Beverly Gwyn Boswell

NORTH CAROLINA STATE ETHICS COMMISSION 2018 STATEMENT OF ECONOMIC INTEREST CANDIDATE NO CHANGE FORM 2018 ELECTION FILER'S NAME (FIRST, MIDDLE, LAST) Prefix First Name Middle Name Last Name Suffix Beverly Gwyn Boswell REASON FOR FILING (SELECT ALL THAT APPLY) CANDIDATE For (Specify the office for which you are running) House of Representatives STATE GOVERNMENT JOB (Specify the agency for which you work or are being considered) BOARD/COMMISSION (List complete name of all State boards on which you are serving or are being considered) JUDICIAL OFFICER (Specify the office you hold) LEGISLATOR (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 2017 Statement of Economic Interest and that as of December 31, 2017, 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 3/12/2018 Signature Date Beverly Gwyn Boswell Printed Name The SEI and any attachments, excluding the Confidential Form, are public records. Page 2 of 2

NORTH CAROLINA STATE ETHICS COMMISSION 2018 STATEMENT OF ECONOMIC INTEREST NO CHANGE FORM FILER'S NAME (FIRST, MIDDLE, LAST) Prefix First Name Middle Name Last Name Suffix Beverly Gwyn Boswell REASON FOR FILING (SELECT ALL THAT APPLY) STATE GOVERNMENT JOB (Specify the agency for which you work or are being considered) BOARD/COMMISSION (List complete name of all State boards on which you are serving or are being considered) JUDICIAL OFFICER (Specify the office you hold) LEGISLATOR (Specify House or Senate) House of Representatives 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 2017 Statement of Economic Interest and that as of December 31, 2017, 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 3/12/2018 Signature Date Beverly Gwyn Boswell Printed Name The SEI and any attachments, excluding the Confidential Form, are public records. Page 2 of 2

oa NORTH CAROLINA STATE ETHICS COMMISSION FOR ETHICS COMMISSION USE OLY & 2017 STATEMENT OF ECONOMIC INTEREST NO CHANGE FORM Checked for complevon (4 THIS ENTIRE FORM MUST BE COMPLETED TO | syne ro FULFILL YOUR ETHICS FILING OBLIGATION Z | ee [Fruer's name crinst. wicoLe, LasT) 1 prefix FirstName | Middle Name Last Nome. | suffix Ws [Bevely | 4 Doowel { 4 ) bowed? 1 I REASON FOR FILING (COMPLETE ALL THAT APPLY) __ y STATE GOVERNMENT OB (Speci Agency and Posion) | BOARD/CONMISSION (ust the complete name of ll State eats om wi you au sme aot vm comdor JUDICIAL OFFiceR (spect Oficel | LEGISLATOR (spe House + Serre) House AFFIRMATION ee | A filing person who knowingly conceals or knowingly fails to disclose information that is required to be disclosed on | nears ton anaes 6.5. 3035. | 8 uasa2r, rena for ase formation | A filing person who provides false information on a statement of economic interest as required under this Article | CT hereby affirm tha X have reviewed my mst recently fled 2016 Statement of Economic Interest and that as of Dacaber 31, 7016, my tespanses continue to be 1a correct snd complete to the best of my knowledge on beter \ [71 Agree [PN all ; See TL ——— — | | submit s1GNED, ORIGINAL dacuments only. Do not fox or e-mail this form. a This entire document i » public record.

Bs 2, NORTH CAROLINA STATE ETHICS COMMISSION | ror ETHICS CoMMISSION USE ONLY a He Sv 2016 STATEMENT OF ECONOMIC INTEREST | Oste Received: ee 7 CANDIDATE 915-814-3600 wow eticscommission.ncgov | qn FES 73 PIE 59 eect tor cmpson ‘THIS ENTIRE FORM MUST BE COMPLETED TO FULFILL ___Scanned Date YOUR ELECTION FILING OBLIGATION TE a vers em mm a en pou emli eres maven Ta wy 2H 016 ELECTION LENS NAVE FIRST, MIDDLE AST) comment snore 0 AE Cnc on ee or soemiss — = TTT TL IL or — a Te San LT TT NC, House _ _ Tp yom TR for which you work or are being considered) ‘State boards on which you are serving or are being rn - _— r— — a RR em a A, Do other Immediate Family members reside in your household? Ne Ono en huts rn, th ta meat Family ude your spouse (ries gal separated). ae includes members of your extended family (your and your spouse’s children, grandchildren, parents, grandparents, and a Lt Tp Pre Tg pr Tg prey I A Sb ra ane oroured | earowsae | swnoven | were | near pre ne or “The SEI and any attachments, excluding the Confidential Form, are public records. Page 1 of 10 B. List ONLY th initials of al unemancipated minors in your househod below, A minor iso cid under 18 years Gino ae emancipated by mariage, enlistment n the US miltary o 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 | RELATIONSHIP NATURE OF UNEMANCIPATED ‘BUSINESS MINORS 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 Carolin rea estate (including your residence) with a market value of $10,000 or more? Hyves ano % Ownership Interest | Location by City Location by County [BE Bee Sle Li vot tills | Dave 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? Ove tho ‘Name of Lessor If Real Estate, Location | If Personal Property, by City & County Describe 2. At any time during 2014 ar 2015, did you, your spouse, or members of your immediate fami sell to or buy from the ‘State of North Carolina personal property with a market value of $10,000 or more? Ove No Nome of Seler__ The SEI and any attachments, excluding the Confidential Form, are public records. Page 20f 10 FINANCIAL INTERESTS 3. As of December 31, 2015, did you, your spouse, or members of your immediate family own any of the following financial [ ownerormmerest | Full Name of Company (Do not use a ticker symbol) Gres the or i pr C. Interests in a non-publicly owned company or business entity (Including interests in sole proprietorships, Des Op lo - If "No," proceed to question 4. — ETI mses Tey Nima (2). 1F you know that any company or business entity listed in 3.C or 3.C(1) above has any material business. Gerling or business contracts with the State of North Carolina, or is regulated by the State, provide a brief escrption of that business activity. ‘Name of Company or Business Entity Description of Business Activity with the State {fone or Not Koown [3.2 of December 31. 2015, were you, your spouse, or members of your immediate family the beneficiaries of a vested Trust with 3 Vala oF $10,000 or more that was created, established, or controlled by you? 00 not lst assets held in biind trusts.” See 2016 SEI Heloful igs for the definition of "Vested Trust” and Bind Trust” Oves Mino Name and Address of Trustee ‘Your Relationship to the Trust 5. As of December 31, 2015, did you, your spouse, or members of your immediate family have labilties of $10,000 or more, EXCLIING the mortgage on your primary personal residence? Examples include credit card debts, auto loans, Student loans, personal loans and Intra-family deb. Ove Ne Name of Debtor (You, Spouse, Immediate Family | Type of Creditor (Commercial Bank, Credit Union, | Member) Individual, etc.) 6. List each source of income (not specie amount) of more than $5,000 received by you, Your spouse, or members of Your immediate. fami during 2015. Include salary, Wages, state/local government. retirement, professional fees, Ronorara, interest, dividends, rental income, business income, and other types of income require o be reported on your State and federal tax returns. Do not include income received from the following sources: | » Capital gains » Federal government retirement 1 > Military retirement » Social security income/SSDX Recipient of Income Type of Type of Income. Business Industry [1 had no reportable income over $5,000 in 2015. uch Nodicol (br, | Mubo] [Hestliors han | - IR I The SEX and any attachments, excluding the Confidential Form, are public records. Page dof 10 PROFESSIONAL AND CIVIC RELATIONSHIPS 7(a). During 2015, were you, your spouse or members of your [mmediate 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 iterary, public health and safety, or educational purposes? i¥es [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 fst organizations of which you are a mere member. ‘Name of Person His/Her Position Name of Nonprofit Nature of Business or Corporation or Organization | Purpose of Organization PR thot pote Supooi] Condon [med og Wettig [Geshe 5 ¥ ~— [Ray Pe ech Ouran Teed Foe [Toontipsy prowbites ¥ y 2 I (5). IF the nonprofit corporations or organizations listed above do business ith 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 diigence could reasonably be known. "Name of Nonprofit Corporation or Organization Describe State Business or State Funding None or Not Known ©. During 2015, were You, your Spouse, or members of your [MmEdALE fami a Grector, OFicer, 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? [ves YNo []Legisator Judicial Officer - You are not required to complete this question if you are fing because You are a legisator or a judicial officer or you are fing as an appointee to those offices. 00 not lst organizations of which you are only a member (not serving in a leadership rol). Name of Person Name of Society, Organization Leadership Position or Advocacy Group. (Director, Officer, Board Member) The SEI and any attachments, excluding the Confidential Form, are public records. Page 5 of 10 9(a). List the name of each company or business with which you were associated where you or a member of your inmediate family was an employee, director, officer, partner, proprietor, or member or manager as of December 31, 2015. ams arvemon | raiomiptorier | Wameotconpany | maw orrern | [Rio Busines Associations - 1a” proceed to question 1 1 I I I EE ER Eee | 3059. If you know that any company or business entity sted 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 a TT Em (ail eerie ted on #30) LING rr hk known _ rr 1] I - 10. Are you a practicing attorney? } TT Cives theo [Judicial Officer/State Attorney pe oa Fr— or [] Decedent's Estates [J Environmental (J insurance [Labor {01 Local Government. [J Real Property. [J Securities OTax 1 a git (including [] utilities Regulation C] Other category not listed. 11. During 2015, were you a licensed professional (ather than an attorney) or did you provide consulting services. 1 I I ne St and ay aachments, cui te Contin Frm, sr ub crt. SR eyo a aur amply, yur sae o mara au mediate amy, hr employer cre: Lens th Ste ard x amply antsy ih which you aor wb assed or Reulte by th Sot board employing en ih ic you ar vi be asccatd or ie. ies laos ith to Sots bard or Ping ety ith Wh You re o il b associa? rer Ete Cspot vour rt erat cpt isotonic a od aes ude Ses anne th SE Hol Te) o ou ino appa ee ass ‘Name of Employer Type of Relationship rappicavey (ticensig, Reuiatory, Business) OR aan ta _| Poach Opdical (ae | Madica] Poche — I 1 5 re you you pou oa emer of vour Emad ay carey regard a SBS o BYE PI, of ‘were you registered as such within the 12 months preceding your filing of this form? Oves THe Name of Lobbyist Covet Princo varear | western Registration Expiration OTHER bisclosures 14. During any calendar quarter in 2015 (but only the time period after you were appointed, employed or filed or were. Rone 204 Ca 5a vou aca ary Ge" exceading $200 par cuatro pron or gro of person acing together, and + when both you and those person(s) were outside North Carolina at the time you accepted the gift(s), and In gt) wire en der creumstances tht wad ead 3 reasonable prion to conclude at ey were avn | ori aves Nyro vo rn SG by RT Oy eR ba nt repre. ie het how, reviosy bo reported by you 0 the Depart of th Secretary of State on the pens rept fr Sremprad prone” Name and Address of Donar(e) | Desai tam Received | Estimated Harker Venue The SEL and any attachment, exciuding the Confidential Form, ae pub records. Page 7or10 15. During 2015 (but only the time period after you were appointed, employed, or filed or were nominated as a candidate) | PA AAI i sty no yt cpr Aer Sars ho ef Co RI TTT Ra ay gr Foon Yes We 1f “Yes”, list all contributions you (NOT immediate family members) made during 2015 with a cumulative Ser nh coon yo " mmedte pner) ds dros ut wi whatsoever.” CT — Coma [TNs conoion wi ume tot of mor han $1,600 svete amb seen ti TS Ror re psn — 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 o District Court Judge; or c. 3 member of any of the following boards: + ABC Commission + Coastal Resources Commission + State Board of Education Oves re + State Board of Elections « Division of Employment Securty If “No” proceed to « Environmental Management Commission ‘question 18. + Industrial Commission + Human Resources Commission « Rules Review Commission + Board of Transportation + UNC Board of Governors + tities Commission « Wildife Resources Commission a 1f so, were you appointed or are you being considered for appointment to that | (1Yes [1No public postion by 3 Counc of State member? Councl of State members are listed | yf “No,” proceed to in question 16. I, ©. If 50, 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 Counc of State member who appointed you to your public position: | OYes [Ne | 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. i. Hosted a fundraiser at your residence or place of business? Oves CiNo Ti. Volunteered for campaign-related activites, 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? 15, Have you ever been convicted of a felony for which you have not recelved elther: (1) a pardon of innocence; or (1) an order of expungement regarding that conviction? Oves jo Offense Date of Conviction | _ County of Conviction State of Conviction 15. Are you aware of any other information that you belfeve may assist the State Ethics Commission In advising you concerning your compliance with the State Government Ethics ACt? [ives Wo if yes, lease provide such information below. The SEI and any attachments, excluding the Confidential Form, are public records. Page 9 of 10 — eee | AFFIRMATION 1 affirm that the information provided in this Statement of Economic Interest and any attachments hereto are tru, complete, and accurate to the best of my knowledge and belief. 1 also certify that have not transfered, and will not transfer, any asset, interest, or property for the purpose of concealing it | from disclosure while retaining an equitable interest. 1 understand that my Statement of Economic Interest and any attachments or supplements thereto (with the exception of the Confidential Form regarding Unemancipated Children) arc public record. Iacknowledge that have read and understand N.C.G.S. 138A-26 reganding concealing or filing to disclose material information and N.C.G.5. 138A-27 regarding providing falc information: § 1384-26. 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 Asticle 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 fale information on a statement of economic intrest a required under this Article knowing that the information i false is guilty of a Class H felony and shall be subject to disciplinary action under GS. 138A, Signature LY) — Printed cH 2 ‘Submit SIGNED, ORIGINAL documents only. Do not fax or email this form. The SEI and any attachments, excluding the Confidential Form, are public records. 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