Benita Lowder Conrad

Ps NORTH CAROLINA STATE ETHICS COMMISSION | or eruucs commission use oni I Py 2017 STATEMENT OF ECONOMIC INTEREST | one kecened si9-e14-3500 wn atnescommssonegoy | SPATS Foo of THIS ENTIRE FORM MUST BE COMPLETED TO FULFILL Eras to cin YOUR SEI FILING OBLIGATION B ne oe Supp. Sent Date oy Supp. Received Dove Entered in database G1 By OB | FILER'S NAME (FIRST, MIDDLE, LAST) _ Prefix | First Name igate ame "Last ame Suffix mes [Bente [bower [Conca [= | CURRENT EMPLOYER Jo08 TITLE | Covarrus County Shuriffs Office | Finance Coorcmmator 1 er ———————s] BubbicSafety REASON FOR FILING (COMPLETE ALL THAT APPLY) ‘STATE GOVERNMENT JOB (Specity Agency and Position) | BOARD/COMMISSION (Us complete name of all State | ER | boards on which you ore serving or are being considered) | | Horrisbum Town Council nla 1 “9 [unter oven (SpectyOfice) | LEGISWAIOR (Speci House or senate) | | le lo ll A. Do other immediate family members reside in your household? oo — Pe Oto hen used throughout this orm, the term Immediate family includes your spouse (unless legally separated). t also includes members of your extended family (your and your Spouse's children, arandchidren, parents, 3randporents, and siblings, and the spouses of each of those persons) who reside in your household. | List the ful ame of all adults and emancipated minars in your hovseholc. A minor i a cid under 18 yeors od. | Fins src emancipated by marriage, sistent the US miltay, or cour order fo emancipation. | FULL NAME OF ADULTS & | RELATIONSHIP | EMPLOYER 308 TITLE NATURE OF EMANCIPATED MINORS | Bint _susiness | Victor A.Conmd spouse | UPS | ReTiReD logistics | Carley F Conrad | child stuart | — | — ! — 1 1 _ 1 — The SEX and any attachments, excluding the Confidential Form, are public records. Page 10f 10 [B. List ONLY the initials o al uncmoncipated minors in your household below. A minor is a child under 18 years od. | Note: You must lst the full name of each minor child on the Confidential Form available at the end of this document. " strom INITIALS FOR | RELATIONSHIP EMPLOYER JOB TITLE NATURE OF UNEMANCIPATED | BUSINESS ions — = n/a - | _ | | | PROPERTY INTERESTS A. Mave an ownership interest in North Carolina real estate (including your residence) with a market value of { Cioran or mores | res Oo | Owner of Real Estate| 9% Ownership Interest Location by City Location by County | | Victor s Benita, _loo% 1] Harrisburg | Cabacrus | Sylvie P- Lowder | 100% | Marcisburg | Ca barrus | ~ T Sylvia © Lowder 100% | Chaclotte ~ | pecklenbug Sylvie ¥ Lowoler |__ 100%. ___| Jackson Springs [“ioore 7 | amr ote a rt rogers a tf Cos we 3 mar ve of Sior000 or mores Ove gam Name of Lessor Name of Lessee | If Real Estate, Location i If Personal Property, B | Ghorver) | by city ounty Pe escribe Nf ~ oo 2. At ony time during 2015.07 2016, did you, your spouse, or members of your immediate family 321 to ar buy from the ‘State of North Carolina personal property with a market value of $10,000 or more? ves [KNo Name of Purchaser I Name of Seller I Type of Property Np SE 1 The SEX and any attachments, excluding the Confidential Form, are public records. Page 201 10 FINANCIAL INTERESTS 3. As of December 21, 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. Stack in a publicly owned company? __JElves [No i I, __ D0 han Ver oper eres 3 wel eid investment fund ching Trout funds, equioel veer Companies or persion of deterred compensation plans) (1) ha fund 15 PUI add or ns 3aets are wadely overhead ad toy meer vou morn mediate {ami abe ar 31 10 Onl ta s5ets eld 1 th muta) Ac, neestment Compares of Denman o defereed omperaston por Owner of Interest Full Nome of Company (00 not use a ticker symbol) Nido hloncack | uPs ©. Stock Options i a company or business? Ove pre Owner of Stock Option Full Name of Company (00 not use a ticker symbol) C. Interests 1.2 nr-publicly one company or business entity (including interests. n 50k praprietorsDs, mara. Wowied parame, Jom vartates, Irohed abby compares, tet aby pOPeraWES, Enel hes corporations) [Ives M{to- 1670," proceed to question 4 Owner of Tmterest Name of Company or Business Entity C1), For wach nom publicly owner company or uries entity (he primary company) dented in question | above, pane ox sr mimes of tes OPTI Gusass vrs ch Te PATY SomPATY Non-Publcly Owned Company or Business Entity | Other Companies in which the Primary Company (ne primary Compan) Owns Security or Equity Interests The SEL and any attachments, excluding the Confidential Form, are public records. Page 301 10 [7 Cay. you know that amy company or business city sted n 3. or 3.C(1) above has any material business | ims or ones comiocts ih te Stars of Norn Carolin, o 4 reuoed os ch Site, rawie 3 ort | Geacrpuon of tht ousness actly. Name of Company or Business Entity | Description of Business Activity with the State [1 S— — — BE —— 47 of December 31, 2016, were you, your spouse, o mambers of your Immediate family the benehines of a vested | trust with a value of $10,000 or mare that was created, established, or controlled by you? | Do not list assets held in blind trusts. Soe 2017 SEI Helpful Tips for the definition of “Vested Trust” and “Blind Trust.” i Oves ne 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 immediate family have libibtics of $10,000 or | re tng vod ya oh Your BA De! FCSIENCE” Examples MCs cred card ebis, Sto oars, Laden | Tone, persona oans and nia. omy Geb | Yes. fio | Name of Debtor (You, Spouse, Immediate Family | Type of Creditor (Commercial Sank, Credit Union, ember) " ee Tndividunl ete) _Vidhort Benita (onradl | Bank _ Marshall P, Concod! | Stott Loans] selliemac | 7. is each source of income (not specific amounts) of more Shan $5,000 received by you, Your Spouse, or members of Sour saciste Tomi ung. 2016. Include saa, wages, Satelocal Soverament fetrement, professional fees, meron. rast, Gand. rental Income, BuSIeSs income, and one types of come reared t oe reported on your | Stat and frat tx revue. | Do net include income received from the folowing sources: | » Capital gains » Federal government retirement | |» wiltary retirement » Social security income/ S501 | | J1 had no reportable income over $5,000 in 2016. Victer Conrad | UPS/Baticempct | Logistics | payroll [retirens.d enitaConcad | Cab.Co Sheel) Pubjc Sufe wages. | Vidoclmead | wPs | Logishes | ovidends | Brian Concad | Norfolk Soham | Transportetio] wages | Brian Covad Freck Smith Co. Conshuchon wages Docs Conrad Romane Mged. Rasthcane. wages The SEX and any attachments, excluding the Confidential Form, are public records. Page of 10 Frere p—— ‘member, employee, independent contractor, or registered lobbyist of a nanpaftcormarabion or organization operating in | | ee Spt, apt Sei, ns ly Fp ep fron on | | purposes? | pres [Io - If “No,” proceed to question 8. | > Go not Ist State boards or entities, or entities created by a political subdivision of the State. . | Name of Persan Win Mer postion | Name of Nonprofit ature of Business or ” IR —— SE rt G1 | 7. 1 [8 otto Concosl [Toca muses | SeudhusiCobo Rony _philathiopc| [Benito L.Conead | Boned Monks. | Fousdotiont/Cucclied phi lecthropic. | J EE E— J | HNone or Not Known 1 | 8. During 2016, were you, your spouse, or members of your immediate family a director, officer, or governing board | have jurisdiction? | Eves Ee teooraded offc Your sk ue 0 comet th star vou re 1g bce | » Do not list organizations of which you are only a member (not serving in a leadership role). STII | ree Sherer Sta List ho nam of cad company o busines wih which you were associated where you or member of your Immediate family was an employee, director, officer, partner, proprietor, or member or manager as of December 31, 2016. | ameotpenon | neitonmiptorier | nameot company Reo vere fo Business Assoctons B | | | (0). 1 you know that any company or business entity stad in 9(a) above nad any materia business dealings or as | Bf description of that business activity. | Name of Company or Business Entity | Description of Business Activity with the State gt potcne ces eso 203 10, Ave you 3 practicing atorney” I PN Ae— | Ves, check each category of egal resresentation n which you o the aw firm with which ya ae afiaed hos earned egal fees of more than $10,000 during 2016 | [1 Adminstravwe £Agmeaty 2 comorate crm I [Decedent's Estates C1 Environmental [Clinsurance 0 Labor | 1 Local Government £3 Real Property Cysecunties roe | | [Tort gation icluing 1 utiities Regulation other category not sted nesigence) 11. Duting 2016, were you 3 licensed professional (othe than an attorney) or did you provide consulting services indy o 25 member of a professional association for Which you aharded o were pod over $10,007 Oves Fito [ Type of Business Nature of Services Rendered The SET and any attachments, excluding the Confidential Form, are public records. Page Gof 10 License iy the Sate board or amploying entity ith which ou ae o wil b associted or + Regulated by the State board or employing entity with which you are or will be associated or ives [No [ Legsator/lucical Office You are not required t complete tis question you are fling because Vouor' iano oo cal once bal eee. Sehnert tho SE Hel Teton vo | IL. LL — Name of Parson Name of Employer Type of Relationship 1 (if applicable) (Licensing, Regulatory, Business) | EY FE EE 1 ‘were you registered as such within the 12 months preceding your filing of this form Ove ole | I Name of Lobbyist Lobbyist's Principal 7 bateor Registration | Renmiraton | "Emmasion — oTHER DISCLOSURES 14, During any calendar quate In 2016 (but oy he ime period ar you were Soporned, employed o ied or were + receive any "gift(s)” exceeding $200 per quarter from a persan or group of persons acting together, and + when both you and those person(s) were outside North Carolina at the time you accepted the gift(s), and | | roan ove pe FE rn [ate Team Received | Name and Address of Darer(e) | Describe oom Received | Estimated Marker | | Vetue | i | hl The SEX and any attachments, excluding the Confidential Form, are public records. Page ot 10 * accept a “scholarship” exceeding $200 from a person or group of persons acting together and Tes oe [Judicial Officer - You are not required to complete this question if you are a judicial officer or you are » Legislators are not required to report scholarships paid by a nonpartisan legislative organization of which the legislator | Yr FT TR pT cca —— » Governor. » Lt. Governor » Secretary of State Hl | » Commissioner of Insurance | Ove (Poo | CS comet ne | ES | [47 Are you an aopomtee or prospective appomee to - [5 the head of a principal state department (9. cabinet secretary) appainted by the | Sovemor or |b. a North Carolina Supreme Court Justice, Court of Appeals, Superior or District | Count vuage; or |. a member of any of the following boares: | + ABC Commission © Coustal Resources Commission | + State Board of Education [Ove Xno | * State Baar of lection: | + Oson of Employment Security I No” proceed to | + Environmental Management Commission Question 18. | © Industrial Commission — | + Human Resources Commission | © Rules Review Commissin | | © Board of Transportation © UNC Board of Governors | + Utites Commission | | ite meses Commision oo oo | a 0, were you appointed or are you being consered for spponsent to that | (Yes Mo PUBL Boson by 0 Counci of State member? Coun of State mambers are 51¢3 | 14 opto ewoceed to in question 16. question 18. ©. 1f 50, you must indicate whether during 2016 you (not immediate family | members) engaged m any of the folowing scutes with respect 1 of on behalf of | i he candiaate oF campaign commit of the Counc of State member who. appointed you to your pubic postion [ves CMe | 1. Coleced contributions from multiple contributors, took passessio of such | multiple contributions, and tranehrred or deheered thos colectod I bb EL aesion 16 | 4. Mostet a fundrarser at your residence or place of business? [ves (mo 1 i. Vluntoered for Campaign-related actties, which Include, tat ae mot Invted ] Lo, phone banks, event assistance, maings, convasang, sare. or any | (ves [No | other actiy that advances the compra of a candidate’ 1115. Mave you ever been convicted of a felony for which you have not recived either. (1) a pardon of mnocence; o (1 on | order a xpunement renin tht conucton” Oves Mo | offense Date of Conviction | County of Conviction | _ State of Conviction 1119. Ae you aware of any other formation that ou believe may assist the Sate Fics Commision n advising you | concerning your compliance with th State Government Fins A ves KiNo If yes, please provide such information below. | The SEX and any attachments, excluding the Confidential Form, are public records. Page 9 of 10 _— AFFIRMATION | | and accurate to the best of my knowledge and belict. information and N.C.G.S. 138A-27 regarding providing False wlonmation: { | A filing person who provides false information on a statement of economic inter! as required under this Article | | GS IAs 11 wre brerito. pmol lamad 3 a4 il | Benin Lowoler Conrod [Fens | Submit SIGNED, ORIGINAL documents only. Do not fax or email this form. The SEX and any attachments, excluding the Confidential Form, are public records. Page 100f10

COMPLETE THIS FORM AND MAIL SIGNED, ORIGINAL TO STATE ETHICS COMMISSION, 1324 MAIL SERVICE CENTER, RALEIGH, NC 27699-1324 NORTH CAROLINA STATE ETHICS COMMISSION 2016 STATEMENT OF ECONOMIC INTEREST 919-814-3600 www.ethicscommission.nc.gov FILER'S NAME (FIRST, MIDDLE, LAST) Prefix First Name Middle Name Last Name Suffix Mrs. Benita Lowder Conrad CURRENT EMPLOYER JOB TITLE Cabarrus County Sheriff Finance Coordinator NATURE OR TYPE OF BUSINESS Law Enforcement REASON FOR FILING (SELECT ALL THAT APPLY) STATE GOVERNMENT JOB (Please specify the agency for which you work or are being considered) BOARD/COMMISSION (Please list complete name of all State boards on which you are serving or are being considered) Cabarrus-Rowan MPO (TAC); JUDICIAL OFFICER (Please specify the office you hold) LEGISLATOR (Please specify House or Senate) The SEI and any attachments, excluding the Confidential Form, are public records. Page 1 of 11 A. Do other immediate family members reside in your household? Yes No When used throughout this form, the term Immediate family includes your spouse (unless legally separated). It also 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) who reside in your household. List the full name of all adults and emancipated minors in your household. A minor is a child under 18 years old. Minors are emancipated by marriage, enlistment in the US military or court order for emancipation. FULL NAME OF ADULTS & EMANCIPATED MINORS RELATIONSHIP EMPLOYER JOB TITLE NATURE OF BUSINESS Victor Alvin Conrad Husband Retired UPS Dispatch Supervisor Logistics Marshall Parker Conrad Son Unemployed Student Education Carley Frances Conrad Daughter Behavioral Technician Homecare worker Respite care Simeon Pierce Conrad Son Unemployed Student Education B. List ONLY the initials of all emancipated minors in your household below. A minor is a child under 18 years old. Minors are emancipated by marriage, enlistment in the US military 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. INITIALS FOR UNEMANCIPATED CHILDREN RELATIONSHIP EMPLOYER JOB TITLE NATURE OF BUSINESS 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? Yes No Owner of Real Estate % Ownership Interest Location by City Location by County Victor & Benita Conrad 100 Harrisburg Cabarrus Victor & Benita Conrad 67 Harrisburg Cabarrus B. Lease or rent real estate or personal property to or from the State of North Carolina with a market value of $10,000 or more? Yes No Name of Lessor Name of Lessee (Renter) If Real Estate, Location by City & County If Personal Property, Describe The SEI and any attachments, excluding the Confidential Form, are public records. Page 2 of 11 2. At any time during 2014 or 2015 , 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? Yes No Name of Purchaser Name of Seller Type of Property FINANCIAL 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 at $10,000 or more? A. Stock in a publicly owned company? Yes No Do not list ownership interests in a widely held investment fund (including mutual funds, regulated investment companies, or pension or deferred compensation plans) if: (i) the fund is publicly traded or its assets are widely diversified; and (ii) neither you nor an immediate family member are able to control 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) Victor Alvin Conrad United Parcel Service B. Stock Options in a company or business? Yes No 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 (including interests in sole proprietorships, partnerships, limited partnerships, joint ventures, limited liability companies, limited liability partnerships, and closely held corporations)? Yes No If "No", proceed to question 4. Owner of Interest Name of Company or Business Entity The SEI and any attachments, excluding the Confidential Form, are public records. Page 3 of 11 C (1). For each non-publicly owned company or business entity (the “primary company”) identified in question 3.C above, please list the names of any other companies or business entities in which the primary company owns securities or equity interests valued at over $10,000, if known. Non-Publicly Owned Company or Business Entity (the Primary Company) Other Companies in which the Primary Company Owns Security or Equity Interests None or Not Known C (2). 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 activity. Name of Company or Business Entity Description of Business Activity with the State None or Not Known 4. As of December 31, 2015, were you, your spouse, or members of your immediate family the beneficiaries of a vested trust with a value of $10,000 or more that was created, established, or controlled by you? Do not list assets held in blind trusts. See 2016 SEI Helpful Tips for the definition of “Vested Trust” and “Blind Trust.” Yes No 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 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. Yes No Name of Debtor (You, Spouse, Immediate Family Member) Type of Creditor (Commercial Bank, Credit Union, Individual, etc.) Victor & Benita Conrad Commercial Bank Benita Conrad Toyota Credit Marshall Parker Conrad Sallie Mae The SEI and any attachments, excluding the Confidential Form, are public records. Page 4 of 11 6. List each source of income (not specific amounts) of more than $5,000 received by you, your spouse, or members of your immediate family during 2015. Include salary, wages, state/local government retirement, professional fees, honoraria, interest, dividends, rental income, business income, and other types of income required to be reported on your State and federal tax returns. Do not include income received from the following sources: Capital gains Federal government retirement Military retirement Social security income/SSDI Recipient of Income Name of Source Type of Business/Industry Type of Income I had no reportable income over $5,000 in 2015. Victor Alvin Conrad UPS Logistics Wages Victor Alvin Conrad UPS Logistics Dividend Benita Lowder Conrad Cabarrus County Law Enforcement Wages Benita Lowder Conrad Town of Harrisburg municipality Stipend Victor Alvin Conrad & Benita Lowder Conrad Tenant Rental house Rent Marshall Parker Conrad NC Legislature Government Wages Carley Frances Conrad Esseola Resort Restaurant Resort Wages Simeon Pierce Conrad Reedy Creek Landscape Lawn Care Wages PROFESSIONAL AND CIVIC RELATIONSHIPS 7(a). During 2015, were you, your spouse or members of your immediate family a director, officer, governing board member, employee, independent contractor, or registered lobbyist of a nonprofit corporation or organization operating in the State of North Carolina primarily for religious, charitable, scientific, literary, public health and safety, or educational purposes? Yes No If "No", proceed to question 8. Do not list State boards or entities, or entities created by a political subdivision of the State. Do not list organizations of which you are a mere member. Name of Person His/Her Position Name of Nonprofit Corporation or Organization Nature of Business or Purpose of Organization Benita Lowder Conrad Treasurer Southwest Cabarrus Rotary Philanthropy Benita Lowder Conrad Board Member Cabarrus Community Foundation for the Carolinas Philanthropy The SEI and any attachments, excluding the Confidential Form, are public records. Page 5 of 11 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 description of the nature of that business, if known or with which due diligence could reasonably be known. Name of Nonprofit Corporation or Organization Describe State Business or State Funding None or Not Known Please answer the following question as it pertains to the following board/agency: Cabarrus-Rowan MPO (TAC) 8. During 2015, were you, your spouse, or members of your immediate family a director, officer, or governing board member of any society, organization, or advocacy group with an interest in matters over which your agency or board may have jurisdiction? Yes No Legislator/Judicial Officer - You are not required to complete this question if you are filing because you are a legislator or a judicial officer or you are filing as an appointee to those offices. Do not list organizations of which you are only a member (not serving in a leadership role). Name of Person Name of Society, Organization or Advocacy Group Leadership Position (Director, Officer, Board Member) 9(a). 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. Name of Person Relationship to Filer Name of Company Role of Person No Business Associations Benita Lowder Conrad Self Cabarrus County Sheriff Finance Coordinator Victor Alvin Conrad Husband United Parcel Company Dispatch Supervisor Benita Lowder Conrad Self Town of Harrisburg Mayor Pro Temp Marshall Parker Conrad Son Reedy Creek Landscape Employee Carley Frances Conrad Daughter Esseola Resort Restaurant Employee Simeon Pierce Conrad Son Reedy Creek Landscape Employee Simeon Pierce Conrad Son Esseola Resort Restaurant Employee The SEI and any attachments, excluding the Confidential Form, are public records. Page 6 of 11 9(b). If you know that any company or business entity listed 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 December 31, 2015, provide a brief description of that business activity. Name of Company or Business Entity Description of Business Activity with the State Not applicable (No entities listed on #9a) No relationship / Not known Cabarrus County Sheriff Enforcement of State Laws United Parcel Company Transportation Regulated by the State of North Carolina Town of Harrisburg Numerous; Muncipalities regulated by the State of North Carolina Reedy Creek Landscape Business regulated by the State of North Carolina Esseola Resort Restaurant Business regulated by the State of North Carolina 10. Are you a practicing attorney? Yes No Judicial Officer/State Attorney If “Yes”, check each category of legal representation in which you or the law firm with which you are affiliated has earned legal fees of more than $10,000 during 2015. Administrative Admiralty Corporate Criminal Decedent’s Estates Environmental Insurance Labor Local Government Real Property Securities Tax Tort litigation (including negligence) Utilities Regulation Other category not listed. 11. During 2015, were you a licensed professional (other than an attorney) or did you provide consulting services individually or as a member of a professional association for which you charged or were paid over $10,000? Yes No Type of Business Nature of Services Rendered The SEI and any attachments, excluding the Confidential Form, are public records. Page 7 of 11 Please answer the following question as it pertains to the following board/agency: Cabarrus-Rowan MPO (TAC) 12. Are you or your employer, your spouse or members of your immediate family, or their employer currently: • Licensed by the State board or employing entity with which you are or will be associated or • 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? Yes No 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 are filing as an appointee to those offices. Name of Person Name of Employer (if applicable) Type of Relationship (Licensing, Regulatory, Business) 13. Are you, your spouse, or a member of your immediate family currently registered as a lobbyist or lobbyist principal or were you registered as such within the 12 months preceding your filing of this form? Yes No Name of Lobbyist Lobbyist’s Principal Date of Registration Registration Expiration OTHER DISCLOSURES 14. During any calendar quarter in 2015 (but only the time period after you were appointed, employed or filed or were nominated as a candidate), did you • receive any gift(s) exceeding $200 per quarter from a person or group of persons acting together, and • when both you and those person(s) were outside North Carolina at the time you accepted the gift(s), and • the gift(s) were given under circumstances that would lead a reasonable person to conclude that they were given for lobbying? Yes No Do not report gifts given by members of your extended family. Do not report gifts that have previously been reported by you to the Department of the Secretary of State on the "Expense Report for Exempted Persons." Date Item Received Name and Address of Donor(s) Describe Item Received Estimated Market Value The SEI and any attachments, excluding the Confidential Form, are public records. Page 8 of 11 Please answer the following question as it pertains to the following board/agency: Cabarrus-Rowan MPO (TAC) 15. During 2015 (but only the time period after you were appointed, employed, or filed or were nominated as a candidate) did you • accepted a “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, either direct or indirect, to attend a conference, meeting, or similar event, including tuition, travel, lodging, meals, and other similar expenses. Yes No Judicial Officer - You are not required to complete this question if you are a judicial officer or you are filing as a judicial officer appointee. Do not report gifts 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 organization of which the legislator or the General Assembly is a member or participant or an affiliate of that organization. Date of Scholarship Name and Address of Donor(s) Describe Event Estimated Market Value Please answer the following question as it pertains to the following board/agency: Cabarrus-Rowan MPO (TAC) 16. Were you appointed or are you being considered for an appointment to a covered board by the Governor or another Council of State member? Council of State members are: • Governor • Lt. Governor • Secretary of State • State Auditor • State Treasurer • Superintendent of Public Instruction • Attorney General • Commissioner of Agriculture • Commissioner of Labor • Commissioner of Insurance Yes No 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.S. 163-278.6(6) and include, but are not limited to, “any advance, conveyance, deposit, distribution, transfer of funds, loan, payment, gift, pledge or subscription of money or anything of value whatsoever.” Date Amount Contributed to 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 9 of 11 Please answer the following question as it pertains to the following board/agency: Cabarrus-Rowan MPO (TAC) 17. Are you an appointee or prospective appointee to: a. the head of a principal state department (e.g. cabinet secretary) appointed by the Governor; or b. a North Carolina Supreme Court Justice, Court of Appeals, Superior or District Court Judge; or c. a member of any of the following boards: • ABC Commission • Coastal Resources Commission • State Board of Education • State Board of Elections • Division of Employment Security • Environmental Management Commission • Industrial Commission • Human Resources Commission • Rules Review Commission • Board of Transportation • UNC Board of Governors • Utilities Commission • Wildlife Resources Commission Yes No If "No", proceed to question 18. d. If so, were you appointed or are you being considered for appointment to that public position by a Council of State member? Council of State members are listed in question 16. Yes No If "No", proceed to question 18. e. If so, you must indicate whether during 2015 you (not immediate family members) engaged in any of the following activities with respect to or on behalf of the candidate or campaign committee of the Council of State member who appointed you to your public position: i. Collected contributions from multiple contributors, took possession of such multiple contributions, and transferred or delivered those collected contributions to the candidate or committee? Contributions are defined in question 16. Yes No ii. Hosted a fundraiser at your residence or place of business? Yes No iii. Volunteered for campaign-related activities, which include, but are not limited to, phone banks, event assistance, mailings, canvassing, surveying, or any other activity that advances the campaign of a candidate? Yes No 18. Have you ever been convicted of a felony for which you have not received either: (i) a pardon of innocence; or (ii) an order of expungement regarding that conviction? Yes No Offense Date of Conviction County of Conviction State of Conviction The SEI and any attachments, excluding the Confidential Form, are public records. Page 10 of 11 19. Are you aware of any other information that you believe may assist the State Ethics Commission in advising you concerning your compliance with the State Government Ethics Act? Yes No If yes, please provide such information below. AFFIRMATION I affirm that the information provided in this Statement of Economic Interest and any attachments hereto are true, complete, and accurate to the best of my knowledge and belief. I also certify that I have not transferred, and will not transfer, any asset, interest, or property for the purpose of concealing it from disclosure while retaining an equitable interest. I understand that my Statement of Economic Interest and any attachments or supplements thereto (with the exception of the Confidential Form regarding Unemancipated Children) are public record. I acknowledge that I have read and understand N.C.G.S. 138A-26 regarding concealing or failing to disclose material information and N.C.G.S. 138A-27 regarding providing false information: § 138A-26. Concealing or failing to disclose material information. A filing person who knowingly conceals or knowingly fails to disclose information that is required to be disclosed on a statement of economic interest under this Article shall be guilty of a Class 1 misdemeanor and shall be subject to disciplinary action under G.S. 138A-45. § 138A-27. Penalty for false information. A filing person who provides false information on a statement of economic interest as required under this Article knowing that the information is false is guilty of a Class H felony and shall be subject to disciplinary action under G.S. 138A-45. I Agree. It is my intention that this check box constitutes my electronic signature. By checking this box I certify that the information provided in this Statement of Economic Interest and any attachments hereto are true, complete, and accurate to the best of my knowledge and belief. Filed Electronically 3/17/2016 Signature Date Benita Lowder Conrad Printed Name The SEI and any attachments, excluding the Confidential Form, are public records. Page 11 of 11