Angela Coleman

This entire document is a public record. STATE ETHICS COMMISSION 2025 STATEMENT OF ECONOMIC INTEREST NO-CHANGE FORM ELECTRONIC FILING This entire form must be completed to fulfill your ethics filing obligation. Filer’s Name (First, Middle, Last) Prefix First Name Middle Name Last Name Suffix Angela Alvarado Coleman Reason for Filing (Complete all that apply.) Are you a CANDIDATE for elected office? ☐ Yes ☒ No If yes, for what position are you seeking election? (Specify name of office seeking in box below.) Do you currently hold this position? ☐ Yes ☐ No State Government Job or Post-Service Filer (Specify agency and position.) Board/Commission (List the complete names of all State boards on which you are serving or are being considered.) NC Central University Employees - Vice Chancellor for Student Affairs Judicial Officer, Post-Service Filer, or Appointee (Specify office) Legislator, Post-Service Filer, or Appointee (House or Senate) This entire document is a public record. AFFIRMATION I have carefully reviewed my most recently filed Statement of Economic Interest Long Form and my responses continue to be true, correct, and complete to the best of my knowledge and belief. 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 No Change Form is a public record. I have read and understand the following statutes: N.C.G.S. § 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 . . . shall be guilty of a Class 1 misdemeanor and . . . subject to disciplinary action under G.S. 138A-45. N.C.G.S. § 138A-27. Penalty for false information. A filing person who provides false information on a statement of economic interest . . . 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 affirm under penalty of perjury that the foregoing is true and correct. Filed Electronically 03/26/2025 Signature Date Angela Alvarado Coleman Printed Name Submit signed, original documents only. Do not fax or e-mail this form.

This entire document is a public record. STATE ETHICS COMMISSION 2024 STATEMENT OF ECONOMIC INTEREST NO-CHANGE FORM ELECTRONIC FILING This entire form must be completed to fulfill your ethics filing obligation. Filer’s Name (First, Middle, Last) Prefix First Name Middle Name Last Name Suffix Angela Alvarado Coleman Reason for Filing (Complete all that apply.) Are you a CANDIDATE for elected office? ☐ Yes ☒ No If yes, for what position are you seeking election? (Specify name of office seeking in box below.) Do you currently hold this position? ☐ Yes ☐ No State Government Job (Specify agency and position.) Board/Commission (List the complete names of all State boards on which you are serving or are being considered.) NC Central University Employees - Vice Chancellor for Student Affairs Judicial Officer or Filing Post-Service (Specify office.) Legislator or Filing Post-Service (Specify House or Senate.) AFFIRMATION I have carefully reviewed my most recently filed Statement of Economic Interest Long Form and my responses continue to be true, correct, and complete to the best of my knowledge and belief. 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 No Change Form is a public record. I have read and understand the following statutes: N.C.G.S. § 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 . . . shall be guilty of a Class 1 misdemeanor and . . . subject to disciplinary action under G.S. 138A-45. N.C.G.S. § 138A-27. Penalty for false information. A filing person who provides false information on a statement of economic interest . . . 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 affirm under penalty of perjury that the foregoing is true and correct. Filed Electronically 04/24/2024 Signature Date Angela Alvarado Coleman Printed Name Submit signed, original documents only. Do not fax or e-mail this form.

This entire document is a public record. STATE ETHICS COMMISSION 2023 STATEMENT OF ECONOMIC INTEREST NO-CHANGE FORM ELECTRONIC FILING This entire form must be completed to fulfill your ethics filing obligation. Filer’s Name (First, Middle, Last) Prefix First Name Middle Name Last Name Suffix Vice Chance llor Angela Alvarado Coleman Reason for Filing (Complete all that apply.) Are you a CANDIDATE for elected office? ☐ Yes ☒ No If yes, for what position are you seeking election? (Specify name of office seeking in box below.) Do you currently hold this position? ☐ Yes ☐ No State Government Job (Specify agency and position.) Board/Commission (List the complete names of all State boards on which you are serving or are being considered.) NC Central University Employees - Vice Chancellor for Student Affairs Judicial Officer or Filing Post-Service (Specify office.) Legislator or Filing Post-Service (Specify House or Senate.) This entire document is a public record. AFFIRMATION I have carefully reviewed my most recently filed Statement of Economic Interest Long Form and my responses continue to be true, correct, and complete to the best of my knowledge and belief. 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 No Change Form is a public record. I have read and understand the following statutes: N.C.G.S. § 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 . . . shall be guilty of a Class 1 misdemeanor and . . . subject to disciplinary action under G.S. 138A-45. N.C.G.S. § 138A-27. Penalty for false information. A filing person who provides false information on a statement of economic interest . . . 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 affirm under penalty of perjury that the foregoing is true and correct. Filed Electronically 03/01/2023 Signature Date Angela Alvarado Coleman Printed Name Submit signed, original documents only. Do not fax or e-mail this form.

1 rk i a— an STATE ETHICS COMMISSION Date Received: Eh Aa es hy) 2022 STATEMENT OF ECONOMIC INTEREST RECEIVED Mell eg No Change Form JAN 20 2022 This entire form must be completed to fulfill . COMMISSION your SEI filing obligation. WO ETHCS COMMS Filer's Neme (First, Middle, Last) — I | IE wT rr sue Bn x Cen C1 Reason for Filing (Complete all that apply) State Government Job (Speci agency and postion) | Boara/Commission (Let the complete names of al State * peste boards on which you are serving or are being considered.) ork ato Cor Unvei, Vie Chan or Sd AT ‘ Currently Serving as a Judicial Officer (Specify office.) Currently Serving as a Legislator (Specify House or Senate.) Are you a CANDIDATE for a covered elected office? | | If Yes, specify office and District/County if, applicable: (District, Superior, or Supreme Court, Court of || Goncaran See Am, Gerson Yes @No AFFIRMATION 1 have carefully reviewed my most recently filed Statement of Economic Interest Long Form and my responses continue 0b tree, correct, and complete to the best of my knowedge and belle. 1 have ot transferred, and will not transfer, any asset, interes, of property forthe purpose of conceain i from disclosure whie retaining an equitable terest. understand that my No Change Form i 2 public record. have read and understand the following statutes: N.C... § 138A-26. Concealing or falling to disclose material information A fing person who knowingly conceals o knowingly fal to disclose information that i required to be disclosed Oa Statement of sconomic Interest. shall be QUIty of & Class 1 misdemeanor and subject to dcilnary Seton under G.5. 1388.45, N.C.G:S. § 138A-27. Penalty for ale information. A filing person who provides fais Information on a statement of economic terest... knowing that the information false 5 Quit of Class felony and shall be subject t disciplinary action under G.. 136A-45. Zatfirm under penalty of perjury that the foregaing i true and correct. nature oat Stones A, / yd te go, Ye, | Angela A. Cbleman Printed Name ‘Submit signed, original documents only. Do not fax or e-mail this form. oo This document is a public record

“, 2 CE a Gy STATE ETHICS COMMISSION | oe meceves i 7 2021 STATEMENT OF ECONOMIC INTEREST 7 NO CHANGE FORM RECEIVED This entire form must be completed to fulfill JAN 21 2021 your SEI filing obligation. NCETHICS COMMISSION ~~ | Filers Name (First, Middle, Last) i} _ 1] prefix First Name Middle Name Last Name. Suffix 1 Br Amel x Coleman Reason for Filing (Complete all that apply.) ate Government Jb (Speciy 3geney aC PORT) | Soara/Commizzion (Li ie complete names of of State Boards on which you are serving or ere being cons dered.) Judical Officer (Specy office.) | Cegisiator (Specify House or Senate.) AFFIRMATION | 1 have carefully reviewed my most recently fled Statement of Economic Interest Long Form and my responses continue | 0/58 true, correc, and completa to the beat of my knowledge and bet. 1 have not transferred, and wil not transfer, any asset, interest, or property for the puroese of concealing & from closure whic retaring an equtabie rierest Tuncerstand that my No Cange Form is a public record have read anc uncerstand the folowing siatutes: K.C.G.5. 5 1383.26. Concealing or failing to disclose materal information A fling person who knowingly conceals or know gly fis to disclose information hat s reguired to be disclosed 313 Statement of economic interest» shal 5¢ GUI of 8 Clas 1 misdemeanor and subject fo disciplinary | stonwdercs. eas N.C.GS. 5 1368-27. Penalty for fase infermation. | A fling persen who provides faise information on a statement of ecorcmie Interest... knowing that the | Information false 3 Gulty of 3 Clas H felony an 31 be subiect to IScipmary action uncer G.S. 1394-4. Taffir under penalty of perjury that the foregoing is true and correct. pi A Siarature Bate Angela A. Coleman Printed Name Submit signed, original documents only. Do not fax or e-mail this form. “This entire document is a public record.

" ” [FOR STAFF USE ONLY Faia STATE ETHICS COMMISSION Date Received: § Py 2020 STATEMENT OF ECONOMIC INTEREST RECEIVED vf NO CHANGE FORM MAR 19 2020 This entire form must be completed to fulfill your SEI filing obligation. oedETIGREIMAS PN same ll one 3-1-2 enerea in 0B_by [ Fier’ Name (Fst, Wadle, Last) Oe Prefix First Name Middle Name Last Name Suttix Dr Angela KE oo Coleman = Reason for Filing (Complete all that apply.) ‘State Government Job (Specify agency and position.) Board/Commission (List the complete names of all State boards on which you are serving or are being considered.) North Carolina Central University, Vice Chancellor for Student Affairs. oo | Judicial Officer (Specify office.) Legislator (Specify House or Senate) AFFIRWATION Ihave carefully reviewed my most recently fled Statement of Economic Interest Long Form and my responses continue tobe true, correct, and complete to the best of my knowledge and belie, have not transferred, and il ot transfer, any asset, interest, o property fo the purpose of concealing i from disclosure whi retaining an equitable terest understand that my No Change Form 2 public record have read and understand th following statutes N.C.GS. § 138-26. Conceaing o ailing to disclose material information. A fling person who knowingly conceals or knowingly fais to discose information that required to be disclosed ona saree of economic teres shal be guy of a Class 1 misdemeanor and subject 10 scpInaTY ction under G.5. 130-45 NCGS. § 1385-27. Penaty or fase information A fling person who provides false information on a statement of economic terest... knowing that the information fs false 1 Guity ofa Class H felony and shal be subject to iscipinary action under G.5. 1364-45. T affirm ur penalty of perjury that the foregoing is true and correct. Og liF|eceg | Signature Bate Lob Cie Printed Name Submit signed, original documents only. Do not fax or e-mail this form. This entire document is a public record.

CEIVED OR FOR STAFF USE ony 4 ANORTH CAROLINA [S555 oe STATE ETHICS COMMISSION 2019 STATEMENT OF ECONOMIC INTEREST checked for compton 4° NO-CHANGE FORM ANT scanned $0 pate 11114 This entire form must be completed to fulfill your — ethics filing obligation. rr Fler's Name (First, Middle, Last) [prefix | FirstName | middle Name | Last Name suffix | State Government Job (Specify agency and position.) Board/Commission (List the complete names of all State. boards on which you are serving or are being considered Nort Coron Cnt vty Vice Chancellor for Stdent Afas Judicial Officer (Specify office.) Legisiator (Specty House or Senate.) | opr TEg—eeerrer————————— AFFIRMATION The Information provided i this Statement of Economic Interest and any attachments are true, complete, and accurate to the best of my knowledge and beler. Ihave not transferred, and will not transfer, any asset, interest, or property for the purpose of concealing it from disclosure hie retaining an equitable interest. 1 understand that my Statement of Economic Interest and any attachments except for the Confidential Form Regarding Unemancipated Children public records Ihave read and understand the following statutes: N.C.G.5. § 1634-191. Concealing or failing to disclose materia information. A fing person who knowingly conceals or knowingly fais to disclose information that is required to be disclosed on 2 statement of economic interest - shal be guilty of 2 Class 1 misdemeanor and... - subject to disciplinary action Under G.S. 163A-415, N.C.G.5. § 163-192. Penalty fo flse information. A fing person who provides false information on a statement of economic interest. knowing that the information | 1s false 1s uly of a Class felony and shal be subject to disciplinary action under G.5. 163A-415. I affirm that I have reviewed my most recently filed 2018 Statement of Economic Interest and that as of December 31, 2018, my responses continue to be true, correct, and complete to the best of my knowledge and belief. Taffitm yhder penalty of perjury that the foregoing is true and correct. i) : R 5 Erp Printed Name Submit signed, original documents only. Do not fax or e-mail this form. This entire document is a public record.

.4+%. NORTH CAROLINA STATE BOARD OF || ror compumnce unr use oma {HJ ELECTIONS AND ETHICS ENFORCEMENT Oe Recwtieés “+A; . 2018 STATEMENT OF ECONOMIC INTEREST 919-814-3600 ww. nCsbe. gov/Ethics/SEl | ( SP— THIS ENTIRE FORM MUST BE COMPLETED TO FULFILL aii YOUR SEI FILING OBLIGATION ope te Swop Senco by Spo. Receives Dore _____ Lr FILER'S NAVE (FIRST, MIDDLE, LAST) Prefix | FirstName | middie Name Last Name suffix ZS FT CURRENT EMPLOYER 108 TIME Node Codie Cotenl Un [Vie Goi Sho At, | NATURE OR TYPE OF BUSINESS Miho. €or, REASON FOR FILING (COMPLETE ALL TWAT APPLY) STATE GOVERNMENT JOB (Specify Agency and Position) | B0ARD/COMMISSION. (List complete name of all State | - | boarts on which you ere serving or are being considered) A rE a [Ve Son Ava, Nin JUDICIAL OFFICER (Specty Mice) LEGISLATOR (Specify House or Senate) A. Do other immediate family members reside in your household? |@rves Tno When used throughout this form, the term Immediate family Inclices your spouse (unless legally separated). ft 350 includes members of your extended family (your and your spouse's children, grandchildren, parents, grancoarants, and sibiings, and the spouses of each of those persons) who reside In your household. | Ust tre ul nan of ail adults and emancipated minars 1 your housenald. A minor sa chic under 18 years od. | Minors are emoncipated by marriage, enlsament in the US miltary, or cour order or emancipation FULL NAME OF ADULTS & | RELATIONSHIP | EMPLOYER 308 TITLE NATURE OF | EMANCIPATED MINORS _ BUSINESS < RTT © \ Mise € Cte So LES Dene ob StantN ta, Else Alvan, Lia VE Rg nN] . Li] : | a — —— EE EN SE The SEI and any attachments, excluding the Confidential Form, are public records. Page 10f 10 B- LIst ONLY the initials of ail unemancipated minors n your household below. A mor s a chid under 18 years oa. | Note: You must list the full name of each minor child on the Confidential Form available at the |__end'ot thf document. INITIALS FOR | RELATIONSHIP EMPLOYER 108 TITLE NATURE OF UNEMANCIPATED | | BUSINESS MINORS | L = I A n ET RE SY LNA NA i Mion $0 Cul Ch} nA YAY AY | PROPERTY INTERESTS 1. As of December 31, 2017, did you, your spouse, or members of your Inmadiate family: 4 A Have an ownersnin interest in North Carolina real estate {including your residence) with a market valus of 510,000 or more? i ove ute | Owner of Real Estate 9% Ownership Interest | Location by City Location by County I Bs 7 B. Lease or rent real estate or personal property to or from the State of North Cargiina with a market vaiue of $10,000 ar more? | Oves Te | — _- | Nome or tassar “Name of Lossea | If Real Estate, Location | I Personal Property, ! (Renter) by City 8 County Describe 2. At any time during 2016 or 2017, 6d you, your spouse, or members of your (mmadiate family sel! to or buy from the | State of North Caroing personal property with a market value of $10,000 or mores Oves Bho I Name of Purchaser Name of Seller Type of Property The SEX and any attachments, excluding the Confidential Form, are public records. Page20r 10 FINANCIAL INTERESTS i Fen ERT ———— | 3: As of December 31. 2017, iC y0u, your spouse, or members of your immed ata army own any of ha alow ng nancial interests vaiued at $10,000 or more? LIST EACH COMPANY INDIVIDUALLY, | A. Stack in a publicly owned company? Yes [io *00 005 Ist ownership interests In a widely held investment fund (nuding Titual fords, requimed Testa | Companies, or pension or deferred compensation plans) if: (i) the fund i publicly traded or ts assets ave wel | diversified; ana (i) neither you nor an immeciate family mambar are able t control the assets eld in se mtial fone, investment company. or pension or deferred compensation plan. Owner of Interest Full Name of Company (Do not use a ticker symbol) pr ownerotinterest | Full Name of Company (Do not use a ticker symbol) | — 8. Stock 0gtions 11 2 company or business? Ces Iho Owner of Stock Option Full Name of Company (Do not use a ticker symbol) EEE Ea EN ©. Interests in & nan-publicly Quned company or Susiness entity (inchuding interests in sofe proprietorshins, partnerships, imied partnerships, Joint veatures, im ted labity companies, Imited ably parinershigs, and closely hald corporations)? | Ove @No- ito," proceed to question a. Owner of Interest Name of Company or Business Entity C1). For 23ch non-publicly ovine company or business entey (ine primary company) dented mn question 3C_above, please Ist tna names of any other companies or business entities n which the primary company Wns Securitas or equity interests valued ot over $10,000, known Non-Publicly Owned Company or Business Entity | Other Companies in which the Primary Company. (the Primary Company) ‘Owns Security or Equity Interests £ None or Not Known | I —— 1 | The SET and any attachments, excluding the Confidential Form, are public records. Page 3 of 10 (2). 1f 790 know hat any company or business sxtky bsted 1 3.C or 3.C(1) above nas any materi business Gealngs or ness contracts with re State of Noch Carolina, & quoted the Sire, pros oe » het 1 description of that bushess scivty | Nami of Company or Business Entity Description of Business Activity with the State Business Entity | Description of Business Activity with the State | Rone or to Kaan: a EE 4. As of Dacemper 31, 2017, were you, your spouse, or members of your immediate family the beneficiaries of a vested | USC With 8 vale of $70,000 or more that was created, esanlohad, or Criraled by yous [omer ost hed bi ust. Sep 2047 SEL atl Tos for he denon of “Vessd Trust and “Bod Tus” | Oves tio — ee Name and Address of Trustee Description of the Trust Your Relationship to the Trust | ——— | I 5. As of Dacembar 31, 2011. 3 you, your Spouse, of memers of your MnmEdata family have abies of $10,000 or mare, excluding the mortgage on your primary personal resicence? Examples include credit card debts, auto loans, student ans, personal oans and rs family Gen. Oves Cho Name of Debtor (You, Spouse, Immediate Family | Type of Creditor (Commercial Bank, Credit Union, | Member) [ Individual, ete. > i N C8 «TT Dn, Vo | 6. List each source of income (not specific amounts) of more than $5,000 received by you, your spouse, or members of | your immedaiz family. duricg 2017. Inchude Saar, wages, Se 0Ga. Goverrmen retsemant, orotesuonal oss, Ronan, ares: cvidands, Encl nome, business ome, A GUher Ypes of eore Fe9U 10 D1 repared on yout State and drat tax retams D0 not Include income received from the following sources » Capital gains » Federat government retirement > Miltary retirement » Social security income) 501 Recipient of Income Name of Source Type or Type of Income | Business/industry 1 ad mo reportable incomes over $5,090 n 2017. tenes om oer sso00y Ade Uh Ncw [SW lean N - .j BLN Se Sem SAT) Sven Duane, Tees, Ra. = : LSE Ss ’ | The SEE and any attachments, excluding the Confidential Form, are public records. Page 4 of 10 MH CC CU RCE CI OH |proresstonaL AND CIVIC RELATIONSHIPS | a | 7%). During 2047, were you, your Spouse or members of your nzedats family 8 Greco, ofcer, Governing boars ember, amainyee, indspendent contractor, or registered bbyist of a NoNGrofit corporation ar organrsaton operating i | he Stats oF orth Corina primary for Tv, arian ae arora So akon 8 oenisaton operat puposes TJ¥es THo- “No,” proceed to question s, D0 nat It State boards or entities, or entites created by 3 potical subdivision of he Ste. | Do nox list organizations of which you are 3 mere membar Name of Parson His/Her Position Name of Nonprofit Nature of Business or Corporation or Organization | Purpose of Organization | (0). 1 the nanprofic corporations ar organizations listed above do business with the State of North Carolina or receive State funds, pieass rovice a brief description of the nature of that business, f known or with which due dligence could reasonably be known. Name of Nonprofit Corporation or Organization Describe State Business or State Funding ane or Not Known | S. Dura 2007, were you, your Spouse, OF members of your Imaal arly a rector. oicer, or govarng board | member of any society, organization, or SAYOCACY GTOUD WI an Interest in MARters over WhEh your 33ency of Do my have fursdiction? | Dives [No JLegisiator/Judicial Officer - You are nat requrad to completa tis question if you are fing because You are a lagilator or a judicial oficer or you are ing as an appointee to hase offices > 09 ot lst organizations of which you are only a member (not serving in a leadership role). Name of Person Name of Society, Organization Leadership Position or Advocacy Group (Director, Officer, Board Member) epee The SEX and any attachments, excluding the Confidential Form, are public records. Page 5 of 10 9(a). List th name of each company o business with which vou wars assocated where you ora member of your = family was an employee, director, officer, partner, proprietor, or member or manager as of December 31, 2017. Fe of person Relationship to Filer | Name of Company Roleof person | | Mo Business Associations rr (0). 1 you know that any company or business entity [sted in 9(3) sbave had any material uses deaings or | business contracts with the Stats of North Carona 07 was rA9uated by he State 35 of DUGEmRgE £1, 2017, provide » are Gearon of hat business act. 1 Name of Company or Business Entity Description of Business Activity with the State Not appicable (No entes ted on £30) 10. Are you a practicing attomey? . 1 Yas", Gheck each caegary of legal rprasantaton n whieh you or the aw fim wih Which you ae fated nas earned legal fees of more than $10,000 during 2017. | ramnstazve J acraty Tcomerate Drm | [ES—— Er——" pe Citar ! J tocal Government. CC Real Property securities Tax Open (nes Cl usices Reguiation J otmer category not sted. negigencs preres Vou 3 lensed professional (other than an sttomey) or dd you provide consulting services | individual or 3 5 member of a professional 33566aUon fo whieh veo charged or mare Sais over 910,0003 Ces ENe { Type of Business Nature of Services Rendered The SEI and any attachments, excluding the Confidential Form, are public records. Page 6 of 10 + Lena the State boa along en i ah yo aro mt scat a * Regulated by the State board or employing antity with which you are or will be associated or || Des S05 Dleqsbrorision Ofce vou re ot ried comple th guest fy re org onc | you ara mt o 3 deat ocr Joh Ser duhoe oo Sek ee { Name of Person Name of Employer Type of Relationship. (if applicable) (Licensing, Regulatory, Business) SE | [13:7 vou, vor spovas ar 3 mamas o our Irma ly curry gad 3 3 voy o ane re | were you registered as such within the 12 months preceding your filing of this form? QYes ©No Name of Lobbyist Lobbyist’s Principal Date of Registration. neaisuanon | "Cepreton JA OTHER biscLosures j = _ 14. Owing any xen ata © 37 (uk ony te om par a yu Wr apsentne emai ed 7 oe proto bg Smad rca ary "(exci $200 pe asarer from pars grou of rons cin ogee, and | he da ou ang ths eros) war ots orth Comin st im sou scpted a amt | oy Cves [fie #50 at rar 15 ven oy marbers ova sanded fay >D0 rt report its cha have, previously Seen reported by you to the Deparment of the Secretary of State on ths | pone haps tr remotes pre | Date Item Received Name and Address of Donor(s) Describe Item Received Estimated Market | Venue The SEE and any atachmonts, excluding the Cantata Form, are public records. bage 7or10 15. During 2017 {but only the time period after you were appointed, employed, or filed or were nominated as a candidate} | diva + acct a “scholars” exceading $200 from 3 parson or groun of parses acting gether and those person(s) ware utsioe North Carolin amd | + the scholars was reine to your pubic posizon? A scholarship” s a grantin-aid, either direct o Indirect, to attend a conference, meeting, or similar event, including tuition, travel, lodging, meals, and other Tran expenpen: ves ETNo C Jubal Offcer - ou are ro requred to complete tis question you are a Jal ofcar a you are Ting 3s 8 ual acer appomice > 09 not report gifs tht have pravisly baen reported by you 0 he Depariman of tha Secretary of Sate on tre erpare separ fr Bxamore person. > Logisators ar oot requred to report scholars ga by a nonpartisan egsative organization of whch the fegsiator or he Gnsrl AGE 5 3 mamoer or PORICPar o 27 ANNA of tek organ ater Date of | Name and Address of Donor(s) Describe Event Eatimated Market Scholarship Valve 26. Were you saponted or are you beng sansdared for an eopommant 5 a cover ard by the Governor ar another Conch of Ste amber? Council of State members are: » Governor » Lt. Governor » Secretory of state » state Audion » State Treasurer » Superintendent of Public struction + Atorney Genera » Commisiner of Agicutuie > Commisiones of Labor ; + Commissioner of Insurance Dyes ¥INo If "Yes", list all contributions you (NOT immediate family members) made during 2017 with a cumulative Total of more than $1,000 to the Govamor or othor Counci of State Member whe appointed vou. e-_ > Contributions are cefinod in N.C.G.S. 163-2765(8) and include, bt are nt mit to, “any advance, conveyance eat, ctnbuian, antes of funds, an, payment SI, 12s or ubseroton of Marr or BAIS aT ie whatsoever” oats Amount T Contributed to No contribution(s) with a cumulative total of more than $1,000 a —— — The SET and any attachmants, excluding the Confidential Form, are public records. Pages of 10 17. Ave you an appointee or prospective appointee to: i RE re pee 2. the hea of o principal stace department (e.g. cabinas secretary) appomeed by the | 1.7 Governar; or \ | . 2 North Caraiina Supreme Court Justice, Court of Appeals, Superior or District | Court Judge; or ! © a member of any of the folowing boards: i + ABC Commission i + Coastal Resources Commission i + State Board of Education CYes (ZNo | | + State Board of Elections | + Divison of Employment Security [1t “No” proceed to + Environmental Management Commission question 18. + ndustrial Commission + Human Resources Commission | + Rules Review Commission i | + Board of Transportation ! + UNC Board of Governors + Utilties Commission + wii fe Resources Commission 4. 1f 50, were you appointed or are you being considered for appontment to that | (1 Yes [INo public postion by Counail of State member? Counci of State Members are 1520 | 11 vo,” proceed to in question 16. question 18. i e. 1150, you must indicate whether during 2017 you {not immediate family the candidate or campaign committee of the Council of State member who. appointed yau 10 your puke position I (Yes [No 1. Collected contrinutions from muiopie contributors, took possession of such multiple contributions, and transferred or dolwercd those colected contributions to the candidate or committee? Contributions are cefined in question 16. 1. Hosted a fundraiser ot your residence or place of business? Oves ONo i. Volunteers for campaign-reiated activities, which include, but are not lmied 10, ohone beni, event assistance, mallngs, canvassing, surveying, or any | [Yes [No other activity that advances the campagn of a candidat? 18. Have you ever bean convicted of a felony for which you nave not received sites (1 3 pardon of innozance; or (1) an order of expungement regarding that conviction” Cves Tho I a— Date of Conviction | County of Conviction State of Conviction 19. Ate you aware of aay other information that you believe may assist the State Ethics Commission n advising you concerning your compliance with the State Government Ethics A? ves [So If yes, please provide such information below. ‘The SEI and any attachments, excluding the Confidential Form, are public records. Page 9 of 10 TE. AFFIRMATION 1 affirm that the information provided in this Statement of Economic Interest and. any attachments hereto are true, complute. andcetasc 5 the best of my knowledge and bl Talso certify that | have not wrunsferred, and will not transfer, any asset, interest, or property for the purpose of concealing it from disclosure while retaining an equitable interest. | understand that may Statement of Economic teres: and any attachments or supplements thereso (with the exception of the Confidential Form regarding Unemancipated Children) are public record. acknowledge that | have reed and understand N.C.G.S. [384-26 regarding concealing or failing to disclose material | | information and N.C.G'S. 138A-27 regarding providing false iormation: | 5a Conlon dine en A fing person who knowingly conceals or owingly fit to disclose informaion thas is reuied tobe disclosed on siatement of conor interest unde this Article sll be uly of 4 Clas | isdeneanor and shi be subj to disciplinary ection under G.S. 1384-45. A tiling person who provides false information or a statement: of economic interest as required ander this Adticle knowing that tae information is fase is guilty ofa Class H felony and shall he subject to disciplinary action unde GS. 135A ) . / p Coy fy Zi h | Sars pt —— awe Ang, AC Fnteaams ; ) | | submis stone, otcrnassscument cn. oon trem fm. The SET and any attachments, excluding the Confidential Form, are public records. Page 100f 10