” proceed to question 16 ese 15, e150, you must indicate whether during 7017 you (not mediate fry members) engaged in any of the allowing aches wih respect 0 o on behalf of ih candidate or compalgn committe of the Counc of State member Who SPpointed You 0 your publ postion: I. Collected contributions from multiple contributors, taok possession of such multiple contributions, an transfered or delered those colected contributions to the candidate or commitee? Contributions re defined in Question 16, i. Hosted a fundraise at your residence ar place of business” Ove Ome i. Volunteered for campaign related activities, which include, but are ot Imited to, phanc bank, event assistance, mailngs, canvassing, surveying, or any | C1¥es [INo other acivty tha advances the campaign of candidate? 18. Have you ever been convicted of felony for Which you hove na received ether: () 2 pardon of Innocence; or (1) an order of expungement regaring tha conviction? Ove fhe [of | oateorcomioton | Coumyofcomviction | state of conviction 19. Are you aware of any athe Information that you believe may assist th State Ethics Commision n advising You Concerning your cmpance wih the State Government Ethics AEs Des Kto if yes, please provide such information below. ! The SEE and any attachments, excluding the Confidential Form, are public records. Pages of 10 aff that the information provided inthis Statement of Economic Interest and any attachments hereto ae rus, complete, | den hs Ste Loony ar ave nor fre, wil not sie s,s reper for oe pps fling et nt at vii I ndrtand it my Sot of coon nr nds spl rt (ihe xpos oi ons st rd en TE tah ep 92, Conlin i fee tl fran FE ————— ot os Soe so Sis fron fot edd bod, a , R—— DT —— ent anol rt etude bs ane ER ya ool i = fears 6, Maer lili so ronan, enema comments, ___porettessromattoss term, Toe SEL at ey atchments, exci he Gonidentet ar, aap veces aon 390130

= NORTH CAROLINA STATE ETHICS COMMISSION | rox enuics commission use omy i" 7 2017 STATEMENT OF ECONOMIC INTEREST | ate kecened 919-814-3600 wa ethicscommission.nc.gov | . THIS ENTIRE FORM MUST BE COMPLETED TO FULFILL | (eked orcompieton YOUR SEI FILING OBLIGATION Fo ore —— Supp. Sent ate or | Supp. Recevea ome | entered in antabuse 1c my 125C [[FiLEn's AE (FIRST, MIDDLE, LAST) | prix [First Name Middle Name Last Name [ suttix Ps booed | Clam Aoaerz | CURRENT EMPLOYER [os rme (avses a7 oF wusT (ht cvuntr Comers! Fdmiaths {0 S47 Coynen win BitTors | nature or vee or Business oo Lies REASON FOR FILING (COMPLETE ALL THAT APPLY) —— STATE GOVERNHENT JOB (Specify Agency) | BOARD/ COMMISSION (List complete name of oll State oo oo | boards on which you are serving or are being considered UMir acy oF 520TH Clo nk - Conrad fdas A lon JUDICIAL OFFICER (Specify Office) LEGISLATOR (Specty House or Sanat) | A. Do other immediate family members reside in your household? Rves Ono When used throughout this form, the term Immediate family includes your spouse (urless legally separated). It iso Includes members of your extended family (your and your spouse’s chikiren, grandchildren, parents, grandparents, and Siblings, and the spouses of cach of those persons) who reside in your household. List the ull name of all adults and emancipated minors in your household. A minor is 3 hid under 18 years oe. Hinors are emancipated by marriage, enistment in the US miltary, or court order for emancipation. co FULL NAME OF ADULTS & | RELATIONSHIP | EMPLOYER 308 TITLE NATURE OF EMANCIPATED MINORS . a BUSINESS |€ Laguey faeeiz | ie LZ) 7 SE N/R l SE I 1 The SEL and any attachments, excluding the Confidential Form, are public records. Page 11 10 1. st ONLY th nino al nermancpte unr i sur Roxsehold blow. A ivr 3 hid andr 16 yes. | Note: You must list the full name of each minor child on the Confidential Form available at the end of this document, INITIALS FOR RELATIONSHIP EMPLOYER JOB TITLE NATURE OF RS eres | | Sees Nos EE EE | ill IE i Cin | sm | wh | EV N20 EW ! [property nTerests 1. As of December 31, 2016, di you, your spouse, or members of your Immediate family: . Have om nership nres in Hore Cara rea ste inching you esiince) witha marke valu of $1000 moe |e owm [rrr Er —— pa —— prevemmym— I EE I — 5 eae o ron ea stots or personal property 6.51.5 the tote of ath Carel wih market vale of Si6.008 or mover Des No Name of Lessor Name of Lessee 1f Real Estate, Location T If Personal Property, om renters ov Cie County Destrve SE EE SE ‘State of North Caroling personal propery with a market value of $10,000 or more? Ores Pro The SEL and any attachments, excluding the Confidential Form, are public records. vage 20110 FINANCIAL INTERESTS 3. As of December 31, 2016, did you, your spouse, or members of your immediate family own any of the following financial interests valued at $10,000 or more? LIST EACH COMPANY INDIVIDUALLY, A. Stock in a publicly owned company? Cl Mves Owe 55 nat (st owmersivp interests in 3 widely held investment fund (including mutoal funds, regulated imvestment companies, or pension or deferred compensation plans) i: () the fund Is publicly traded or ts assets are widely diversified; and (i) neither you nor on immediate family member are abl to €anrol the assets held in the mutual fund, investment company, or pension or deferred compensation plan. Owner of Interest Full Name of Company (Do not use a ticker symbol) Dito pote1 _ eT Dire y Crvss abel fosel ai " g Di _tr2 1B Code united Tey Grp | A | Cee spspem B 6. Stock Optigns in a company or business? B Oves Qo owner of Stock option Full Name of Company (Do not use a ticker symbol) C. Inforeats in non-publicly owned company or business entity (Including Interests n so propietorshps, partnerships, ited pornrships, Joint ventures, mid Iabity companies, Imited Iabity partnerships, and closely held corporations) Yves [INo- If "No," proceed to question 4. Owner of Interest I Name of Company or Business Entity (#ecy . oo Fighort 492 5 Spina Chek 0 L0C Vn! Gir R BE 1. LT 7715 1 LY 0, LY Io mt Ra vel dort 3 woe finan taboos 55 4b € (1). For each non-publicly owned company or business entity (the "primary company”) identified in question 5.C above, please lst the names of any other companies or business entiies in which the primary company owns securities or equity interests valued ot avar $10,000, 7 known. Non-Publicly Owned Company or Business Entity | Other Companies in which the Primary Company (the Primary Company) ‘Owns Security or Equity Interests Hone or Not Known The SEE and any attachments, excluding the Confidential Form, are public records. Page 3 of 10 C2) 1 you Know that any company o busines anil Ise 03. or 3.C(1) above has ny material business esi or pines canto wih ch Sea of Noth Corin, o i eguIed by he Soi, provi bet descr of hat bones acy. Nome of Company or Business Entity Description of Business Activity with the State KI None ar tat Known B 4. As of December 21, 2016, were you, your spouse, or members of your immediate family the beneficiaries of a vested Hu ih 3 010 of $10,000 oe tht ws reat, APSE, or contol by vouT Do not st assets hed n bing fuses. S201 SELHlpll Tp for the definition of “Vested Trust and “Sin Trt.” Oves no Nome 3nd Address of Trustee | Description ofthe Trust Your Relationship o the Trust 5. As of December 31, 2016, did you, your spouse, or members of your immediate family have liabilities of $10,000 or are, CLAN he Morn of out BAN prena esdence’ Exams lide ced cr bis, aun oo, ude To, personal fon and a amy Geb. Oves [ine Name of Debtor (You, Spouse, Immediate Family | Type of Creditor (Commercial Bank, Credit Union, Vember) Individun, etc.) List ach sure of ince (1 seclc amounts) of oe: an $5,000 received by you, your spouse, or members of your immediate. fom during 2016. Inco salary, was, Sat ocl Government, profesional fe, Fora. rest, didn, fea come, Busnes come, 1 oLhr oes of Come ted a bf repirted 3 Yok Ste a feral tox retos Do nat include income received from the following sources: » Capital gains » Fedora! government retirement > Miltary retirement > Social security income/ S01 Recipient of Income Name of Source Type of Type of income Blsiness/ Industry C11 had reportable income ovr $5,000 n 2016, R = R Loses © One| lophed shai vases | Piviosvey | The SEX and any attachments, excluding the Confidential Form, are public records. Page 3.01 10 PROFESSIONAL AND CIVIC RELATIONSHIPS } 700). During 2016, were you, your spouse or members of your mediate family 3 director, offer, governing board | member, employee, independent contractor, ot egitercd 1obbyst of 8 panpra corporation of arganisatin operating the State of Nortn Carcina primarily fo relious, charkable, scientific, Inérary, Pubic health and safely, or educations! Purposes? [es No - 1°10,” proceed to question &. | Do nl fs State boards or entities, or ene created by » povica aubdiion of he Sate. > Do not lst organizations of which you are a mere member. J Name of Person Wis/ Her pasition Name of Nonprofit Nature of Business or | Corporation or Organization | Purpose of Organisation — | | Coruorationor Organization | Purpose of Organization | | I 7 T I § EE 7(b). If the nonprofit corporations or organizations listed above do business with the State of North Carolina or receive State funds, please provide a brief escrpton of the nature of tha business, f Known or wh Which due dlgence could easanatly be known ‘Name of Nonprofit Corporation or Organization | Describe State Business or State Funding £1 ane or Not Known | During 2016, were you, your Spas oF embers of your immediate arly 3 dvector, ofcer, or governing bard cbr of an SGC, GrGANTaNGN, or AOVOCHEY OToup Hh 31 INKEreSE Im MANETS Over which your 306ncy of bord ay Have orsdcton’ [ies No [J Lagislator Judicial Officer - You are nt required to complete this question you are fing because Vou are 3 legislator o a judicial officer or you ar ing a5 on appointee to those offices. 00 not lst organizations af which you re only a meme (not serving in leadership ric). JE Name of Person ‘Name of Society, Organization Leadership Position or Advocacy Group (Director, Officer, Board Member) The SEE and any attachments, excluding the Confidential Form, are public records. Page sof 10 9(a). List the nome of each company or business with which you were associated whee you or member of your Inmeate family was an employee, director, officer, partner, proprietor, or member or manager 85 of December 31, 2016. NameofPerson | Relationship to Fler | Name of Company Role of person =| Do Business Associations (0). If you know that any company or business entity sed in (a) above hod any material business dealings or business contracts withthe State of North Carolina or wos regulated by the State as of December 31, 2016, provide a brief description of that business activity. I Name of Company or Business Entity Description of Business Activity with the State |. NameofCompany or Business Entity | Description of Susiness Activity with the State 2 ot applicable (Ho enties sted on 59a) 10. Are you a practicing attorney? Cves YoNo [Judicial Officer/State Atormey 11Ves?, check each category of legal representation In which you o the law itm with which you are aflated has cored y legal fees of mre than $10,000 during 2016. (0 Administrative C1 Admiralty 0 Corporate criminal [Decedent's Estes Environmental Cltnsurance Cltabor CJ tocal Government [Real Property [securites Cex Tort ttgaton (including Uses Regulation [other category not fisted. negligence) 11. During 2016, were you o licensed professional (other than on attorney) or did you provide consulting services individually or 25 3 member of a professional association for which you charged or were 5aid over $10,007 Oves fino Type of Business Nature of Services Rendered The SEE and any attachments, excluding the Confidential Form, are public records. Page 6 of 10 12. Are you or your employer, your spouse or members of your immediate family, or thelr employer currently: + Licansed by the State board or employing entity with which you ae o will be associated or | Regulated by the State board or employing entity with which you are or will be associated or + Hove. business rolationship with the State board or employing entity with which you are or wil be associated” ves Mo []Legsator dic Offer - You are not required to complete th question f you are fing because You are a legislator or a Judicial officer CJudical officer” fs defined In the SEL Helpful Tp) or you are fing as an appointee to those cffces Name of Person Name of Employer Type of Refationship it applicable) (Licensing, Regulatory, Business) 13. Are you, your spouse or a member of your immediate family currently registerad a5 a lobbyist or lobbyist principal, or vie you registered a5 such vithin the 12 months preceding your fing of hs form? ! Oves mo Name of Lobbyist Lobbyist's Principal 7 Date of Registration HL SS =— + mms OTHER DISCLOSURES ~ SE 14. During any calendar quarter in 2016 (but only the time period after you were appointed, employed or fled or were nominated os 8 candidate), did you + receive any "git(s)" exceeding $200 per quarter rom a persan or group of persons acting together, and + when both you and thase person(s) were outside North Carolina at the time you accepted the gift(s), and + the gifts) were given under circumstances that would lead reasonable person to conclude that they were oven for lobbying? Ove Ro > 00 not report ifs given by members of your extended family. »00 not report gifts that have previously been reported by you to the Department of the Secretary of State on the “Expense Repor for Exempted Persons. Date Item Received | Nome and Address of Donor(s) | Describe Item Received | Estimated Market Value The SEX and any attachments, excluding the Confidential Form, are public records. Page 7 of 10 [135. During 2016 (9ut only the Ume period ofter you were appsinted, employes, or led or were nominated 0s » candidate) | a ou || accent ashlar” encecing 3200 fom a person or grup of persons acting together and + those person(s) were outside Korth Corolna and + the scholars was reated to your pubic postion? A “scholarship” is 3 grant-in-aid, either direct o indirect, 10 attend conference, meeting, or similar event, including tuition, travel, lodging, meats, and other Similar expenses. [ves Ho [Judicial Officer - You are not required to complete this question if you are a Judicial aficer or you are ing 55 2 dal oficer appointee. | > D0 not report gifs that have previously been reported by You to the Department of the Secretary of State on the | “Expense Report for Exempted Persons.” | » Legislators are not required to report scholarships paid by a nonpartisan legislative crganization of which the leislator | on Genre bs mam or parcar ram fla of at argent Datcof | Name and Address of Donor(s) Describe Event Extimated Market Scholarship | Value i i 16. ere you appointed or ae you being considered fo an appointment to a covered boord by the Governor or another | Counc of State members | Council of State members are: > Governor > Lt. Governor » Secretary of State -l » State Auditor » State Treasurer » Superintendent of Public Instruction » Atomey General » Commissioner of Agricuture ~~» Commissioner of Labor » Commissioner of Insurance gre a 10 "Ves", list il contributions you (NOT immediate family members) made during 2016 with a cumulative otal of more than $1,000 to the Governor or other Cauntil of State member who appointed you. Contributions are defined in N.C.G.S. 163-27.6(6) and Include, but re not mite to, “any advance, conveyance, deposi, isttion, transfer of funds, loan, payment, Of, peda o ubscrpan of ancy of ANN of alc witsoéver” Date I Amount Contributed to Ie contrbution(s) wih a cumulative total of more than $1,000 1 i | [E— The SET and any attachments, excluding the Confidential Form, are public records. Pages or 10 | a. the head of a principal state department (e.g. cabinet secretary) appointed by the | + State Board of Education {Yes ¥ No | 0.110, ware you appointed or are you beng considers for apporntment to tat | (Ives [Io «. If so, you must indicate whether during 2016 you (not immediate family 1 [Yes [INo ii. Hosted a fundraiser at your residence or place of business? lYes [INo to, phone banks, event assistance, mailings, canvassing, surveying, or any LCiYes [No Oves [ne Offense Date of Conviction County of Conviction | State of Conviction Oves [No If yes, please provide such information below. | arrirmaTION 1 | fin thas he information provided in this Stanment of Economic Interest and any atschments hereto are te. complet. and accurate to the best of my knowledge and belch | also certify that | have not rans ferred. and will not transfer, any asset, interes, or property for the purpose of concealing it | Fo does we ein a sia res | 1 understand that my Statement of Economic Interest and any attachments or supplements thereto (with the exception of the Confidential Form regarding Unemancipated Children) are pabic record. acknowledge that have read and understand N.C.G $. 1384-26 regarding concealing o filing to disclose material information and N.C.G.5. 138-27 regarding providing false information § 1384-26. Concealing or filing to disclose material information, A ili person who knowingly conceals or knowingly fis fo disclose information tha i required to be disclosed oni sateen of economic ieee under his Article shal be gait of a Class | misdemeanor and shal be subject wo disciplinary action under G.5. 138A-45 §138A:27, Penal for fase nformarion. A Fling person who provides false information ona statement of conomic interest 2 required under his Aeticle Known that the information i false is ily of a Class H felony and shall be subject to iscpliary action under | GS. 138-45. | [Dt Agree / i Wa 3/7 | Signature Ea—— tapes Gera | Printed Name | | Submit SIGNED, ORIGINAL documents only. D0 not fax or email this form. 1 The SEX and any attachments, excluding the Confidential Form, are public records. Page 10.0f 10

, NORTH CAROLINA STATE ETHICS COMMISSION | fog ervics commission use omy Ji}. 2016 STATEMENT OF ECONOMIC INTEREST | 0ute feceved Re 919-814-3600 www.ethicscommission.nc.gov qoig 1°" 17 St I 23 THIS ENTIRE FORM MUST BE COMPLETED TO FULFILL bo YOUR SEI FILING OBLIGATION ond pate | compete 22 | sup. Sent Date By Sup. Roce Date |= nawavase 7/0 vp FILER'S NAME (FIRST, MIDDLE, LAST) protic | ristrame | Wide Name Coo ame CT CURRENT EFPLOYER ~ {son Time | Vues ny of pont (aime (en \ Monier UT oF Stuf Conoed Fob foams } NATURE OR TYPE OF BUSINESS } REASON FOR FILING (SELECT ALL THAT APPLY) | (XI STATE GOVERNMENT 10B (Please speclly the agency | [] BOARD/CONMISSION (Please lst complete name of al | for which you work or are being considered) State boards on which you are seri or are beng | _ considered) : CJ JUDICIAL OFFICER (Please specify the office you hold)_| [J LEGISLATOR (Pease speciy House or Senate) | | A. Do other Immediate Family members reside in your household? {fives Do | Vien used throughout this form, the ter Immediate Family includes your spouse (unless legally separated). It also | includes members of your extended family (your and your spouse's chidren, grandchildren, parents, arandparents, and Siblings, and the §pouses of each of those persons) who reside in your household. | Ust the ful name of all adults and emancipated minors in your household. A minor is a chid under 16 years od. | Minors are emancipated by marrage, enlistment in the US mltary or court order for emancipation. | FULLNAME OF ADULTS & | RELATIONSHIP | EMPLOYER | JOBTITLE | NATUREOF EMANCIPATED MINORS. | ousmess Pamatyewy pein |e | nh | | The SEI and any attachments, excluding the Confidential Form, are public records. Page 10f 10 B. List ONLY the initials of all unemancipated minors in your household below. A miror i a child under 18 years old. Minors are emancipated by marriage, enlistment m the US miltary or court order for emancipation. | | Note: You must list the full name of each minor child on the Confidential Form available at the | | end of this document. | UNEMANCIPATED BUSINESS | | minors | | 4 tn Sar | wh | Hmm Praca | ya | > Gm DAE Ten WIA I PROPERTY INTERESTS | | 1. As of December 31, 2015, did you, your spouse, or members of your immediate family: | A. Have an ownership interest in North Carolina real estate (including your residence) with a market value of | $10,000 or more? i ves Ono | Owner of Real Estate | % Ownership Interest Location by City | Location by County Dew farcwy feo Rah wate | 8. Lease or rent real estate or personal property to or from the State of North Caroling with a market value of | | 510,000 or mare? i Cves fino Name of Lessor Name of Lessee | 1f Real Estate, Location | 1f Personal Property, | (Renter) by City & County | Describe | ] | i | | i 2. At any time during 2014 or 2015, did you, your spouse, or members of your immediate fom sell 10 or buy from the | ‘State of North Caran personal property with a market value of $10,000 or more? Oves fino | Name of Purchaser Name of Seller Type of Property | The SET and any attachments, excluding the Confidential Form, are public records. Page 2 of 10 JE . _ . _ |FinancraL interests | 3. As of December 31, 2015, did you, your spouse, or members of your immediate family own any of the following financial | Interests valued 3¢ 310.000 or more? A. Stack In publicly owned company? 0b cot st owners interests a 3 widely held vest 7nd (nding mutual fonds, vegUNed vest Companies, or pension ar deferred compensation pane): () the une 1s publicly adad or te aveess ave wily Giarsiiea; and (1 nether Yau nor a immediatly Mambar are i 15 Control te assets held the mural fond, investment company, o pension or deferred compensation pan Owner of Interest Full Name of Company (Do not use a ticker symbol) _Hmm[sen Ciinetn Gomes willy | Drew MopeTT — Diswey, Exes; ttn] Busivess cH | Dien Mortiz | wited ” Fechanleyies Gort (vy) Gan oo L Cse | pew Morert ed Chtecws mills LAvCeY faege 1 Duke Canty | | [iavGuy foreT? sfecren go. st | i [Yes x No Owner o stock Option Full Name of Company (Do not use a ticker symbol) I C. Interests in a non-publicly owned company or business entity (including interests in sole proprietorships, arnershis, IRSA partnarShivs, JO Yemrcs, ted 1abIY Companies, Hes 1abity partnersngs, and | sae corporation | {0%s CINo - 11 No,” proceed to question 4. { Owner of Interest I Name of Company or Business Entity | Lwaley pacer Fight 4857 Stedes (hed td tic | | Prew fropste Rae phan RTE tcf Ch tgs (LE Died prac . Whi ll: psa (07 Lec | € (1). For each non-publicly owned company or business entity (the “primary company”) identified in question SLL ovove, pease at the ames of ry Sint compares of business xii whch ihe prety company ohn Sacuriis equity Inreats valued at over $10,000, known mn Non-Publicly Owned Company or Business Entity | Other Companics in which the Primary Company he Primary Company) + Ou Security or Equity interests | ions o Not known — — S— NR | The SEE and any attachments, excluding the Confidential Form, are public records. Page 30f 10 | © (2). If you know that any company or business entity listed in 3.C or 3.C(1) above has any material business ealings or Business contracts with the State of Norih Caroling or 1 reguiated by the State, prowie a bret Gescription of that business activity. Name of Company or Business Entity | Description of Business Activity with the state ons or Not Known 4. As of Dagember 21 2015, were you, your spouse, or members of your immediate family the benaficares of # vested rust with a value of $10,000 or more that was created, established, or Controlled 6 you? Do not list assets held in blind trusts. See 2016 SEI Helpful Tips for the definition of "Vested Trust” and "Blind Tryst.” Ove Ere Name and Address of Trustee Description of the Trust Your Relationship to the Trust 5. As of December 31, 2015, did you, your spouse, or members of your immediats family have abities of $10,000 or more, excluding the mortgage on your Arar persanal esklence? Examples ncuge credit card debts, auta loans, tudent aan, persona loans and intra- family debt. | ave ne | Name of Debtor (You, Spouse, Immediate Family | Type of Creditor (Commercial Bank, Credit Union, Viember) ol Individual, etc.) SE i E— 6. List each source of income (not specific amounts) of more than $5,000 received by you, your spouse, or members of your immediate fomiy during 2015. Include salary, wages, state/ocol government retirement, professional fecs, Ronoraria, interest, dividends, ental Income, business came, and other types of come reared o be reported on your | Sat and Teer a returns, | Do not include income received from the following sources: » Capital gains » Federal government retirement > Miliary retirement > Social security income/SSDI Recipient of Income Name of Source Type of I” typeof Income Business Industry | C11 hod no reportable income over $5,000 in 2015. oo I | eon fort a | us focal puma] Enplye Srcany The SEX and any attachments, excluding the Confidential Form, are public records. Page 4 of 10 [— AND CuviC RELATIONSHIPS 7(2). During 2015, were you, your spouse or members of your immediate family a director, officer, governing board | member, employes, independent coniaeor, o registred Ibbyist of 3 OMI COTpOTBiON of o3aEaton operaing th State. of North Carola primary for raiious, Chartabie, SRP, Ferry, pub1E haath Sn safors or sducatonsl Purposes? [Yes Kno If "No," proceed to question 8. Do not [at State boards or entities, or He created By 3 pola subi of he Sate. | > Do not bt arganizations of which you a a mere member. } © ameotperson | Wis/er Position Name of Nonprofit Nature of Business or | Corporation or Organization | Purpose of Orgamratien 1 | |: | i 700. IF the nonprott corporations or organizations sted above do business with the Sate of North Carling a receive Stok funds, lage provide > ref Gascon of he nature of hat busines, f Known o with Whih due diigance cours Teasanably be known Fg — pT —— GTI, | 0 fone or Not Known © Curing 2015, were you. your spouse, or members of your immedaté ary 8 director, officer, o governing board member of any socly, rGaEBtan, 0 SAVORAGY 0roup kh an INGHESE in MAIGrs over Wh your D9ency o board may Rove heen [ves [No [J Legisiator/ Judicial Officer - You are not required to complete this question if you are fing because Vou are egator or 5 judcil afc o You ars 1g 5 an BRpoSe to thos ofces > 00 na list xganizations of which you are only 2 member (not serving in leadership roe) Name of Person Name of Society, Organization Leadership Position of Advoracs Goeep (Director, onfcer, Board Member) The SET and any attachments, excluding the Confidential Form, are public records. Page 5 of 10 | 5a). List the name of each company or business with which you were associated where you or a member of your immediate. | family was an employee, director, officer, partner, proprietor, or member or manager as of December 31, 2015. I — —. | Nameorperson | Relationship to Filer Name of Company | Role of Person _. mn ~ SE ——— | | 9(b). IF you know that any company or business entiy sted in 9(a) above had any material business dealings or ! business contracts with the State of North Carolina or was regulated by the State as of Degember 31, 2015, provide a | brief description of that business activity. | Name of Company or Business Entity Description of Business Activity with the State | TR ot applicable (Ro entities listed on #92) [No relationship / Not known | i i { 10. Ave you a practicing attorney? Oves [INo [Judicial Officer/Stote Atorney 16s", check aach category of egal representation in which you or the law firm with which you are affliated has carmed legal feds of more than $10,000 during 2015. [7] Administrative [Admiralty [J Corporate [7] Criminal | [Decedent's Estates [Environmental 13 insurance [Labor [1] Local Government (1 Real Property [Securities [Tax [Tort tigatin (inducing £]utiites Regulation 7] Other category rot sted neghgence) | 11. During 2015, were you a licensed professional (other than an attorney) or did you provide consulting services indiidually o os & member of a professional association far which you charged or were pad aver $10,000 [ves No Type of Business I Nature of Services Rendered The SEX and any attachments, excluding the Confidential Form, are public records. Page 6 of 10 Met the State Sado elon wns with hich yn ave or wil ced or | «het oe Sova sone mon cee in onc veh ene 06 i Olives bil No ['] Legislator/Judicial Officer - You are not required to complete this question If you are filing because NI Se A a A | NE Reve] wa ot i Emp —— Leen (tenn, nage nese) | were you registered as such within the 12 months preceding your fing of thi form? 1 - | area apy [rr— Prep a — ne | "glin | OTHER DISCLOSURES. oo oo 1 « when both you and those person(s) were outside orth Carolina at the time you accepted the git(s), and. | = the gift(s) were given under circumstances that would lead a reasonable person to conclude that they were given | » Do not report gifts given by members of your extended family. - To 1 | Date Item Received | Name and Address of Donor(s) Describe Item Received Estimated Market | | wl The 5 ty tachment dis he Gonttrtn Som, re wale cede rowers | 15. During 2015 (but only the time period after you were appointed, employed, or filed or were nominated as a candidate) | dd you | + accept a “scholarship” exceeding $200 from a person or group of persons acting together and | + those person(s) were outside North Carolina and 1 + the scholarship was related to your public position? A “scholarship” i a grant-in-aid, either direct or indirect, | to attend a conference, meeting, or similar event, including tuition, travel, lodging, meals, and other | similar expenses. | ves {Ko 0) dudical Officer - You are not required to complete this question if you are a judicial office or you are ling 45 8 Judicial officer appantes. > 00 not report ifs hat have previously ben reparted by you to the Department of the Secretary of Stare on the | “Expense Report for Exempted Persons.” | > Legisiators are not required to report scholarships paid by a nonpartisan legislative organization of which the legisitor | or the General Assembly is & member or participant or an aflate of that organization Date of Name and Address of Donor(s) Describe Event | Estimated Market | Scholarship | Value. 16. Were you appointed or are you being considered for an appointment to a covered board by the Governor or anather | Cotmnel of State member Council of State members are | > Governor > Lt. Governor > Secretory of State » State Auditor > State Treasurer > Superintendent of Public Instruction > Attorney General > Commissioner of Agriculture > Convmisioner of Labor | > Commissianer of Insurance | Oves fpno J | If "Yes", list all contributions you (NOT immediate family members) made during 2015 with a cumulative total of more than $1,000 to the Governor or other Council of State member who appointed you. | Contributions are defined in N.C. G.5. 163-278.6(6) and include, but are not mited to, “any advance, conveyance. deposi, istration, transfer of funds, loan, payment, i, pledge or subscription of money or anything of value: broom Date Amount | Contributed to | JR Ma contributions) with a cumulative total of more than $1,000 | The SEI and any attachments, excluding the Confidential Form, are public records. Page 8 of 10 f | 17. Are you an appalntee or prospective appoint o: ] a. the head of » principal state department (2.9. cabinet secretary) appointed by the | | Govemors or b. 3 North Carolina Supreme Cour Justice, Court of Appeals, Superior or District | fbn | | | co member of any of the los boss | + ABC Commission | + Constal Resources Commission | 1 + State Board of Education |Oves Jane + State Board of lection 1 | + Division of Employment Security I “No proceed to | + Environmental Management Commission question 15. ! | + Industrial Commission | + Human Resources Commission | | + Rll Review Commission | | + Bord of Transportation | | + UNC Board of Governors | + Unites Commission + Wife Resources Commission . _ | 4 150, were you appointed or are you being considered for appointment to that | [ves (1No Jub postion bY a Council af State member? Councll of State members are sted | 1¢ "no” proceed to | | In question 16. | auestion 18. | |e. 10, you must indicate whether during 2015 you (not immediate family | | Inenioers) cnaaged In any of the following actiies with respect o or on behalf of | | | he Candidate or campaign convmitee of the Council of State member who | | Ives [INo | L. Collected contributians from multiple contributors, took possession of such | muitiple contributions, and transferred or delered those collected | Contrioutions to the candidate or committee? Contributions are defined in Question 16 I 1. Hosted a fundraise at your residence or place of business? [Oves (ino ! i Volunteered for compangn- related activities, which include, but are nt hited To phan banks, event assistance, malig, canvassing. surveying, or ony | [1¥es (INa | other activity that advances the Campaign of 3 candidate? | | 16. Howe yore ever be eons lp fo wt rout cris hr: 3 gators of acne or 4 om | order of expungement regarding that conviction” | Ove ne | [ offense | bate of conviction County of Conviction | State of Conviction | 19. Are you aware of any other information that you believe may assist the State Ethics Commission n advising you | Lancer vou compance wih the Sie Government Euncs A | (ves YINo If yes, lease provide such information below. | The SEX and any attachments, excluding the Confidential Form, are public records. Page 9 of 10 AFFIRMATION | atti thot th information provided inthis Stent of Eeonomie Interest snd ny attachments hereto are ue, complete. | nd accurate the best of ny knowledge and belief | ato certify that | have not transferred, and will not transfer. sy asset, interest, or property for the purpose of concealing it 1 understand that my Statement of Economic Interest and any attachments or supplements thereto (with the esception of the | Contidenial orm regaeding Unemancipatcd Children) are public record | acknowledge that 1 have read and understand N.C.G.5. 138-26 regarding concealing or Gling to disclose material | information and N.C.G.S. 138A-27 regarding providing fase information & 138-26, Conceaing or failing to disclose material informatio. A filing person who knowingly conceals or Knowingly fist disclose nforstion that i required 0 be disclosed ot atement of conic interest under his Article shall be guilt of a Clas | misdemeanor and shall be subject | to disciplinary ation under G8. 1384-45 | § 1387-27. Penalty for false information. | A filing person who provides false information on a statement of economic interests required wader this Article Korwin hat the information i alse is ily ofa Claws 1 felony and shall be subject 0 disciplinary action der Gs. 138405 Mirage 70, / tA 4 38 fre | Signature Gate | Lhates LL MITT Printed Name The SET and any attachments, excluding the Confidential Form, are public records. Page 100f 10

75%, NORTH CAROLINA STATE ETHICS COMMISSION HEN) 1 "37° 2015 STATEMENT OF ECONOMIC INTEREST | FO ETHics comissionuse ony | 919-715-2071 www.ethicscommission.nc.gov WSR 15 M8 41 [ eesthame [middie Name | Last Name [sur | foters [ V0 of Sle Grusrmmint Berrys Liaessps oo REASON FOR FILING (SELECT ALL THAT APPLY) [RSTATE GOVERNMENT JOB (Please specify the agency for | (] BOARD/COMMISSION (Please list complete name of ail Which you work or are being considered) State boards on which you are sering or re being Consgeres we ch JUDICIAL OFFICER (Pease spec the ofice you hold) _| [J LEGISLATOR (Please speelfy House or Senate) 50 other immediate fom members reside in your household? x Yes [No nen used throughout this form, the term Immediate family includes your spouse (unless legally separated). I also includes members of your extended family (your and your spouse's rldren, randchidren, parents, grandparents, and siblings, and the spouses of ach of those persons) who reside in your household. ONLY LIST THE INITIALS OF UNEMANCIPATED CHILDREN. However, you MUST submit the childrens ful names on the Confidential Form avalabe a the end of tis document Minors are emancipated by marrage, enlistment in the US miltary, or court action for emancipation. EMANCIPATED MING Clreeybbpud wf | wp mw |e | [eer low | 1 7] The SEX and any attachments, excluding the Confidential Form, are public records. Page 10110 INITIALS FOR E— pro FZ Location by County Lpusy J puen wre B. Lease or rent real estate or personal property to or from the State of North Carolina with a market value of $10,000 I TRIE TE a | a | 2. At any time during 2013 or 2014, did you, your spouse, or members of your immediate family sell to or buy from the ‘State of North Carolina personal property with a market value of $10,000 or more? Ove fon I I est nt cms, ct comin ert oti FINANCIAL INTERESTS 3. As of December 31, 2014, did you, your spouse, or members of your immediate family own any of the following financial interests valued at $10,000 or more’ A. Stock in publicy owned company? faves One »00 nat lst ownership interests in widely held investment fund (including mutual funds, regulated investment companies, or pension or deferred compensation plans) if: (0 the fund Ie pUbly traded of Its asets ore widely diversified; and (i) neither you nor an immediate family member are abi to control the assets held fn the mual fund, investment company, or pension o deferred compensation pian. oweotimes | rowan como Gomera ia vn Aeoiey_poserz _ Eovge Mose Gost Jette MotiT2 18m lors futerz = Laity forT2 Poke Gresoy © sPecmte Eregy G Cen B. Stock Options in a company or business? Dves gto Full Name of Company (Do not use a ticker symbol) C. Interests in 2 non-publicly owned company or business entity (including interests in sole proprietorships, partnerships, limited partnerships, Joint vervures, limited 1abilty companies, Imted Habity parcnersnps, and closely held corporations)? [Yes CINo - 1*No", proceed to question 4 Owner of Interest Name of Company or Business Entity Hird 48 o0 Siete, Gl 14 11 Apter nim Toe Aroten WRET® Visio~ Amacrt Gibebes, LLC The SE and any attachments, excluding the Confidential Form, are public records. Page 30f 10 i C2). For each non-publicy owned company or business entity (the “primary company? identified In question 3.C abave, piease Ist the names of any other companies or business entities in which the primary company owns securities or equity Interests valued at over $10,000, i known. Non-Publicly Owned Company or Business Entity Other Companies in which the Primary Company (the Primary Company) ‘Owns Security or Equity Interests C2). If you know that any company or business entity listed In 3.C or 3.C(1) above has any material business dealings or business contracts with the State of North Carolina, or is regulated by the State, provide a brief description of that business acti. amo of Company or Business Entity 4.5 of December 31, 2014, were you, your spouse, or members of your immediate family the benficares of 3 vested rust with a value of $10,000 or morc that was created, established, or controlled by you? D0 not lis assets held in bind trusts. See 2015 SE Helaful Tas or the definition of "Vested Trust” and "Bing Trust.” Oves gto Description of the Trust 5. As of December 31, 2014, did you, your spouse, or members of your immediate family have liabilities of $10,000 or more, excluding the mortgage on your primary personal residence? Examples Include credit card debts, auto loans, student loans, personal loans and intra-family debt. Oves no Name of Debtor (You, Spouse, Immediate Family | Type of Creditor (Commercial Bank, Credit Union, Member) Individual, etc.) ‘The SEX and any attachments, excluding the Confidential Form, are public records. Page 4.0f 10 TT LT Y To mr mm ymmpr— your immediate family during 2014. Include salary, wages, state/local government retirement, professional fees, orastwitammeret tt ——— fp creer rakes ant TR Recipient of Income Type of Type of Income Ex. [11 had no reportable income over $5,000 in 2014. fino MotiT | tre som ste ae CIE EES 7(a). During 2014, were you, your spouse or members of your immediate family a director, officer, governing board 0 B03, we Yo I pone mnt oo nts ri © dot, Sh, ein ond Dies YiNo - if "No", proceed to questions. A NEN Lon hs neo wh amare mer © EE Be re i BL CTT" me | Er IT Ti rns Sa ek esc ste Buns a at Fring Crome nt xm TER nas SH Tory rer raesario (re foe Diep toss ores ott os sonore ig cs Tu pre Sa re So ert immediate family was an employee, director, officer, partner, proprietor, or member or manager as of December 31, 2014. [ omearreson | seitenpterier | vameorcompmny | sowtrenan | a A DE . [YG Not applicable (No entities listed on #92) [No relationship / Not known 10. Are you a practicing attorney? Cves (Qo Cuca Offcer/Sate Attorney OE oo I A he SE and a cmt, clin he Conn Frm, ro alc cr. remsorso Ove )vo ter See Renders «+ Licensed by the State board or employing entity with which you are or will be associated or ClYes re 0) Legisiator/Judicial Officer - You are not required to complete this question if you are filing because ames Cameo errs CT por cron ea es) ‘were you registered as such within the 12 months preceding your filing of this form? Sr Tg TTT i | » when both you and those person(s) were outside North Carolina at the time you accepted the gift(s), and Oves XiNo eso, | Pome mam meee cma aa eS nd 0 tachment, chin he Conds Form, re etc rc. ran ti0 15. During 2014 (but only the Ue period aftr you were appointed, employed, or fled or were nominated 5 a candidate) did you + accept “scholarship” exceeding $200 from a person or group of persons acting together and those person(s) were outside North Carolina and. + the scholarship was related to your public position? A “scholarship” is a grant-in-aid to attend a conference, mating, or similar event. (C1¥es YONo [Judicial Officer - You are not required to complete this Question i you are Judicial officer or you are flog 25a judicial officer appointee. > Do not report gis that have previously been reported by you to the Department of the Secretary of State on the “Expense Report for Exempted persons.” > Legisators are not requir to report scholarships pad by a nonpartisan legislative organization of which th legislator or the General Assembly fs a member or participant o an affiite of tat organization. Date of Name and Address of Donor(s) | Describe Event Scholarship | 16. Were you appointed or ae you being considered fo an appoiment to a covered board by the Governor or anather Counc of State member? Council of State members are: » Governor > Lt. Governor > Secretary of state > state Auditor > state Treasurer > Superintendent of Public Instruction > Attormey General » Commissioner of Agriculture» Commissioner of Labor > Commissioner of Insurance Cves Yoho 1 "Yes", list ail contributions you (NOT immadiate family members) made during 2014 with a cumulative total of more than $1,000 to the Governor or other Council of State member who appointed You. Contributions ae defined in N.C.G.5. 163-276.6(6) and include, but are not limited to, “any advance, conveyance, deposi, distribution, transte of func, lan, payment, if, pledge or subscription of money or anAhind of vale uhatsogver.” TT — conmigo CI No contribution(s) with a cumulative total of more than $1,000 The SEI and any attachments, excluding the Confidential Form, are public records. Page sof 10 17. Ave you an appointee or prospective appantee to: 2. the head of principal state department (9. cabinet secretary) appointed by the Governor; or b. a North Carolina Supreme Court Justice, Court of Appeals, Superior or District Court Judge; or . a member of any ofthe following boards: + ABC Commission + Coastal Resources Commission + State Board of Education Oves Kno + State Board of Elections + Divison of Employment Security I No, proceed to + Environmental Management Commission auestion 18. + Industril Commission + Human Resources Commission . + Rules Review Commision + Board of Transportation + UNC Board of Governors + Utities Commission + Widife Resources Commission 4.1 50, were you appointed or are you being considered for appointment to that public | [Ives [JNo position by 8 Council of Sate member? Counc of State members are fisted in tr Proceed Gueston 16. HL eoia, e150, you must indicate whether during 2014 you (not immediate family members) engaged in any of the following actives WI respect o oon behalf of the candidate or campaign committe of the Council f Sate member wha appointed You to your public postion: Oves CNo i. Collected contributions rom multiple contributors, tock possession of such multiple contributions, and transferred ar delivered those collected contributions 10 the Condidate o committee? Contributions are defined n question 16. i Hosted a fundraiser at your residence or place of business? Oves Ono i. Volunteered for campaian-relaed activites, which ncude, but ae not imited o, phone banks, event asistance, mailings, canvassing, surveying, or any other civity that advances the campaign of 3 cance? 18. Have you ever been convicted of 3 felony for which you have not received ether: (1) & pardon of innocence; or (1) an order of expungement regarding that conviction? Oves gino [ oteme T oateot conviction | County of conviction | state of Conviction 19. Are you aware of any other information that you believe may sist the State Ethics Commission in advising you concerning your compliance with the State Government EINCs Ac? [Ives (No yes, please provi such information below. The SEI and any attachments, excluding the Confidential Form, are public records. Page 9 of 10 Yaffe that the information provided inthis Statement of Economic Interest an any attachments hereto ar ru, complete, and accurate to the bet of my knowledge and belt also cerify that | have not transfered, an will not transfer, any ssf nest, or property for the purpose of concealing it om disclosure while retaining an cquiable interest 1 understand that my Staten of Economic Interest and any stachments or supplements thereto (with he exception of the Confidential Form regarding Unemancipated Children) are public record. Lacknowledge ha have read and understand N.C... 138A-26 regarding concealing or filing to disclose material information and N.C.G:S. 1384-27 regarding providing alse information: § 138.26, Concealing or filing to disclose material information. A fling person who knowingly conceals or knowingly fils to disclose information tat i required o be disclosed on a taement of ccononi interes under this Aric shall be guilty of a Class 1 misdemeanor and shal he sbjct 10 disciplinary action under G.S. 1384-45. §138A-27. Penalty fo fils information. A fling person who provides false information an a statement of economic intrest as required under this Article knowing that the information is false i uity of a Cass H felony and shall be subject to disciplinary action under GS. 138245, 1 Agree Hroaow G. mort © Printed Name po 20 Signature Date Do not fax or ema this form. | The SEE and any attachments, excluding the Confidential Form, are public records. Page 1001 10