Betty Jo Shepheard

FOR STAFF USE ONLY GER STATE ETHICS COMMISSION Date Receved: FRI 3S RECEIVED R43} 2020 STATEMENT OF ECONOMIC INTEREST 5 NO CHANGE FORM | wm2022 | This entire form must be completed to fulfill | yc ETHICS COMMISSION | your SEI filing obligation. Cheedtor complet, | EnteredinDB_by___ | Fier's Name (First, Middle, Last) [Prom | Firsthame | widdieName | Lastmame | sumx I [Bey [| Jo | Shepherd [| Reason for Filing (Complete all that apply.) State Government Job (Specify agency and position.) Board/Commission (List the complete names of all State Soars on which you are serving or are being copsidered.) | Z eo TMM UNIT | Colne Roougd of Trustees [Sudical Office (specify office) Legislator (8Becfy House or Senate.) Ree Ihave carefully reviewed my most recently fled Statement of Economic Interest Long Form and my responses continue to'be true, correct, and complete tothe best of my knowledge and belie. have not transferred, and will not transfer, any asset, interest, or propery for the purpose of concealing it from disclosure while retaining an equitable interest. Tunderstand that my No Change Form is 2 public record. | 1 have read and understand the following statutes: | N.C.G.S. § 1384-26. Concealing or ailing to disclose material information. | A fing person who knowingly conceals or knowingly fas o disclose Information ha s required to be disclosed | on a statement of economic Interest... shall be guilty of a Class 1 misdemeanor and . . subject to discinary | action under G.S. 1384.45, | N.C.G.S. § 1384-27. Penalty fo fase information A fing person who provides false information on a statement of economic interest . . . knowing tht the | information is false is guilty of a Class H felony and shall be subject to disciplinary action under G.S. 1384-45. | 1 affirm under penaity of perjury that the foregoing is true and correct. blip sphat ture Er— Bed, SH Printed Nam Submit signed, original documents only. Do not fax or e-mail this form. | This entire document i a public record.

. RECEIVED = FOR STAFF USE O Gro) STATE ETHICS COMMISSION Cone neces: JAN 3 12018 (Abe 84 Wl 7 2019 STATEMENT OF ECONOMIC INTEREST STATE ETHICS COMMISSION = INO-CHANGE FORM Checked for completion 5.5 This entire form must be completed to fulfill your scanned £17 pate 211111 ethics filing obligation. TT el Fler's Name (First, Middle, Last) = ——_——— Tpretix | First name dale Name Last Name [sor [ [®& To | Shegheavdk Reason for Filing (Complete all that apply. | State Government Job (Spey agency and positon.) Board/Commission (Lit the complete names of all tate | boards on which you are serving o are being considered. Edgecombe Community CoV a oo gr of Trustees Judicial Officer (Speciy office.) Legisiator (Spey House or Senate.) TT [AFFIRMATION oo — The information provided in this Statement of Economic Interest and any attachments are true, complete, and accurate to the best of my knowledge and belie. Ihave not transferred, and wil no transfer, any asset, interest, or property fo the purpose of concealing It from disclosure while retaining an equitable interest. | 1 understand that my Statement of Economic Interest and any attachments except for the Confidential Form Regarding Unemancipated Children public records Ihave read and understand the following statutes: N.C.G.S. § 1634-191. Concealing or failing to disclose materia information. A fling person who knowingly conceals or knowingly fais to disclose information that s required to be disclosed on 2 statement of economic interest... shal be Quilty of a Class 1 misdemeanor and... subject to disciplinary action Under GS. 163A-415 N.C.G.5. § 1634-192. Penalty for faise information. A fling person who provides false information on a statement of economic interes ... knowing that the information is fase s gui of 2 Class H felony and shall be subject to disciplinary action under G.5. 163A-415. | I affirm that T 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. Tafirm under penalty of perjury that the foregoing is true and correct, S 1 [24/19 Signaty ate RELY S\Shepheerd Printed Name Submit signed, original documents only. Do not fax or e-mail this form. J This entire document is a public record.

“4. NORTH CAROLINA STATE BOARD OF FOR COMPLIANCE UA, 45% ONLY 7 ELECTIONS AND ETHICS ENFORCEMENT [ows recive: 2018 STATEMENT OF ECONOMIC INTEREST |. -4 : mANGLPL2 30 NO CHANGE FORM sonmestl4liS5 KEW) THIS ENTIRE FORM MUST BE COMPLETED TO |... 0s 05 4, [CU FULFILL YOUR ETHICS FILING OBLIGATION kk FILER'S NAVE (FIRST, MIDDLE, LAST) REASON FOR FILING (COMPLETE ALL THAT APPLY) STATE GOVERNMENT JOB (Specify Agency and Position) | BOARD/COMMISSION (List the complete name of al State boards on which you are serving or are being considered) Edgecombe Communi p/ley< Bern CRD JUDICIAL OFFICER (Specify Office) LEGISLATOR (Speci House or Senate) 1 afm tha 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 belie. also certify that have not transferred, and wil not transfer, any ass, interest, or property for the purpose of concealing it from disclosure while retaining an equitable ntorcst. understand that my Statement of Economic Interest and any attachments or supplements thereto (ith the exception of the Confidential Form regarding Unemancipated Children) are public record, 1 acknowledge that | have read and understand N.C.G.S. 1384-26 regarding concealing or filing to disclose material information and N.C.G.S. 138A-27 regarding providing false information: § 1384-26. Concealing or failing to disclose material information. A fling person who knowingly conceals or knowingly ais to disclose information that is required to be disclosed ona statement of economic interest under this Artic shall be guity of a Class 1 misdemeanor and shall subject o disciplinary action under G.5. 138A-45. § 1394-27. Penalty for false information. fling person who provides false information on a statement of economic interest as required under this Article knowing tht the information is fase is uity of a Class H felony and shall be subject o disciplinary action under G5. 1368.45, Bel pps Gate PZ] ev Printed Na Submit SIGNED, ORIGINAL documents only. Do not fax or e-mall ths form. This entire document is a public record.

i = NORTH CAROLINA STATE ETHICS COMMISSION TOR ETHICS COMMISSION USE OMY ny Dace Roce Yd; 2017 STATEMENT OF ECONOMIC INTEREST NO CHANGE FORM Io necked to compton THIS ENTIRE FORM MUST BE COMPLETED TO scien Date. . FULFILL YOUR ETHICS FILING OBLIGATION i J cneanch fy J) FILER'S NAME (FIRST, MIDDLE, LAST) - Prefix | First Name Middle Name Last Name Suffix Mo [Betty OF Shepheovd REASON FOR FILING (COMPLETE ALL THAT APPLY I STATE GOVERNMENT JOB (Specify Agency and Position) | SOARD/COMMISSION (List the complete name of all State a boards on which you are serving or are being €ansidered) y- i lea Edgecombe Community Solis JUDICIAL OFFICER (Specity Office) LEGISLATOR (Speci House or Senate) AFFIRMATION SE 1 Tafirm that the information provided in ths Statement of Economic Interest and any attachments hereto are true. complete, and accurate t the best of my knowledge and belie. i also certify that 1 have not transferred, and will ot transer, any asset, interes, or property fo the purpose of concealing trom disclosure whi retaining an equitable terest understand that my Statement of Econamic Interest and any otachments o supplements theret (with the excestian of the Confidential Form regarding Unemancipated Chirem) ae publ: record acknowledge that have read and understand .C.G.5. 1384-26 regarding concealing o falling to disclose material information and N.C.G.5. 138-37 regarding providing fase information § 1398.26. Concealing or ailng to disclose material information A fling person who knowingly conceals or knowingly fais to disclose information that is required to be disclosed an a statement of economic interest under this Article shal b Quy of 8 Class 1 misdemeanor 3nd shal be subject to cpa action under G.5. 138A-45 § 1388-27, Penalty for fais information. A fing person who provides false information on a statement of economic interest a required under tis Ate Knowing that the information is fos 5 Guilty of a Class felony and shall be subject to disciplinary action under GS. 136845 I hereby affirm that 1 have reviewed my mast recently filed 2016 Statement of Economic Interest and that as of December 31, 2016, my responses continue to be true, correct, and complete to the best of my knowledge ang belief, thoren J DS A Jj-41177 ; Signa Gate ! KN 30 Shepheard ] Printed Name | ‘Submit SIGNED, ORIGINAL documents only. Do not fax or e-mail this form. | This entire document is a public record.

4%, NORTH CAROLINA STATE ETHICS COMMISSION | ror emis commission use ont {413 2016 STATEMENT OF ECONOMIC INTEREST | Ore fuceied : 919-814-3600 ww ethicscommission.nc.gov THIS ENTIRE FORM MUST BE COMPLETED TO FULFILL p25 Ceeied for competion YOUR SEI FILING OBLIGATION aT completes _ Supp. Sent Date or Supp. Received Date Entered in catavase 2021 sy Bede FILER'S NAME (FIRST, MIDDLE, LAST) Prefix [FirstName | Middle Name [lasthame sux | Hro So Shepheard [1] CURRENT EMPLOYER poorme ~~ | U.s. Senute -Fed Govt. re ld fepre sented ve. "NATURE OR TYPE OF BUSINESS | Govt. Relations REASON FOR FILING (SELECT ALL THAT APPLY) i (CJ STATE GOVERNMENT 108 (Please specify the agency | pBOARD/COMMISSION (Pease list complete name of all Tor which you wri or are being considered) State boards on which you ae serving or ae being consiered over nore DorRigs Group Vetere Eety S8S — ] (Edgecombe Lon Colley Od Tos JUDICIAL OFFICER (Please specif the office you hod) _| CJ LEGISLATOR (Please spec House or Senate) ‘A. Do other Immediate Farmily members reside In your household? (ves Oto Then used throughout tis 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 fall name of all adults and emancipated minors In your househald. A minor is a child under 18 years old. Minors are emancipsted by marriage, onistment in the US miltary or court order for emancipation. EMANCIPATED MINORS 2 treet BUSINESS Bode od Shphendd Re... The SEL and any attachments, excluding the Confidential Form, are public records. Page 10f10 B. List ONLY the initials of all unemancipated minors in your household below. A minor is a child under 18 years. 7 ad. Minors re emancipated by marrage, enlistment n the US milkry or cout oder for mandation. Note: You must ist the full name of each minor child on the Confidential Form available at the end of this document. | INITIALS FOR JOB TITLE NATURE OF UNEMANCIPATED Business MiNoRS PROPERTY INTERESTS 1 As of December 31. 2015, dK you, your spouse, or members of your Immedate family: A. Have an ownership interest in North Carolina rea estate (including your residence) with a market value of $10,000 of more? Res Ono owner of Real Estate| %% Ownership interest | Location by Cty oe Locationby city | BRET chepheed | 100 90 bord Sl ip ent | 100 3, venkln | LT ol Bers, So Sephewrdd | 00 _ hitoRars ash | BF hugh | 1277) Hacon re. B. Least or rent real estate or personal property to or from the State of North Caroling with a market value of 210,000 or mores Oves (Aso If Real Estate, Location | It Personal Property, by city & County “bescribe’ 2. At any time during 2014 or 2015, dd you, your spouse, or members of your immediate family 2eL10 or buy from the ‘State of North Carolina personal property with a market value of $10,000 or more? Oves gan mm [—— em The SEX and any attachments, excluding the Confidential Form, are public records. Page 20f 10 TT ——————————————————————— Er— 3. As of December 31, 2015, did you, your spouse, or members of your immediate family own any of the following financial A. Stock in a publicly owned company? B. Stack Options In a company or business? ves No (the Primary Company) ‘Owns Security or Equity Interests (I None or Not Known Do not list assets held in blind trusts. See 2016 SEI Helpful Tips for the definition of "Vested Trust” and “Blind Trust.” Oves Ano Name and Address of Trustee Description of the Trust S. As of December 31, 2015, did you, your spouse, or members of your immediate family have liabilities of $10,000 or Clves (@No 6. List each source of income (not specific amounts) of more than $5,000 received by you, your spouse, or members of (Bit, So Ohepheard [4.5 Send e Salarq Cet, 0v Shephard [Contin lin KR | Felecommunzations fetice ment Vd Shepherd pe stote Gort Bont Ueto] Selary PROFESSIONAL AND CIVIC RELATIONSHIPS 7(2). During 2015, were you, your spouse or members of your immediate family a director, officer, governing board member, employes, independent contractor, o registered lobbyist of a Nonprofit corporation or Grganization operating In the State of North Carolina primarily for relgious, charitable, scientific iterary, public health and safety, or educational purposes? Clves io - 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 lst organizations of which you are a mere member. i Name of Person His/ Her Position Name of Nonprofit Nature of Business or Corporation or Organization | Purpose of Organization (6). If the nonprofit corporations or organizations sted above do business with the State of North Carolina or receive Slate funds, please provide bref description of the nature of that business, If known or with which due diigence could reasonably be known. Name of Nonprofit Corporation or Organization Describe State Business or State Funding CJ None or Not Known . Duting Z015, were you, your spouse, or —1 of your immediate Tamiya director, officer, or governing board member of ony society, organization, or AdVocacy group with an Interest in matters ove Which your agency or board may have jurisdiction? [OYes §ANo [ Legisator/udicil Office - You are not required to complete this question if you are fling because: You are a legislator or » judicial officer or you are fling as an appointee to those offices. D0 not lst organizations of which you are anly a member (not serving in a leadership role). Name of Person ‘Name of Society, Organization Leadership position or Advocacy Group (Director, Officer, Board Member) The SEX and any attachments, excluding the Confidential Form, are public records. Page 5 of 10 (a). List the name of each company or business with which you were associated where you or a member of your [medlate Tami was an employee, recto, officer, partner, proprietor, or member or manager as of December 31, 2015. No Business Associations - If “No,” proceed to uestion 10 (6). 1f you know that any company or business entity listed in 9(a) above had any meteril business dealings or business contracts with the State of North Carolina of was regulated by the Stote 4s of December 31. 2015, provide 3 brief description of that business activy. vam or company or sues Ey | scion of ess Act wi oe Src. 0 Not applicable (No entities listed on #92) _(] No relationsivp / ot known 10. Are you a practicing attorney? [Olves BNo [Judicial Officer/State Attorney 18 Vest, check each category of legal representation n which you or the aw im with which you are affliated has earned legal fees of mare than $10,000 during 2015. 0 Administrative 0 Admiralty Olcorporate, 0 criminal [Decedent's Estates Environmental Citnsurance Dtabor 0 ocal Government Creat Property 0 Securties Ox 0 Tort gation (including Duties Regulation (CJ Other category not ised. negligence) 11. During 2015, were you 3 licensed professional (other than on attorney) or did you provide consulting services individually or 25 » member of professional association for Which you charged or were paid over $10,0007 Ove @no The SEE and any attachments, excluding the Confidential Form, are public records. Page sof 10 12. Ar you or your employer, your spouse or members of your immediate family, or thei employer curenty: + 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 2 business relationship with the State board or employing entity with which you are or will be associated? [Yes $0. (Legislator Judicial Officer - You are not required to complete tis question if you are fing because You are a legislator o a Judicial oficer Cyudicial officer” is defined in the SEI Helpful Tos) or you are fling a5 an appointee to those offices. Name of Employer Type of Relationship Gt applicable) (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? Oves no Name of Lobbyist Lobbyists principal Date of Registration OTHER DISCLOSURES 14. During any calendar quarter In 2015 (but only the time period after you were appointed, employed or fled or were | nominated as 5 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 gif(s), and + the 9) were given under circumstances that would lead a reasanable person to conclude that they were given for lobbying? Oves ino 55 not report 9 Gen by members of your extended omy. D0 not report gifts that have previously been reparted by you to the Department of the Secretary of State on the “Expense Report for Exempted persons.” The SEX and any attachments, excluding the Confidential Form, are public records. Page 7 of 10 - EE 0) Yes 8 No [Judicial Officer - You are nt required to complete this question If you are a udical officer or you are Hhves Oto If “Yes”, list all contributions you (NOT immediate family members) made during 2015 with a cumulative whatsoever.” CI comreate + [17 ve you an appointee or prospective appointee to: a. the head of a principal state department (c.g. cabinet secretary) appointed by the Governor; or b. 3 North Carolina Supreme Court Justice, Court of Appeals, Superior or District Court Judge; or c. 2 member of any of the following boards: + AC Commission + Coastal Resources Commission + State Board of Education OYes No + State Board of Elections « Division of Employment Security I “No” proceed to + Environmental Management Commission question 18. | + Industral Commission | + Human Resources Commission | + Rules Review Commission | + Board of Transportation | + UNC Board of Governors | + tities Commission | + Wikife Resources Commission | Lc Ny ——— d. If so, were you appointed or are you being considered for appointment to that | (1 Yes [INo. ] public poston by a Counc of State members Cound of tots members are sted | 1 omar sroceed to | in question 16 question 18. | =. 150, 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: | Oves Oo 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. J Lk — I { i. Hosted a fundraiser at your residence or place of business? OYes CINo il. Valunteered for campalgn-related activites, which Include, but are not imited to, phone banks, event assistance, mailings, canvassing, surveying, or any | [Yes [INo other activity that advances the campaign of a candidate? 18. Have you ever been convicted of a felony for which you have not received either: (1) a pardon of innocence; or (i) an order of expungement regarding that conviction” Oves [no offense Date of Conviction | County of Conviction State of Conviction 19. Are you aware of any other Information that you belleve may assist the State Ethics Commission in advising you concerning your compliance with the State Government Ethics Act? OYes MNo 1fyes, please provide such information below. The SET and any attachments, excluding the Confidential Form, are public records. Page of 10 AFFIRMATION afi tat he information provided in this Ststement of ono erst and any atachmens hereto ar re, complet, and accarte th best of my Knowledge and belt Vals certfy hat ave not transferred, and will not rast, ny asset, eres, o property fo the pups of concealing it from disclosure while ening an equisbl inecest. 1 understand tht my Statement of Economic Interest and any tachment of supplement thereto (withthe exception of the ‘Confidential Form regarding Unemancipated Children) are public record. acknowledge that | hve res nd understand N.C.G.5. 138A-26 regarding concealing o alin to disclose mera information nd N.C.G.5. 38-27 regarding providing ls information: § 138-26. Concaling o filing to disclose mate information A fin person who knowingly concals or knowingly fis to disclose information tha is required t be disclosed on siatcment of economic terest under this Arce shal be guilty of a Class 1 misdemeanor and shal be subject To disciplinary scion under GS. 138445. §138A.27. Penalty or fl information. A filing person who provides fle informtion an a satement of sanomic terest a required unde is Article Knowing hat he information is fle 1 uy of Class H felony ad sal be subject disciplinary action under GS. 136A45, Biagree Shephaard 6:30-/b Sigmatu ote To Shepherd Printed Rafe Submit SIGNED, ORIGINAL documents only. Da not fax or email this form. The SEI and any attachments, excluding the Confidential Form, are public records. Page 10.f 10