Betty Jean Marrow-Taylor

The SEI and any attachments, excluding the Confidential Form, are public records. Page 1 of 10 STATE ETHICS COMMISSION 2025 STATEMENT OF ECONOMIC INTEREST 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 Ms. Betty Jean Marrow-Taylor Current Employer Job Title NC Department of Commerce Chief Culture and Community Engagement Officer Officer Nature or Type of Business Public Service 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 complete names of all State boards on which you are serving or are being considered.) Commerce, Department of - Chief Culture and Community Engagement Officer Judicial Officer, Post-Service Filer, or Judicial Officer Appointee (Specify office.) Legislator, Post-Service Filer, or Appointee to Legislative Office (Specify House or Senate.) A. Do any immediate family members reside in your household? ☒ Yes ☐ No On this form, ”immediate family” includes your spouse (unless legally separated) and unemancipated children (minors under 18 years of age). 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. Minors are children under 18. They are emancipated by marriage, enlistment in the US military, or court order for emancipation. Full names of Adults and Emancipated Minors Relationship Employer Job Title Nature of Business Ezekiel Jerome Taylor Child Student & Self Employed President/Founder Uniting People Ministry The SEI and any attachments, excluding the Confidential Form, are public records. Page 2 of 10 B. List only the initials of all unemancipated minors in your household below. A minor is a child under 18 years old. List the full name of each minor child on the Confidential Form at the end. Initials of Unemancipated Minors Relationship Employer Job Title Nature of Business Property Interests 1. As of December 31, 2024, did you or any 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 Betty Jean Marrow-Taylor (Self) 100.00% Durham Durham 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 2. At any time during 2023 or 2024, did you or any members of your immediate family sell or buy personal property worth $10,000 or more to or from the State of North Carolina? ☐ Yes ☒ No Name of Purchaser Name of Seller Type of Property The SEI and any attachments, excluding the Confidential Form, are public records. Page 3 of 10 Financial Interests 3. As of December 31, 2024, did you or any members of your immediate family own any of the following financial interests valued at $10,000 or more? List each company individually. A. Stock in a publicly owned company? ☐ Yes ☒ No ► Include stocks held individually of in a portfolio managed by a financial services company Do not list interests in a widely held investment fund (including mutual funds, regulated investment companies, or pension or deferred compensation plans) if: 1. the fund is publicly traded or its assets are widely diversified; and 2. neither you nor an immediate family member are able to control the underlying assets. Owner of Interest Full Name of Company or ticker symbol 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? These include 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 C (1). For each company or business entity identified in question 3.C. (the “Primary Company”), 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 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, briefly describe 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, 2024, were you or any members of your immediate family the beneficiaries of a vested trust with a value of $10,000 or more that you created, established, or controlled? Do not list assets held in blind trusts. See 2025 SEI Helpful Tips for the definition of “Vested Trust” and “Blind Trust.” https://ethics.nc.gov/seis ☐ Yes ☒ No Name and Address of Trustee Description of the Trust Your Relationship to the Trust The SEI and any attachments, excluding the Confidential Form, are public records. Page 4 of 10 5. As of December 31, 2024, did you any 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. Do not disclose the amount of the debt. ☒ Yes ☐ No Name of Debtor Type of Creditor (commercial Bank, credit union, individual, etc.) Betty Jean Marrow-Taylor (Self) Commercial Bank Betty Jean Marrow-Taylor (Self) Credit Union Ezekiel Jerome Taylor (Child) Credit Union 6. List each source of income (not specific amounts) of more than $5,000 received by you or any members of your immediate family during 2024. Include salary, wages, state/local government retirement income, professional fees, honoraria, interest, dividends, rental income, business income, and other types required to be reported on State and federal tax returns. You must disclose your receipt of salary or wages from any governmental or private entity, including those already listed in response to other SEI questions. Do not include income received from the following sources: ► Capital gains ► Federal government retirement ► Military retirement ► Social security retirement, survivors, or disability benefits Recipient of Income Name of Person or Entity from Which Income Was Received Type of Business/Industry Type of Income Betty Jean Marrow-Taylor (Self) NC Commerce State Agency Salary The SEI and any attachments, excluding the Confidential Form, are public records. Page 5 of 10 Professional and Civic Relationships 7(a). During 2024, were you or any 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 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 local governments. ► Do NOT list organizations of which you are a mere member. Name of Person Position Name of Nonprofit Corporation or Organization Nature or Purpose of Organization Betty Jean Marrow-Taylor (Self) Officer - President We Care We Share Community Enrichment Programs Nonprofit 501c3- Impacting Poverty in local community; improving quality of life for people in need; specifically Seniors and children/families Ezekiel Jerome Taylor (Child) Officer - President Uniting People Ministry Community based Outreach Ministry- 501c3 7(b). If the nonprofit corporations or organizations listed above do business with the State of North Carolina or receive State funds, briefly describe the nature of that business, if known or with due diligence could reasonably be known. Name of Nonprofit Corporation or Organization Describe State Business None or Not Known 8. During 2024, were you or any 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 solely because you are a legislator or judicial officer or as a candidate or appointee to those offices. ►Do not list organizations of which you are only a member and do not serve in a leadership role. Name of Person Name of Society, Organization, or Advocacy Group Leadership Position (Director, Officer, Board Member) The SEI and any attachments, excluding the Confidential Form, are public records. Page 6 of 10 9(a). List the name of each for profit business with which you or a member of your immediate family was an employee, director, officer, partner, proprietor, or member or manager as of December 31, 2024. Name of Person Relationship to Filer Name of Company Role of Person Betty Jean Marrow-Taylor Self Glorious Creations LLC Partner 9(b). If you know that any 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, 2024, briefly describe that activity. Name of Company or Business Entity Description of Business Activity with the State None or Not Known 10. Are you a practicing attorney? ☐ Yes ☒ No ☐ Judicial Officer/State Attorney/In House/Employee 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 2024. ☐ 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 2024, 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 10 12. Are you or your employer, or any members of your immediate family, or their employers currently:  licensed by the State board or agency with which you are or will be associated or  regulated by the State board or agency with which you are or will be associated or  in a business relationship with the State board or agency 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 solely because you are a legislator or judicial officer or as a candidate or appointee to those offices. Name of Person Name of Employer (if applicable) Type of Relationship (Licensing, Regulatory, Business) 13. Have you or a member of your immediate family been registered as a lobbyist or lobbyist principal within the 12 months preceding your filing of this form? ☐ Yes ☒ No Name of Lobbyist Lobbyist’s Principal Date of Registration Registration Expiration Other Disclosures 14. During 2024, 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,  when both you and those person(s) were outside North Carolina,  under circumstances that would lead a reasonable person to conclude the gifts were given for lobbying? To answer Yes, all three conditions must apply ☐ Yes ☒ No ► Do not report gifts given by members of your extended family. ► Do not report gifts you have previously reported on the “Expense Report for Exempted Persons.” 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 10 15. During 2024, after you were appointed, employed, or filed or were nominated as a candidate, did you  accept a “scholarship” exceeding $200 related to your public position from a person or group of persons acting together,  when those person(s) were outside North Carolina? To answer Yes, both conditions must apply 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 filing solely because you are a legislator or judicial officer or as a candidate or appointee to those offices. ► Do not report gifts you have previously reported 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, participant, or affiliate. Date of Scholarship Name and Address of Donor(s) Describe Event Estimated Market Value 16. Have you been appointed or considered for 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 made in 2024 with a cumulative total of more than $1,000 to the Council of State member who appointed you. Do not include contributions from immediate family members. ► Contributions are defined broadly in N.C.G.S. 163-278.6(6) and include “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 The SEI and any attachments, excluding the Confidential Form, are public records. Page 9 of 10 17. Are you an appointee or prospective appointee as: 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  Utilities Commission  Wildlife Resources Commission ☐ Yes ☒ No If “No,” proceed to question 18. d. If yes, were you appointed or are you being considered for appointment to that position by a Council of State member? ☐ Yes ☒ No If “No,” proceed to question 18. e. If yes, you must indicate whether during 2024 you 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: i. Collected contributions from multiple contributors, took possession of such multiple contributions, and transferred or delivered those collected contributions to the candidate or committee? ☐ Yes ☐ No ii. Hosted a fundraiser at your residence or place of business? ☐ Yes ☐ No iii. Volunteered for campaign-related activities, including 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; or (ii) an order of expungement? ☐ Yes ☒ No Offense Date of Conviction County of Conviction State of Conviction 19. Are you aware of any other information that you believe may assist the Ethics Commission in advising you concerning your compliance with the State Government Ethics Act? ☐ Yes ☒ No If yes, please provide that information below. The SEI and any attachments, excluding the Confidential Form, are public records. Page 10 of 10 Affirmation The information provided in this Statement of Economic Interest and any attachments are true, complete, and accurate 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 Statement of Economic Interest and any attachments except for the Confidential Form regarding Unemancipated Children are public records. 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 05/01/2025 Signature Date Betty Jean Marrow-Taylor Printed Name

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 Miss Betty Jean Marrow-Taylor 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.) Commerce, Department of - Chief Diversity, Equity, Inclusion, Officer Indian Affairs, Commission of 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 03/14/2024 Signature Date Betty Jean Marrow-Taylor 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 Ms. Betty Jean Marrow-Taylor 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.) Commerce, Department of - Chief Diversity, Equity, Inclusion, Officerr 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 04/17/2023 Signature Date Betty Jean Marrow-Taylor 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 2021 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 Ms. Betty Jean Marrow-Taylor 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.) Administration, Department of - Deputy Secretary Judicial Officer (Specify office.) Legislator (Specify House or Senate.) AFFIRMATION The information provided in this Statement of Economic Interest and any attachments are true, complete, and accurate 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 Statement of Economic Interest and any attachments except for the Confidential Form Regarding Unemancipated Children public records. 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 that I have reviewed my most recently filed 2020 Statement of Economic Interest and that as of December 31, 2020, my responses continue to be true, correct, and complete to the best of my knowledge and belief. I affirm under penalty of perjury that the foregoing is true and correct. Filed Electronically 04/13/2021 Signature Date Betty Jean Marrow-Taylor Printed Name

The SEI and any attachments, excluding the Confidential Form, are public records. Page 1 of 10 STATE ETHICS COMMISSION 2020 STATEMENT OF ECONOMIC INTEREST This entire form must be completed to fulfill your ethics filing obligation. ____ Checked for completion ____Scanned ______Date Incomplete Qs ____ ____ ____ ____ Supp. sent date _______ by _____ Supp. received date _________ Entered in database ______ by ______ Filer’s Name (First, Middle, Last) Prefix First Name Middle Name Last Name Suffix Betty Jean Marrow-Taylor Current Employer Job Title Department of Administration Deputy Secretary Nature or Type of Business Over-site for the Advocacy Division which includes Historically Underutilized Businesses (HUB), Non-Public Education(DNPE), Council for Women/Youth Involvement (CFY/YI), Commission of Indian Affairs (CIA), and Grants Management. Reason For Filing (Complete all that apply.) State Government Job (Specify agency and position.) Board/Commission (List complete names of all State boards on which you are serving or are being considered.) Administration, Department of - Deputy Secretary Judicial Officer (Specify office.) Legislator (Specify House or Senate.) A. Do other immediate family members reside in your household? ☒ Yes ☐ No On this form, ”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. Minors are children under 18. They are emancipated by marriage, enlistment in the US military, or court order for emancipation. Full names of Adults and Emancipated Minors Relationship Employer Job Title Nature of Business Ezekiel Jerome Taylor Child Starbucks & Union Baptist Church Barista, Graphics Designer Coffee Shop, Church For Staff Use Only Date Received: The SEI and any attachments, excluding the Confidential Form, are public records. Page 2 of 10 B. List only the initials of all unemancipated minors in your household below. A minor is a child under 18 years old. List the full name of each minor child on the Confidential Form at the end. Initials of Unemancipated Minors Relationship Employer Job Title Nature of Business Property Interests 1. As of December 31, 2019, did you or any 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 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 2. At any time during 2018 or 2019, did you or any members of your immediate family sell to or buy from the State of North Carolina personal property worth $10,000 or more? ☐ Yes ☒ No Name of Purchaser Name of Seller Type of Property The SEI and any attachments, excluding the Confidential Form, are public records. Page 3 of 10 Financial Interests 3. As of December 31, 2019, did you or any members of your immediate family own any of the following financial interests valued at $10,000 or more? List each company individually. A. Stock in a publicly owned company? ☐ Yes ☒ No ►Do not list interests in a widely held investment fund (including mutual funds, regulated investment companies, or pension or deferred compensation plans) if: 1. the fund is publicly traded or its assets are widely diversified; and 2. neither you nor an immediate family member are able to control the underlying assets. Owner of Interest Full Name of Company or ticker symbol 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? These include 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 C (1). For each company or business entity identified in question 3.C. (the “Primary Company”), 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 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, briefly describe 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, 2019, were you or any members of your immediate family the beneficiaries of a vested trust with a value of $10,000 or more that you created, established, or controlled? Do not list assets held in blind trusts. See 2020 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 The SEI and any attachments, excluding the Confidential Form, are public records. Page 4 of 10 5. As of December 31, 2019, did you any 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 Type of Creditor (commercial Bank, credit union, individual, etc.) Betty Jean Marrow-Taylor (Self) Commercial Bank 6. List each source of income (not specific amounts) of more than $5,000 received by you or any members of your immediate family during 2019. Include salary, wages, state/local government retirement income, professional fees, honoraria, interest, dividends, rental income, business income, and other types required to be reported on State and federal tax returns. Please remember to disclose your receipt of salary or wages from any governmental or private entity. 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 Ezekiel Jerome Taylor (Child) Starbucks & Uniion Baptist Church Coffee Shop and Church Wages The SEI and any attachments, excluding the Confidential Form, are public records. Page 5 of 10 Professional and Civic Relationships 7(a). During 2019, were you or any 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 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. ► Do not list organizations of which you are a mere member. Name of Person Position Name of Nonprofit Corporation or Organization Nature or Purpose of Organization Betty Jean Marrow-Taylor (Self) Officer - Chair We Care We Share Community Enrichment Programs, Inc. Provide programs and services that help to improve the quality of life for families living in imporverished communities. 7(b). If the nonprofit corporations or organizations listed above do business with the State of North Carolina or receive State funds, briefly describe the nature of that business, if known or with due diligence could reasonably be known. Name of Nonprofit Corporation or Organization Describe State Business None or Not Known 8. During 2019, were you or any 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 judicial officer or you are filing as an appointee to one of those offices. ►Do not list organizations of which you are only a member and do not serve in a leadership role. Name of Person Name of Society, Organization, or Advocacy Group Leadership Position (Director, Officer, Board Member) The SEI and any attachments, excluding the Confidential Form, are public records. Page 6 of 10 9(a). List the name of each 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, 2019. Name of Person Relationship to Filer Name of Company Role of Person No Business Associations 9(b). If you know that any 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, 2019, briefly describe that activity. Name of Company or Business Entity Description of Business Activity with the State None or Not Known 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 2019. ☐ 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 2019, 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 10 12. Are you or your employer, or any members of your immediate family, or their employers currently:  licensed by the State board or agency with which you are or will be associated or  regulated by the State board or agency with which you are or will be associated or  in a business relationship with the State board or agency 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 or you are filing as an appointee to one of those offices. Name of Person Name of Employer (if applicable) Type of Relationship (Licensing, Regulatory, Business) 13. Have you or a member of your immediate family been registered as a lobbyist or lobbyist principal within the 12 months preceding your filing of this form? ☐ Yes ☒ No Name of Lobbyist Lobbyist’s Principal Date of Registration Registration Expiration Other Disclosures 14. During 2019, 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,  when both you and those person(s) were outside North Carolina,  under circumstances that would lead a reasonable person to conclude the gifts were given for lobbying? To answer Yes, all three conditions must apply ☐ Yes ☒ No ► Do not report gifts given by members of your extended family. ► Do not report gifts you have previously reported on the “Expense Report for Exempted Persons.” 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 10 15. During 2019, after you were appointed, employed, or filed or were nominated as a candidate, did you  accept a “scholarship” exceeding $200 related to your public position from a person or group of persons acting together,  when those person(s) were outside North Carolina? To answer Yes, both conditions must apply 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 you have previously reported 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, participant, or affiliate. Date of Scholarship Name and Address of Donor(s) Describe Event Estimated Market Value 16. Have you been appointed or considered for 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 made in 2019 with a cumulative total of more than $1,000 to the Council of State member who appointed you. Do not include contributions from immediate family members. ► Contributions are defined broadly in N.C.G.S. 163-278.6(6) and include “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 The SEI and any attachments, excluding the Confidential Form, are public records. Page 9 of 10 17. Are you an appointee or prospective appointee as: 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  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 position by a Council of State member? ☐ Yes ☒ No If “No,” proceed to question 18. e. If so, you must indicate whether during 2019 you 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: i. Collected contributions from multiple contributors, took possession of such multiple contributions, and transferred or delivered those collected contributions to the candidate or committee? ☐ Yes ☐ No ii. Hosted a fundraiser at your residence or place of business? ☐ Yes ☐ No iii. Volunteered for campaign-related activities, including 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; or (ii) an order of expungement? ☐ Yes ☒ No Offense Date of Conviction County of Conviction State of Conviction 19. Are you aware of any other information that you believe may assist the Ethics Commission in advising you concerning your compliance with the State Government Ethics Act? ☐ Yes ☒ No If yes, please provide that information below. The SEI and any attachments, excluding the Confidential Form, are public records. Page 10 of 10 Affirmation The information provided in this Statement of Economic Interest and any attachments are true, complete, and accurate 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 Statement of Economic Interest and any attachments except for the Confidential Form regarding Unemancipated Children are public records. 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 04/06/2020 Signature Date Betty Jean Marrow-Taylor 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 2019 STATEMENT OF ECONOMIC INTEREST NO-CHANGE FORM This entire form must be completed to fulfill your ethics filing obligation. FOR STAFF USE ONLY Date Received: Checked for completion ______ Scanned _______ Date______ Entered in DB ____by______ Filer’s Name (First, Middle, Last) Prefix First Name Middle Name Last Name Suffix Betty Jean Marrow-Taylor 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.) Administration, Department of - Director, Policy/Strategic Development Judicial Officer (Specify office.) Legislator (Specify House or Senate.) AFFIRMATION The information provided in this Statement of Economic Interest and any attachments are true, complete, and accurate 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 Statement of Economic Interest and any attachments except for the Confidential Form Regarding Unemancipated Children public records. I have read and understand the following statutes: N.C.G.S. § 163A-191. 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. 163A-415. N.C.G.S. § 163A-192. 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. 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. I affirm under penalty of perjury that the foregoing is true and correct. Filed Electronically 04/12/2019 Signature Date Betty Jean Marrow-Taylor Printed Name Submit signed, original documents only. Do not fax or e-mail this form.

, NORTH CAROLINA STATE ETHICS COMMISSION | FOR ETHICS COMMISSION USE ONLY " r 2017 STATEMENT OF ECONOMIC INTEREST i Dain Recoivest # | 919-814-3600 wwethicscommissionnc.oov | RECEIVED APR 2.5 2017 THIS ENTIRE FORM MUST BE COMPLETED TO FULFILL bine forcomsietion "YOUR SEI FILING OBLIGATION Pe ail competes Supp. Somme tw Sup coed De Entered in amobasa ____ by ____ TE ] Prefix | First Name Middle Name Lost Npme. N Tsumx | d : I — _ - Nitro Tle | CURRENT FPO | ose [ibdiareer BUSES my — E— | | REASON FOR FILING (COMPLETE ALL THAT APPLY) __ 1 [ stare covemnment 06 (specs gence) BOARD/COMMISSION (1s complete: name of ll te foe | boars on hh you ae servng oe are being conigecc Jor oF Adlasiers arton JUDICIAL OFFICER (Speciy Office) f— ose) : FS — A. Do other immediate family members reside in your household? Ue One When used brcuanout tis fort, th term Kmmediate family includes your spouse (unless egal separated. It slo includes members of our extendas Fail (Your 1d Your SPOUSES CS, arandchlaren, Parents, anGparent, and lings, and the 2p0Use of €ach of those erin) who reside in your household. ET ET TN RT TI ry | Minors are emancipate by marriage. cabstment mh US miliary or court order for emancipation, © | FULL NAME OF ADULTS & | RELATIONSHIP EMPLOYER 08 TITLE NATURE OF | "eMANCIPATED MINORS | pint Sth | susiness \atkit [Tame Tle Son _padint || | | he - The SET and any attachments, excluding the Confidential Form, are public records. Page 10110 1B. List ONLY the initials of all unemancipated minars In your household below. A minor s a child under 18 years od. Note: Yau must list the full name of each minor child on the Confidential Form available at the end of this document. I — INITIALS FOR | RELATIONSHIP empLover Jom TITLE naTuRE OF UNEMANCIPATED | BUSINESS winoms | PROPERTY INTERESTS | 1 he of December 31, 2015, dd you, your spose or members of your immediate family | A. Have an ownership interest in Norih Carolina real estate {inlucing your residence) with » market value of | $10,000 or mare? 1] or One umer of Real Estote | Ownership interest | Location by City Sumer | on oumersiip interest | toca | $10,000 or more? Ove wri Name of Lessor Nome of Lessee | If Real Estate, Location | If Personal Property, oo (Renter) byCity a County | Describe 3. At any time during 2015 2016, dd ou, Your SPOUSE, o members of your (mIEatG family 36180 o bu from the Shane of North Carat irsonal property wi a market veloe o $10,000 or more? Ove fe Name of Purchaser Name of setter TT twpeot property The SEI and any attachments, exchiding the Confidential Form, are public records. page 20f 10 FINANCIAL INTERESTS 3. As of Decernber 31, 2016, did you, your spouse, or members of your immediate family own any of the following financial interests valued at $10,000 or more? LIST EACH COMPANY INDIVIDUALLY, - Sghin 2 lt owned compan es OMe D0 aol lst ownership terests ma widely held investment fund (adding atual funds, requlaad IWesmit companies, of pension or deferred compentaton plans) 1: (1) the fund 1s pUbIly traded or is assets are mil diversified; and (1) neither you nor an immediate family member are able to control the assets held 1 tne. taal func, investment company, of pensicn or dslerred compensation pian: Owner of Interest |Full Name of Company (Do not use a ticker symbol) AVNER... monn. £08 Har of Company (0 tot uae » ic 7 Bly Mpcomi- Tage | Eimer {6 Stack Options in 2 company or business? | ves fo Owner of Stock Option Full Name of Company (Do nat use a ticker symbol) C. Ioterests 0.2 non-public gun company or Dusiness ent (including Terests In sale propreRorships, partnerships, ied parchersnips, Joint ventures, ted amity Companies, Imited 151RY partnerships, and closely held corporations)? EN — Owner of Interest Name of Company or Business Entity | C2) Far saen nar-pubicty owned company or business entity (the “arimary company) identified in question | 5.C above, please st the names of amy other companies 6 Business cries n which the primary Company |. owns secures or equity interests valved ot over $10,003, # Known ) |" Non-Publicly Owned Company or Business Entity | Other Companies in which the primary Company jo (the Primary Company) Gana Security or Equity Interests 1 I Nore or Not Known The SEI and any attachments, excluding the Confidential Form, are public records. Page 3 of 10 | C2). 1 you know that any campany or business entity fisted in 3.C or 3.C(1) above has any material business a Oo tl tp a rE say Description of Business Aci with the sate fone or Not Known 4. As of December 31, 2016, were you, your spouse, or members of your immediate family the beneficiaries of a vested emake or ES rt D0 not list assets held in blind trusts. See 2017 SEI Helpful Tips for the definition of “Vested Trust” ang "Bling Trust,” Lives pte Nome and Address of Trustee | Description of the Trust i Your Relationship to the Trust cere erm see eres se reeves seems rerss eer re re < eve EE ——— or Dp 8 Yo ou pote, ox emer Yur al, rm ave anes oF EEO 3 more, excluding the mortgage on your primary personal residence? Examples include credit card debts, auto loans, student Fite RR wo Ae Ne Name of Debtor (You, Spouse, Immediate Family | Type of Creditor (Commercial Bank, Credit Union, Sis | [Ermita age 5a. R a a . fms Var | Zetia) Conrane Serve © ern ag ol teams sat sous) of Te eae £5,000 feces von os spots, of eribers of BR GE IE a TI pt A Battle rtd mth SR soe than + Federal government retirement Mitkary retirement + Social security income SSD Recipient or coma | Name of Source Type of [roman | emivess/tnaustry | 1 3 i 01 1 fi “Tsor 55 Awis deadlines | Laer ioc fey Dept. 07 Reds = Appa cant 1 | | HR EL 8 SBIR AISI HR CAN BO Sr PS HORST: Peet 10 PROFESSIONAL AND CIVIC RELATIONSHIPS | Aes 1 10 1M." proceed to question 8. » 50 not list Stale baards or entities, or entities created hy a political subdivision of the State. | Corp anion | Soars or sesemreeen — We Gi WEG 4 Mocs Tol Gadi. Lil it Pogtamnc Zico i. REA PDT FP LL mpeamenty) Lut bpm shed | | AA L SUTURE SUN 1 a. H. Dunng 2016, were you, your spouse, or members of your immediate family a director, officer, or governing baard | ep re PR ——— [rev————— li ] ‘or Advocacy Group. (Director, Officer, Board Member) | The SE3 and ao attachments, avchucing the Confidential Form, ae public records. ST Sa) Ls he nam af each company of buses wi which you wr 300A Where you or 2 member of yaur TEdiie aleve, recto, attr, potnen, ropes, of ember of Manager os of Decumes 3, 2016 me of person | _ Relationship to ier ame of Company foe of person S057 vou know tha ary company or sess nity sted 50) above vad amy ter] wings deans or business contracts with the State of North Carlina or was regulated by the State as of December 31, 2016, provide a Ware of Company or Business Entity Description af Business Activity with the State iver applet (to etties ted on #92) Qves (Ae [3 acl Offcer/State Attomey 1£°Ves", check each category offegat representation in which you the I rm th which you are affiata hs earned legal fees of more than $10,000 during 2616. — fyv— [eT— = Caminat = Decadent Estates © Environmental Dtraurance uber = Tor wigtion Gneusing Wiles Reulstion = Other category notte. regione amino potesson vsoeonio for WH Wd chore oF wr pod ovr $30:000% F Type of Business T Nature of Services Rendered The SET and any attachments, excluding the Confidential Form, are public records. Page sor 10 12. Are you or your employer, your spouse or members of your immediate family, or their mplayer currently: + Licensed by the State board or employing entity with which you sre or will be associated or + Regulated by the Scat board or employing entity with which yau are or will be associates or «Mave gy a with the State board or employing entity with which you are or will be associated” | 1¥es aff [J Legislator Judicial Office - You are not required to complete this question if you are fing because | ¥0u are a legislator or a judicial officer CJudial officer” is defines in the SEX Helpful Tips) or you | are fling as an appointee to those offices. Name of person Name of Emplayer Type of Refationship. Gt applicable) (Licensing, Regulatory, Business) 13. Are you, your spouse or 3 member of your [mime family currently registered as a lobbyist or lobbyist princioa, or were you registered as such within the 12 months preceding your filing of this form? Owes rho Name of Lobbyist Lobbyist's Principat Date of Registration Registration Expiration OTHER DISCLOSURES 14. During any calendar quarter in 2016 (but only the time period after you were ApROINEd, employes or fled or were rominated 35.3 candidate). did you + receive any “giN(S)" exceeding $200 per quarter from a person or grup 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 Gis) were given under circumstances that would lead a reasonable person to conclude that they were given for lobbying? ives rio 53 not report gis Gen by members of your extenad fay D0 not report aif hat have previously been reported by you To the Department of the Secretary of State on the _“Pxpense Report for Exempted Persons.” Date Item Received | Name and Address of Donor(s) | Describe Item Received | Estimated Market | Value The SET and any attachments, excluding the Confidential Form, are public racords. Page 701 10 £5. During 2016 (but only the ime. period after you were appointed, employed, or led or were nominated a6 o anaaner| ad you + accept a “scholarship” exceeding $200 from a person or Group of persons acting together and | + those person(s) were outside North Carolina and | + the scholarship ws related to your public position” A “scholarship” is a grant-in-aid, either direct ar indirect, | to attend a conference, meeting, or similar event, including tuition, travel, Isduing, meals, and other | Similar expenses. | ives wn Judicial Officer - You are not required to complete this question if you are a judicial officer or you are | ing a5 a ucical officer appointee. | hdd — > 00 not report gifts that have previously been reported by you to he Department of the Secretary of Sate on the. “Expense Report for Exempted Persons.” 1 Legisators are not require to report scholarships parc by 2 nonpartisan legislative organization of wich the legislator | or the General Assernbly is a member or particoant or an afiiate of that organization. outer ‘Name and Address of Donor(s) Describe Event Scholarship | 16. Were you appointed or are you being considered for an appointment to 3 covered board by the Governor or anciher Coun af tate member? Council of State members are » Govemor > Lt. Governor » Secretory of State » State Auditor » State Treasurer » Superintendent of Public Instruction » Artomey General » Commissioner of Agriculture » Commissioner of Labor » Commissioner of Insurance Ee | 1f “Ves”, list all contributions you (NOT immediate family members) made during 2016 with a cumulative Lotal of more than 51,000 ta the Governor or other Council of State member who appointed you. » Contributions are defined n N.C,G.5. 162-278.6(6) and include, but are not ited to, “any advance, conveyance, Gepost, Gstributan, transfer of fonds. oan, payment, Gf, pledge of SUbSIpton of money or anything of vaua whatsoever.” Date I Amount 1 Contributed to {14ffo contribution(s) with a cumulative total of more than $1,000 S| — I i The SEI and any attachments, excluding the Confidential Form, are public records. Page 8 of 10 17. Arc you an appointee or prospective appoint o: a. the head of 3 principe state deparment (e.. cabinet secretary) appainied by the Govemor. or 5. 2 North Caroline Supreme Court Justice, Court of Appeals, Superior or District Court Judge; or €. 2 member of any of the following boards: + ASC Commission + Coastal Resaurces Commission one” * State Board of Faucation [Yes lo + State Board of Elections + Division of Employment Security I “No” proceed to + Environmental Management Commission | auestion 18. + industrial Commission + oman Resources Commission + Rules Review Cornmission + Board of Transportation + UNC Board of Governors + Utites Commission engin eeeeeeearoeeremeeeeemesmeeese reer mesos famous sep mmeemeeee 4 1 30, were you appointed o are you being considered for appointment that | [ves [1No oublic positon by a Counc of State member? Council of State members ore sed | 1y wo,” proceed to 7 avestion 16 28, members) engaged in any of the following attics Wh respec to 0 on behalf of I the candidate or campaign committee of the Council of State member who. | appa You To your pubic position: lives Iino i. Collected contribucions from multiple contribs, Look possession of such Multiple contributons, and transfered or celvered those collcted Contributions 6 the candidate or commie? Contributions are defined in Guestion 16. i. Hosted a hunaraieer at your residence or place of business? Ces Ono ii. Volunteer for campalan elated acti, which include, but are not ited ote activity that advances the campaign of candiiate” 15. Have you ever been convicted of a felony for which you have not received ether: (a pardon of innocence; or Gi) an ore of expungement segarding that conviction? ves ws Offense Date of Conviction | County of Conviction State of Conviction 15. Ave you aware of any other formation that you beieve may assist the State Etncs Comimissian in aGSIg You | concerning your compliance win the Sate Goverment Fics Ac? | [ves yes presse prove such wlormavon veo. NPR | | | The SET and any attachments, excluding the Confidential Form, are public records. Page 9.of 10 AFFIRMATION | EE ————————— es acknowledge ti ave rad sn undersand N.C... 135A-26 regarding concn o Ging disclose mtr inomaton od SCS. 127 rent providing tse meron § 138A-26. Concealing or filing to disclose material information. | ro nepinany stom anes 5 38H § 138A-27. Penalty for false information. fragt) | [Dareez cE B 2-17 oa go oe we, £75 Sub SIGNED, ORIGINAL documents only. Do ot fa o ems tis form. _ The SEE and any attachments, excluding the Confidential Form, are public records. Page 100110