Benjamin Willis

NORTS : i. +, NORTH CAROLINA STATE ETHICS COMMISSION [xis common at oir J 2017 STATEMENT OF ECONOMIC INTEREST |“ 4 RECEIVED MAY 152017 NO CHANGE FORM [[— did | THIS ENTIRE FORM MUST BE COMPLETED TO | scopes AC. owls 13/17 FULFILL YOUR ETHICS FILING OBLIGATION ow Enteres in 085] of! ul [Fees wave rr, mooi, st) — CT RT EL T sor | JEEP I YN S\N CS — | REASON FOR FILING (COMPLETE ALL THAT APY) Co 1 STATE GOVERNMENT 0B (Specy Agency and Posiion) | BOARD/COMMISSION (it the complete name of all State | I | Doers om wich you are serving or are bow considerea) | — _ WRcoe mPo TAL i JUDICIAL OFFICER (Speciy Office) LEGISLATOR (Spelt House or Senate) i bpp eee em] im that toe information provided in this Statement of Economic Interest and any attachments hereto ae true, | Compete, and accurate to the best of my knowledge and betel rar Sstosure whl rea on equtable Interest | understans tht my Sttement of Econom Interest and ny itachments or supplements here (wth th exceation of Ere Confidential Form reaarding Uncm ance Chien) ora BUS record. | | acknowiedge tht { have read and understand .C.G.5. 1384-26 regarding concealing or fag to Gsclose material | femation n H C.G5. 1398-57 regarang providing fate formato § 1384.26. Concealing or falling to lsciose material information. Bo tomement of acanomic mRerest under this Ale shal be Guity of a Class 1 misdemeanor and shal be suoect to Grscpimary action under G.5. 138445. | fing person who provides fase information on 2 Eatement of economic interest a5 required under this Article Knot toa the Information 1 false is Guy of a Class felony and shall be subject to disciplinary acon under gt | | horeby affirm that 1 have reviewed my most recently fied 2016 Statement of Economic Interest and that as EF Secamber 31, 2016, my responses continue to be true, correct, and complete to the best of my knowledge ang meer” as om) TAT | | 7 ; / slie)ia Ta = Ba Breen Keith WANS | | Frinted wame | Submit SIGNED, ORIGINAL documents only. Do not fax or e-mail this form. | “This entire document is @ public record.

NORTH CAROLINA STATE ETHICS COMMISSION 2016 STATEMENT OF ECONOMIC INTEREST NO CHANGE FORM FILER'S NAME (FIRST, MIDDLE, LAST) Prefix First Name Middle Name Last Name Suffix Mr. Benjamine Keith Willis 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) Transportation, Board of; Greater Hickory 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 2 AFFIRMATION I affirm that the information provided in this Statement of Economic Interest and any attachments hereto are true, complete, and accurate to the best of my knowledge and belief. I also certify that I have not transferred, and will not transfer, any asset, interest, or property for the purpose of concealing it from disclosure while retaining an equitable interest. I understand that my Statement of Economic Interest and any attachments or supplements thereto (with the exception of the Confidential Form regarding Unemancipated Children) are public record. I acknowledge that I have read and understand N.C.G.S. 138A-26 regarding concealing or failing to disclose material information and N.C.G.S. 138A-27 regarding providing false information: § 138A-26. Concealing or failing to disclose material information. A filing person who knowingly conceals or knowingly fails to disclose information that is required to be disclosed on a statement of economic interest under this Article shall be guilty of a Class 1 misdemeanor and shall be subject to disciplinary action under G.S. 138A-45. § 138A-27. Penalty for false information. A filing person who provides false information on a statement of economic interest as required under this Article knowing that the information is false is guilty of a Class H felony and shall be subject to disciplinary action under G.S. 138A-45. I hereby affirm that I have reviewed my most recently filed 2015 Statement of Economic Interest and that as of December 31, 2015, my responses continue to be true, correct, and complete to the best of my knowledge and belief. I Agree. It is my intention that this check box constitutes my electronic signature. By checking this box I certify that the information provided in this Statement of Economic Interest and any attachments hereto are true, complete, and accurate to the best of my knowledge and belief. Filed Electronically 3/17/2016 Signature Date Benjamine Keith Willis Printed Name The SEI and any attachments, excluding the Confidential Form, are public records. Page 2 of 2

NORTH CAROLINA STATE ETHICS COMMISSION 2015 STATEMENT OF ECONOMIC INTEREST No-Change Form FILER'S NAME (FIRST, MIDDLE, LAST) First Name Middle Name Last Name Suffix Benjamin Keith Willis 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) Transportation, Board of; 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 2 AFFIRMATION I affirm that the information provided in this Statement of Economic Interest and any attachments hereto are true, complete, and accurate to the best of my knowledge and belief. I also certify that I have not transferred, and will not transfer, any asset, interest, or property for the purpose of concealing it from disclosure while retaining an equitable interest. I understand that my Statement of Economic Interest and any attachments or supplements thereto (with the exception of the Confidential Form regarding Unemancipated Children) are public record. I acknowledge that I have read and understand N.C.G.S. 138A-26 regarding concealing or failing to disclose material information and N.C.G.S. 138A-27 regarding providing false information: § 138A-26. Concealing or failing to disclose material information. A filing person who knowingly conceals or knowingly fails to disclose information that is required to be disclosed on a statement of economic interest under this Article shall be guilty of a Class 1 misdemeanor and shall be subject to disciplinary action under G.S. 138A-45. § 138A-27. Penalty for false information. A filing person who provides false information on a statement of economic interest as required under this Article knowing that the information is false is guilty of a Class H felony and shall be subject to disciplinary action under G.S. 138A-45. I hereby affirm that I have reviewed my most recently filed 2014 Statement of Economic Interest and that as of December 31, 2014, my responses continue to be true, correct, and complete to the best of my knowledge and belief. I Agree. It is my intention that this check box constitutes my electronic signature. By checking this box I certify that the information provided in this Statement of Economic Interest and any attachments hereto are true, complete, and accurate to the best of my knowledge and belief. Benjamin Keith Willis Printed Name Filed Electronically 4/22/2015 Signature Date The SEI and any attachments, excluding the Confidential Form, are public records. Page 2 of 2