Ashley Smith Trivette

i J). NORTH CAROLINA STATE BOARD OF FOR CEMRIRICE Th 488 dui | 4, Pi ELECTIONS AND ETHICS ENFORCEMENT ate Received. 2018 STATEMENT OF ECONOMIC INTEREST pe WN Rg y Chrecked foe compieon. NO CHANGE FORM ” cannes ome THIS ENTIRE FORM MUST BE COMPLETED TO |... FULFILL YOUR ETHICS FILING OBLIGATION FILER'S NAME (FIRST, MIDDLE, LAST) Prefix | First Name widdio Name Last Name Suffix MS HShicty | Sipwbh Tye ite FE ———— STATE GOVERNMENT JOB (Specity Agency and Position) | BOARD/COMMISSION (List the complete name of all State | boards on which you are serving or re being considered | [RT | Pl Aan. Conky Colley, Bont JUDICIAL OFFICER (Specty Office) [ieGisiAToR (spect rouse or Senate) £7 Ty labs eyed "AFFIRMATION i affirm that the information provided in this Statement of Ecanomic Interest and any attachments hereto are true, complet, and accurte to the best of my knawiedge ond belies also certify that I nave not transferred, and wil not transfer, any asset, interest, or property for the purpose of concealing ¥ from disciosarc while etarning an equtabie mercer understand that my Statement of Economic terest and any attachments o supplements thereto (wih the exception of the Confidential Form regarding Unemancipated Chien) are oui record | | acknowledge tha | hove read and understand N.C.G 5. 1384-26 regarding concealing or faling to disclose material Information and N.C.G.S. 1384-27 regarding providing fase information § 1383-26. Concealing or failing to disclose material information. | # fing person who knowingly conceas or knowingly fas to disclose Information that i required to be disclosed | on a statement of economic interest under ths Acie shall be guity of 8 Cass 1 misdemeanor and shall be Sutiect to disciplinary action under 6.5. 1384.45. § 1385-27. Penalty or false information. tina gern uo provides ase format an sttement of economic res 3s requ unr hs Avice | Knowing that the information s false s Guity of a Class felony and shall be supfect 1 Gc pinary action under Gs. 1345 fs Al Ua hw Hr gjalig | Sars | Gate 18h YS TTwets Printed N | Submit SIGNED, ORIGINAL documents only. Do not fax or e-mail this form. This entire document i » public record.

oo NORTH CAROLINA STATE ETHICS COMMISSION | ror envics commission ust ony HER 2017 STATEMENT OF ECONOMIC INTEREST | Owe Recoved 919.314-3600 [R——— } THIS ENTIRE FORM HUST BE COMPLETED TO FULFILL [77 Geren cose YOUR SEI FILING OBLIGATION ls Bo ad | sto sent ae or pp— TR [reser woe wey] retin | Fisthome | middie Name Loot Name _ CT sum lcomenromores 0 Destme [watune Gh res oF puss rr | Hratth gay [ness 4 walkngso REASON FOR FILING (COMPETE ALL THAT pL) ) — 1 | Stare ovement 108 (spect Agency) Toomcrconmsston ws compete rome of tae | } oo | ards on whieh you are serving or are being considered) | — Erected oFbid = Covaty Cpumissioae | . SILANE | | includes members of your extended family (your and your spouse's children, grandchildren, parents, grandparents, and | | siblings, and the spouses of each of those persons) wha reside in your household. EMANCIPATED MINORS. || I Fo emes | Veacey Scott Tove Mel Spovse iskleq Aumeampp ¢EL lew: Gre bony T i 3 I WIRE — - | nS - A —— Pane 10110 [5 Lt ONLY the iii of ll nemancpaed minors in our household below. A nor 3 child under 16 years ol. | Note: You must list the full name of each minor child on the Confidential Form available at the | endo his document. eee emer eee meee | INITIALS FOR | RELATIONSHIP EMPLOYER | osm NATURE OF UNEMANCIPATED | | | uses | | _MINORS —t ——————————— reeset) I I 1 1 | EE NA SS — | PROPERTY INTERESTS "A of camer 21. 2015, 6 you, your spouse, or members of your nse fon 1 |" Hove an owners interest in North Cardin real state (including your resiierce) ith a market velo of | $10,000 or more | ®es Oto | Owner of Real Estate| % Ownership Interest |__ Location by City | __ Location by County. 1 | See Attacked Lot felt (Gropechy idest) lopor b frtuchncrt A I T i | — —T = — TT — — - J TRUS ENO EO 5. Lense ar rent rest esate or persanal property 1.0 om the State of North Carling with a market value of | $10,000 or more? | | ves ww | 7 Nameor Lessor Name of Lessee | If Real Estate, Location | If Personal Property, | I (Renter) | byCity&County | Describe. ! | INIEN | ! IY V1 § NE EE SN SSS 2. At any time during 2015 ar 2016, i you, your spouse, or members of your immediate fomily sell to or buy from the | State of North Carclna pereorl operty wih a market lus of $10,000 or more? | | | ove Be i Name of Purchaser | Name of Seler [rove otpropeny | I L NTR NA 1 The SET and any attachments, excluding the Confidential Form, are public records. Page 2 of 10 | FINANCIAL INTERESTS 5 7s of December 317016, 4 you, your spouse, or members of your mediate family on any of th following nancial interests valued at $10,000 or more” LIST EACH COMPANY INDIVIDUALLY. A. Stack in 2 public owned company? i 1 | 00 i Ie avers Seats 3 wily Ta ein ond (ncn ml nds, eouied esa | | Companies, or pension or deferred compensation plans) If: () the fund is publicly traded or its assets are widely | nara, ond oy enor vu ox vedio oY Tel re abe 10 COMO! Un 5361S hel the PRGA To | | iwesiment company. pévion o deferred Compensation pan: j | Owner of Interest |Full Name of Company (Do not use a ticker symbol) (Tracy 5 Tewekbe |Soteek Bask « Tak | ne Lobo fon Boiteq o True ce [Branen Bewbog tusk | i | i ———————————} 0 mm —— fr —_— - _— S-— rt ———— mm} { { | 8B. Stock Options in & company or business? | | Ove wo | Owner of Stock Option Full Name of Company (Do not use a ticker symbol) b C. Interests in 2 non-publicly owned company or business entity {including interests in sole proprictorships, | ornare Ihe parershgs. Ym venues, Wiad IoBARY Comp ames, ted aby partners, and | Sosy mei corporations) | Car hVverloneX By | {fen [INo- 1M,” proce to question 4 \ | Hf Dt IN sows EE I Owner of Tnerest | Name of Company or Business entity _ | =ge” Ameren Ape & (3), For each non publicly awed company or business enity (Une “primary capany) enki in question $1 above, pleas sk the nares of ay other companies of uiness nches in which the primary company vs Serie af ea merets vila ot ovr $10,000. # Krom: | | Non-Publcly Owned Company or Business Entity | Other Companies in which the Primary Company (the Primary Company) eT Cw Security or Equity Imarects fone or Not Known The SET and any attachments, excluding the Confidential Form, are public records. Page 3 of 10 : [ (2). 11 you know that any company or business entity listed In 3.C or 3.C(1) above has any material business. a new he Sire f North Colin, or 8 rolted th Set, rowie oe eon or BoA hr Co pe sai prov ) ore of Company o Business Entity | Description of Business Act with the state | lps, foros pond Dice coc Complete qperm bors Spuphocnen | | Loshercts wf we pot foderstede | | — ee———————— er HEN A | 4. As of December 21, 201, were you, your spouse, or members of your immediate family the beneficiaries of 3 vested | ove ot as srsnes, chon or comraes by you? Do not list assets held in blind trusts. See 2017 SEI Helpful Tips. for the definition of “Vested Trust” and “Blind Trust. | ame 6 Address of Truntes | Description of the Trust| Your Relationship to the Trust| EE —T __| [5-7 of pec 31. 2016, 19 you. your spouse, or members of you, mmdiss amiy ove abies of 10.000 or | ‘more, excluding the mortgage on your primary personal residence? Examples include credit card debts, auto loans, student | a se roe. Geb. | | Ove we | Nam of Debtor (You, Spouse, Immediate Forty | Type of Creditor (Cammarcial Bank, Credit Union, | Peer amor | rims L ] 6. List each spures of income (not specific amount) of mare than $5,000 received by you, your spouse, or members of | Jour Immediate family Sanna 2016. Include Salary, wages, statefiocal government fetrement, professional fees, | |e rs 100 nat ctu income received rom th along sources: | [I + Foderat government retirement | | + wiikary retirement + Sociol security income/ SST | | Recipient of Income Nameof Source | Typoof Type of come | cee doecded - Amand © [0] The SEE and any attachment, excluding the Confidential Form, are public records. rage 30110 PROFESSIONAL AND CIVIC RELATIONSHIPS Tt ti 015, ware vos, your spouse o memos of your Immedite. famiy 3 decir, offer, governing board | amber employe, maependent contractor, or registered bbyist of 3 ronprof. Corporation of organization operating n | he State of orth Carina armani for eles. charitable, scenic, Inerary, public health and safety, or educational | | purposes? | Ove fo toto," proceed to questions. | "> Do not Ist State boards or ents, or entities created by 3 polical subdwision of the State. + Go no st organizations of which you are a mere member. ol Name of Person is er position Name of Nonprofit Nature of Business or | Corporation or Organization | Purpose of Organization i oo I oo | | [507.1 the namproft corporations o orgarizations listed above do business wilh the Siate of loth Carolina or receive | State funds, please provide a brief description of the nature of that business, if known or with which due diligence could | reasonatiy be known | ‘Name of Nonprofit Corporation or Organization Describe State Business or State Funding | §#t6ene or fo: known | 1. During 2016, were you, your spouse, or members of your Immadiate family @ director, officer, or Governing board | | mormber of any saciet, orjanizaton. or SduoCacy ara Ah an interes i matiers Over WAICh your Ggeney o board may | have funsdicon’ | | [ves [6 [legisator/Judiciel Officer - You are not required to complete this question if you are fling because | | Vou are a eglator or 8 Jucil offer of ou are fing as on appointee to those offices | | 300 not st organizations of wich you are ony 3 member (rot serving ina leadership role). | | Name of Person Name of Society, Organization Leadership Position I. or Advocacy Group (Director, Officer, Board Member) J — T 1 — reese ———— — The SET and any attachments, excluding the Confidential Form, are public records. Page 5 of 10 5(3), Ls he nar of each company or business with which you were associated where you or member of your Immediate amily was an employee, director, officer, partner, proprietor, or member or manager as of Gecember 31, 2016- | Name of Person Relationship to filer | Name of Company | Role of Person Mo Business Associations. | | T9(0). 1 you know that any company or business cay sted in 9) above had any material business dealings or | Business contracts wih the State of North Carolina o was regulated by the State as of December 31, 2016, provide a | bref description of that business octuty | Name of Company or Business Entity Description of Business Activity with the State | [Ot applicabi (No critics iste 1 #92) | 10. Ave you a practicing attorney” Cives ho Dudica Offcar/State Attorney 16°¥es?, check cach category of legal representation in hich You or the aw fim wath hich you re affaied has cared legal fees of more than $10,000 during 2016. | Dasma [Acmiatty [corporate [crm | Ooecotents esos Cevronmenta Cmsurance Custor | Dhtocat Government eal Property secures Oar | C17ort litigation (including [} unilities Regulation {0 Other category nat listed. negligence) | 11. During 2016, were you a licensed professional (other than an attorney) or did you provide consulting services | Ididualy of 95 2 member of 3 professional association fo which you charged o were paid over $10,000 Fes ONo | Type of Business T Nature of Services Rendered Ra) £dde Penson Leosee, Red Esede EE The SEL and any attachments, excluding the Confidential Form, are public records. Page 6 of 10 Ti. or ve emlonr yout ps a embers of your mde fami tS GT ety Liens oy the State beard or rployig entity wih which you are o wil be associated or | + Regulated by the State board or employing entity with which you are or will be associated or Mart business relations wih th State board or Gmploying entty wih which you are or wil be associated? | Cves fis 0 Lealslator Judicial Officer - You are not required to comglete this question If you are fling because ‘you are a legislator or a judicial officer (“judicial officer” is defined in the SEI Helpful Tips) or you To ho a appa ta those ofc. Name of Person [7 Name of Employer Type of Relationship ] I \ it applicable) (Licensing, Regulatory, Business) | ESN NS SE — ee Femme — te TS SENSI k i i 13. Are you, your spouse or a member of your immediate family currently registered as a lobbyist or lobbyist principal, or odo sah win th 12 mon BreC wu HU o . om? Oves (96 | Name of Lobbyist I Lobbyist's Principal | pateot Registration | | regitration apiration Lomer Disclosures Co oo i Ti. During any calendar quarter in 2016 (but ory the time period after you were appointed, employed or fed or were | | raed 3 comin, 4 vou acne amy ~(e exces ing $300 per quarto rm person a group of persons ackng tgethe, and | = when both you and those person(s) were outside North Carolina at the time you accepted the gift(s), and i | for lobbying? Ove | gt ot ht Ho revi bn prc Yo 0 DEpRmen ofthe Setar of Se on he | | > Ebene port fo Exempted Persons.” | oat tem Recivod | ame ana ies of Donors | Pesci tem Receued | Estimated Market | | | Value PA | | | The SEX and any attachments, excluding the Confidential Form, are public records. Page 7 of 10 "15. Darina 2016 (out ony vs tem prio afte yau wre appointed, employed, or fled o were nominated is a candidate) ad vou Os apt a sch scsi 5200 rom ers cup pron cn esther and © those person(s) vere outside Horth Caroline and | ne scnolarship was elated to your public positon? A”scholaeship” i a grantin-aid, either direct or indirect, | akena 3 Conference, mesing, or Similar event, including twiion, travel, edging, meals, nd other Similar expenses. | i [ives fen [0 udicia Officer - You are not required to complete tis auestion you are a Judkial ofc or you are | hi akin » Do nt report its that have previously been reported by yau to he Department ofthe Secretary of State on the expense Report for Exempned Persons.” ! | + Legitatrs ae not require o report scholarships pa by o nonpartisan egisltive arganizaton of hich th legislator | | 7 of the General Assembly is @ member or participant or an affiliate of that organization. | | | Date of Name and Address of Donor(s) Describe Event T Eotimated Market Scholarship | Value i + [Md Lm. | | | Te. Were you sppomted ar ae you being considered for an appoment 9 2 covered based by the Governor or nother | Counc of Sst me | | Council of state members are: | » Governor » Lt. Governor » Secretory of Sate |e state sudo » State Tessur » Superintendent of Pubic Instruction | | » Attorney General » Commissioner of Agriculture » Commissioner of Labor H » Commisianer of Insurance | Owes fo | 1 “Yes”, list all contributions you (NOT immediate family members) made during 2016 with a cumulative | ota of more than $5,000 t the Governor or other Council of State member who appointed you: |» Contributions are defined inf C.G.5. 163-276.6(6) and include, but ar ot limited to, “any aduance, conveyonce, | | Gepost, istrition, transfer of funds, loan, payment, ik, pledge or subscription of maney or anything. of value whatsoever.” | ote | contre to [57 combton(s) ven cavities tel of ore han 31,060 Bi . — Tie SE and any attachments, excluding the Confidential Form, are public records. Page of 10 17. Are yo on appontes or prospect poe ©: Te mete pn cn ra | I ductal i |b. a North Carolina Supreme Court Justice, Court of Appeals, Superior or District i | { c. a member of any of the following boards: | + ABC Commision | + Coastal Resources Commisicn ~ oe | | Se sovat cnn Dives go | II ie wo | | = owaonot Employment Secrty I Nos proceed to ~ Emeronmenta anagem Comission Guestion 18. | ~ tocustril Commission | | © URE Baad of Governors 1 | + tities Commission i | d. 1f 50, were you appointed or are you being considered for appointment to that | (1¥es [No | pet Cosme of Se emia Counc of Ste memos ha ed | 4 ote mrocesd ta | enone. Fo i os you must mane whether daring 2075 you (oot mediate fay ] 1 meters) engaged m any of the foo ng actvities with respect 1 or on behalf of | H a condos of corral commen of the Cour of State member wo | | [Oves [ino I. Collected contributions from multiple contributors, tack possession of such | | [i Hosted tire a your residences or ince of bose? ves me fen tiosicd somite robeotbuwoes? __ \Cves Owe | Rr —————— TS —T 10, hone banks, event acsistance, mafings, canvassing, surveying, orony | [1¥es (INo he sry i advances the a! 3 CARGOES | ae yo ve rn comity fo hh vo ove nt rcved ar, 3 pardon fee: a 7 oor of upngeTIOR regarding Tht ComuRRon? [ offense | Date of conviction | County of Conviction | State of Conviction | To ve ou aware of any ahr faration Ck yo befcve may 35st the State Es Camtsson i avng you | Conteris camara wih he Sate Gove ment Es 2 | Clves fio if yes, please provide such information below. | The SEX and any attachments, excluding the Confidential Form, are public records. Page 9 of 10 | § 1384-26. Concealing or faifing to disclose material information. H | A Filing person who knowingly conceals or knowingly fils to disclose information that is required 10 be disclosed As . nid 3/13/2017 | _ Asiey Trveklee | Printed Nate 1 ATTACHMENT A NORTH CAROLINA STATE ETHICS COMMISSION 2017 STATEMENT OF ECONOMIC INTEREST ATTACHMENT PAGE A TOR ASHLEY S. TRIVETTE BLADEN COUNTY COMMISSIONER ATTACHMENT A (PROPERTY INTERESTS) Owner of Real Estate % Owned. Location by City Location by County | Tracey & Ashley 1100 [91 Lake Shore Drive Waterford Estates, | Bladen County | | Trivette || White Lake, NC J DE | Tracey & Ashley 7100 | 109 Precious Memories Lane Nathans | Bladen County | | Trivette Cove | H | White Lake. NC i. | — Tracey & Ashiey | 1001 105 Lake Shore Drive Waterford Estates | Bladen County Trivette | | White Lake, NC oo] Ashley Trvetie [BT tn et Cumberland | | | Hope Mills, NC ICounty | Ashley Trivette 150 | 4081 River Landing Drive | Cumberland 1 lL | [Vander NC ef J, _ | Ashley Trivetie 50 | 4094 River Landing Drive | Cumberland I | Vander NC _ | County. Ashley Trivette 133.33 | 04 Myrtle Street Bladen County | A | WhiteLake.NC i 1 ATTACHMENT B NORTH CAROLINA STATE ETHICS COMMISSION 2017 STATEMENT OF ECONOMIC INTEREST ATTACHMENT PAGE B FOR ASHLEY S. TRIVETTE, BLADEN COUNTY COMMISSIONER ATTACHMENT B (NON-PUBLICLY OWNED COMPANIES) Owner of Interest Name of Company or Business Interests [Tracey & Athley Trivetic Ashley Marie Group Pink. Ine. | Ashley Trivete TT Massey Hill Square, Inc. | Tracey 8. Trivetie [Ashley Maric Group, Inc. 1 Tracey S. Trivette ‘Ashley Mare Group, Facilities Maintenance | | TO —— | Division. LLC To ——— [Tracey S$ Trivene Southeast Unlimited, LLC } [Tracey S. Trivetie _ White Sand Realty LLC - Tracey S.Trivette | AMlordable Auto & Tire, Inc - 1 [imeey 8. Trivets Doub Homeplace, LIC |