Brenda Martin Bozeman

This entire document is a public record. STATE ETHICS COMMISSION 2025 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 Mrs. Brenda Martin Bozeman 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 the complete names of all State boards on which you are serving or are being considered.) Wilmington Urban Area MPO (TAC) Judicial Officer, Post-Service Filer, or Appointee (Specify office) Legislator, Post-Service Filer, or Appointee (House or Senate) This entire document is a public record. 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 04/08/2025 Signature Date Brenda Martin Bozeman 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 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 Mrs. Brenda Martin Bozeman 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.) Wilmington MPO (TAC) 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 03/28/2024 Signature Date Brenda Martin Bozeman 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 Mrs. Brenda Bozeman 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.) Wilmington MPO (TAC) 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 03/30/2023 Signature Date Brenda Bozeman Printed Name Submit signed, original documents only. Do not fax or e-mail this form.

The SEI and any attachments, excluding the Confidential Form, are public records. Page 1 of 10 STATE ETHICS COMMISSION 2022 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 Mrs. Brenda Martin Bozeman Current Employer Job Title Coastal Properties Broker Nature or Type of Business Selling real estate 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 complete names of all State boards on which you are serving or are being considered.) Wilmington MPO (TAC) 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 Brenda Michelle Bozeman Child Brunswick County Solid waste Coordinater Solid waste James Howard Bozeman Spouse Graceland portable Buildings SE Sales manager Storage sheds 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, 2021, 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 (Self plus Spouse) 100.00% Leland Brunswick 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 2020 or 2021, 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, 2021, 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, 2021, 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 2022 SEI Helpful Tips for the definition of “Vested Trust” and “Blind Trust.” https://ethics.nc.gov ☐ 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, 2021, 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.) 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 2021. 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 Brenda Martin Bozeman (Self) Coastal Prperties Real estate Salary Brenda Martin Bozeman (Self) Town of Leland Government Salary Brenda Michelle Bozeman (Child) Brunswick County Solid waste Salary James Howard Bozeman (Spouse) Graceland Portable Bldg. SE Storage sheds Salary The SEI and any attachments, excluding the Confidential Form, are public records. Page 5 of 10 Professional and Civic Relationships 7(a). During 2021, 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 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 2021, 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, 2021. 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, 2021, 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 2021. ☐ 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 2021, 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 Real estate Selling properties 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 2021, 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 2021, 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 2021 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 2021 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 01/11/2022 Signature Date Brenda Martin Bozeman Printed Name

The SEI and any attachments, excluding the Confidential Form, are public records. Page 1 of 10 STATE ETHICS COMMISSION 2021 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 Brenda Martin Bozeman Current Employer Job Title Coastal Properties Broker Nature or Type of Business Selling real estate 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.) Wilmington MPO (TAC) 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 Brenda Michelle Bozeman Child Brunswick County Solid waste Coordinater Solid waste James Howard Bozeman Spouse Graceland portable Buildings SE Sales manager Storage sheds 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, 2020, 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 (Self plus Spouse) 100.00% Leland Brunswick 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 2019 or 2020, 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, 2020, 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, 2020, 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 2021 SEI Helpful Tips for the definition of “Vested Trust” and “Blind Trust.” https://ethics.nc.gov ☐ 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, 2020, 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.) 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 2020. 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 Brenda Martin Bozeman (Self) Coastal Prperties Real estate Salary Brenda Martin Bozeman (Self) Town of Leland Government Salary Brenda Michelle Bozeman (Child) Brunswick County Solid waste Salary James Howard Bozeman (Spouse) Graceland Portable Bldg. SE Storage sheds Salary The SEI and any attachments, excluding the Confidential Form, are public records. Page 5 of 10 Professional and Civic Relationships 7(a). During 2020, 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 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 2020, 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, 2020. 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, 2020, 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 2020. ☐ 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 2020, 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 Real estate Selling properties 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 2020, 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 2020, 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 2020 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 2020 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 02/02/2021 Signature Date Brenda Martin Bozeman Printed Name

This entire document is a public record. STATE ETHICS COMMISSION 2020 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 Counse l Brenda Bozeman 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.) Wilmington MPO (TAC) 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 2019 Statement of Economic Interest and that as of December 31, 2019, 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 02/26/2020 Signature Date Brenda Bozeman Printed Name Submit signed, original documents only. Do not fax or e-mail this form.

RECEIVFD = For STArT USE ONAN 3 1 2010 Fr STATE ETHICS COMMISSION ove Receves: IAN 3 1.20 Gat a E170) STATE ETHICS COMiturt \¢EOUSY/ 2019 STATEMENT OF ECONOMIC INTEREST => NO-CHANGE FORM check or completion 515 This entire form must be completed to fulfill your Scanned %5 Date 1/19 ethics filing obligation. TE FO melee Fars Name (Fist, Midi, Los EE LL Lm £2 (Mes | Brews [Macha Bozeman C1 neason for ilng (Compete al that apply. State Government ob (Speciy agency and postion) | Board/ Commission (st the complete names ofall Sate eras on ate om are Seren or re pos comeseed Judicial Officer (Specify office.) Legislator (Specify House or Senate.) AFFIRMATION The Information povided In this Statement of Economic Interest and any attachments ae true, complete, and accurate to the best of my knowedge and bee. have not transferred, and wil not transfer, any asset, interest, or property or the purpose of concealing I from disclosure Whle retaining an eautable mterest Lunderstand that my Statement of Economic Interest and any attachments exct fo the Confident Form Regarding Unemancpated Chidren pub records have read and understand th following statutes: N.C.G.5. § 1634191. Conceaing or falling to disclose material information. A fling person who knowingly conceas or knowingly fas to discos information tht i required o be disclosed on || Statement of scanomie Iteret hal be uly of 3 Cass 1 misdemeanor and. Subject to dcpinary scion | eresnisaans N.CG.S. § 1634-152. Penalty for false information. A fling person who provides fase information on a statement of economic terest . knowing tha the information 15 alse 5 Quy of a Cass felony and shal be subject to disciplinary acon under G.5. 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 betit. L affirm under penaiy of perjury that the foregoing i true and correct. Ae . \N1lig ae Bate SLrenda WB Name Submit signed, original documents only. Do not fax or e-mail this form. This entire document i a public record.

i =. NORTH CAROLINA STATE BOARD OF ER RARE CE pS OY "ELECTIONS AND ETHICS ENFORCEMENT [one keceves 2018 STATEMENT OF ECONOMIC INTEREST " momma EL NO CHANGE FORM Scamea ote THIS ENTIRE FORM MUST BE COMPLETED TO |o..0\ 0s, FULFILL YOUR ETHICS FILING OBLIGATION -: - FILER'S NAME (FIRST, MIDDLE, LAST) oo . prefix LastName | sumx AM Brendes Mer bn | Rozeman . REASON FOR FILING (COMPLETE ALL THAT APPLY) | ‘STATE GOVERNMENT JOB (Specify Agency and Postion) | BOARD/COMMISSION (List the complete name of ol State i ER boards on which you are serving or are being considered] Cot Ting lex Ma Feopelidan JUDICIAL OFFICER (Specify Office) LEGISLATOR (Specify House or Senate) ‘AFFIRMATION - - 1 affirm that the information provided in this Statement of Economic Interest and any attachments hereto are trae, complete, and accurate to th best of my knawiedge and beliet, 1 also cert that 1 have not transferred, and will no transfer, any asset, interest, o property for the purpase of concealing K from disclosure while retaining an equitable interest understand that my Statement of Economic Interest and any attachments or supplements thereto (with the exception of the Confidential Form regarding Unemancipated Chiren) are publ: record. 1 acknowledge that 1 have read ond understand I1.C.G.S. 1384-26 regarding concealing or faling to disclose material formation and N.C.G.5. 1384-27 regarding providing fala Informations § 138426. Concealing or failing to disclose material information A Fling person who knowingly conceals or knowingly fais to disclose information that i required to be disclosed on a Statement of economic interest under this Article shell be guity of a Class 1 misdemeanor and shall be Subject to disciplinary action under G.5. 138A-35 § 1383-27. Penalty for false information. A Hing person who provides alse information on a statement of economic Interest as required under this Article Knowing tha the information is fase fs uty of Class H felony and shall be subject fo Gscipinary action under GS. 1388.35. 200 Mach, Re ar 31%/1% Signature N = Bate . he Bozeman Printed Nome | Submit SIGNED, ORIGINAL documents ony. D0 not fas or e-mail is form. This entire document is a public record.

x NORTH CAROLINA STATE ETHICS COMMISSION | rox enics commission use ony " Pi 2017 STATEMENT OF ECONOMIC INTEREST Date Received 919-614-3600 wow. ethicscommission.ne.gov | oe nos THIS ENTIRE FORM MUST BE COMPLETED TO FULFILL pA — YOUR SEI FILING OBLIGATION —Saannet id mane 10 Soom. Servos by Sop. Resneaome xvnanses [ffi 4; 4 FILER'S NAVE (FIRST, MIDDLE, LAST) bro | Fustname | madiovame [tastvame sun [trs| Brenda | Marton zeman | . CURRENT EMPLOYER } [roe mme [postal Properties [Real £stade Broker REASON FOR FILING (COMPLETE ALL THAT APPLY) STATE GOVERNMENT JOB (Specify Agency) BOARD/COMMISSION (List complete name of all State I | boards on which you are serving o are being considered) | ] | WMPO Tac. Aown oF Leland bY ! [mmr oeetvorten | iecisiaron (spect mousse senate) | — h : Bill Rabe | Senate A. Do other immediate family members reside in your household? Pres Co | When used throughout this form, the term Immediate family includes your spouse (unless legally separated). It also ncludas members of your extended family (your and your sp0u's chen, grandenidren, parents, Srandparents, and Sings, and tha spouses of ach of hose parsons) who reside in your household. List the full name of all adults and emancipated minors in your hauschold. A minor is a child under 18 years od. | Minors are emancipated by marrage, enlistment in the US miltary. or court order for emancipation. FULL NAME OF ADULTS & | RELATIONSHIP | EMPLOYER 208 TITLE NATURE OF EMANCIPATED MINORS I ‘BUSINESS TT 5 [Buen Bozeran De (8 COMES] ooh Broker Veal £gtnbe — [4 ng Les rage Shoe Sones Boreas Spouse | Gretel Sass [Storage pe id Coast oC yd 3 BWMikele Buz ene clauglebar Brasnick Gy 5202 este [R00 | [I J I J The SEL and any attachments, excluding the Confidential Form, are public records. Page 10 10 Note: You must list the full name of each minor child on the Confidential Form available at the end of this document. ene mn o - INITIALS FOR | ReLATIONSHIP enpLover son TrTiE watuRe oF UNEMARGIPATED SUsiness ESTA SE AL | ] PROPERTY INTERESTS £10,000 0 mares Aes CINo Owner of Real Estate| %% Ownership interest | Location by City Location by County joo t Plum lea | 50% | Leland Pranswick Si0.000 of mores Oves aio Name of Lessor Name of Lessee T If Real Estate, Location | If Personal Property, JC oy Cit & County Describe 2. At any time during 2015 or 2016, did you, your spouse, or members of your immediate family sell to or buy from the Shoe of North Corot persona Barty wih a met value o 310,008 ores Oves glo Name of Purchaser Name of Seller I Type of Property ola oo The SEX and any attachments, excluding the Confidential Form, are public records. Page zr 10 FINANCIAL INTERESTS 3.5 of December 31, 2015, i you, your spouse, or members of yout Medial family ow any of th following inancis res aed 0005 of moves LIST EACH COMPANY INDIVIOUALLY. A. Stock na publicly owned company? S55 ak st dfnershp iarets Tn a widely held Tvestment fund (nung mutual funds, equated Investment Compania, or pension o deferred cempensation pans) if: (1) the fund 1s publicly traded or 3 assets are widely Geri; onc 1) Rehr you ho an MEGA family member ar able to coirol he ast eld 1 hl mtu func, ovesiment combone: of ehion br Geerred compensation pian: Owner of Interest Full Name of Company (Do not use a ticker symbol) 5. Stock Options m 3 company o business? Oves 7 f——— Fal ame of Company (0 not se ker symba [7 — | C. Interests in 2 non-publily owned company or business entity (including interests n sole propretorships, 1 anrsiios imivad Bonar, JE ventures, ted am oman, Imi abiey Parnarshs, and Cosel hla corporations)? ves fio - 11°Mo; proceed to auestion 4 Owner of nterest Name of Company or Business Entity Pla SE | 1), For each non-public owned company or business enti (ih “primary company’ dented in question $18 "ott, lass. at che names of any othr companies O Business ences which th primary company ns Securitas o cau Interests valued at over $16,000, known " Non-Publicly Owned Company or Business Entity | Other Companies in which the Primary Company "Al ine Primary Company) “owns Security or Equity iwarests | fone a ot known i npn —] The SEX and any attachments, excluding the Confidential Form, are public records. Page 3010 € (2). 1f you know that any company or business entity listed in 3.C or 3.C(1) above has any material business eB or Dusinass Conrocs withthe Ste of Nor Coron, o glared he Sate, prove Smet Gescrpton of tha business air: Name of Company or Business Entity | Description of Business Activity with the State Fone or Not Known 2. eof Dacambor 31, 2016, were you, your spouse, or members of your mediate family (ha benafiares of a vested nt wn va OF 10.550 or moe tht was Exemen examen, o comrones bY YoU? Do not list assets held in blind trusts. Sea 2017 SEI Helpful Tips for the definition of “Vested Trust” and "Blind Trust.” Oves ne 5. As of December 31, 2016, did you, your spouse, or members of your immediate family have liabilities of $10,000 or ore TR he TAGS on You Pa pO! FeSGenCe Eales bu HEAR Crd Ge, Bt 09, SHG Tears, person! oars and arson Geb. ves fe Name of Debtor (You, Spouse, Immediate Family | Type of Creditor (Commercial Bank, Credit Union, ember) pe oe dunt ete 5 Lit 220 source of Income (ne speci amounts) of more an $5,000 receive by yo, Your Spouse, or members of your immediate family during 2016. Include salary, wages, state/local government retirement, professional fees, Fanoraria, tora, dhidancs, Sal coma: BUSESE come, 303 Aher Pes of imeem fadured 1 be reported on your Shoe and federal tx return. Do nat include income received rom the following sources: » Capital gains » Federal government retirement > Miltary retirement > Social security Income /SSD1 Recipient of Income Name of Source Type of Type of Income Blimess/ Industry C1 nad no regortabie income over $5,000 in 2016. —] 0 — Sumer Foreman, (oxaceland SE. Stugage Clieds salary L “Rocondn Bozena, Censtel Papert. Rey folk | calacy B. Wehelle Birgu | Brunswick Chy | County secuces, su lary Tames Ropers | Social Sevuriy | Gost | Salary The SEX and any attachments, excluding the Confidential Form, re public records. Page sor 10 PROFESSIONAL AND CIVIC RELATIONSHIPS 1 ia). Dung 206, were you, your spose or members of your [TEdaIS family 8 director, officer, governing board LE rasptan sxvioto, esse Who! 3 SA soba. of rs obo so i Cova mar to en apes sete, Wart, bove veaks so seers o atutaronel pd Aes Cho 1 “No.” proceed to question 5 EL Tr a " Name of Parson Wis postion Wome of Nonprofit | Nature of Business or | Corparmtn or Orpamsotion | Purpere of Orgameation [Brends Dopenan, Wages | Asus Leland | township | 700, 1 the nonprofit. corporations or argaszations ted above do business wil the Stte of North Cora o reves Ts de atts ook ese oe ate 8 ot eos no te ov ton anc oo probiurbonets Name of Nonprofit Corporation or Organization Describe State Business or State Funding 1 Eyton oe ame ETE Tr Tr i Ti nS Ta peer, oeion or Mi kpes eau woh a. Rot ar or wh Yoo He o Dou oy en pe lest oes ss ot erst compte aston tu ve hg ecas To re oor 0 odio oer ovo ve hg oo omen th ro CES mt gains of whi a nly amber fn aig dr Name of Parson Name of Society, Organization Leadership position fdas oi (Director, Orfcen Board member) Tho SEE and any attachment, excluding the Confidential Form, are pubic records. Pages or 10 Sa). ist th name of each company or business with which you wer associated wher you or a member of your INTGGSNG Tami was an employes, rector. fice, Parner, proptor o memes or manager 58 of December 31 2046 Nama of Person | _ Relationship to Filer Name of Company Role o Person Hw Business Associations — J E— 8 S00. 1 you Yow that any company or busines any [st in 3a) above had any materia business gesings or Beene conracs with the Sat of arth Carona 0 was related by he Stare 25 of eceroe 31. 3015. provide 3 re description of that business sctuity. Namo of Company or Business Entity | Description of Business Activity with the State fot applicable (40 ents sted on #93) 10. Are you a practicing attorney? - Cves Hho [Duden Ofcer/State Ascomey 16Ves, heck each category of eal representation in which ys or the Iw rm with which you sre affaed has came Legal fess of mors than $10,000 Guin 3016. Ciaminstatie [aamiraty [Er— mnt 1 Decedencs Estates [Sr— Qinserance Cotabar (J Local Government 2 Reat propery O Seaanties Oe Tort tigation Gncuing [Usites Regulation [Other categary not sted regigencs) 13 uring 2016, were you 3 Icenaed profession! (ater than an itorey) or did you provide conEUING Services iia of 35's mamier of a polessinet ssGastion for WhICh you Charged or werd pai over $10,000 [Dfes No Type of Business Nature o Services Rendered Reat £state | Lishing Selling Hyert EE The SEX and any attachments, excluding the Confidential Form, are publi records. Page 6 of 10 12. Are you ar your employer, your spouse or members of your immedite family, or their employer currently + Licensed by the State boord or employing entity with which you ar or wil be associated or + Have 2 business relationship with the State board or employing entity with which you are or wil be associated? [ves No [Legislator udicial Officer - Yau are not required to complete this question if you are filing because You are a legshtor or judicial aficer (“judicial officer” 1s defined in the SEI Helpiul Tips) or You re fing 25 an appointee to tose offices. i applicable) (Licensing, Regulatory, Business) — 1 — — | 13. A you, your spouse or » member of your immedate family curently regitered as a loubyist or foBbyist principal, of Were you eaistered 95 such thin the 12 months preceding your ing of ths form? Dves fo Name of Lobbyist Lobbyists Principal Date of Registration | Registration Expiration OTHER DISCLOSURES _ 1 14. During any calendar quarter in 2016 (But only the Ume period after you were appointed, employed or fled or were ominated 4 a candidate), 4d you + receive any "G(s)” exceeding $200 per quarter fom a person or roup of persons acting together, and + when both you and those persan(s) were outside North Carolina a the ime you accepted the gif(s), and + the gi(s) were given under circumstances that would lead a reasonable person to conclude that they were given for lobbying? ves tho Do not report ifs Given by members of your extended family. — »D0 not report gis that Rave previously been reported by you to the Department of the Secratary of State on the “Expense Report for Exempted Persons.” Date Item Received | Name and Address of Donor(s) | Describe Item Received | Estimated Market Value The SET and any attachments, excluding the Confidential Form, are public records. Page 7f 10 [ 15: During 2026 (ot oy the time penod fer you were appanted, employed, or fed or were nominated as candidate) did you + accept a “scholarship” exceeding $200 from a persan or group of persons acting together and « those person(s) were outside North Carolina and + the schalarehip was related to your public position? A “scholarship” is a grant-in-aid, either direct or indirect, to attend a conference, meeting, or similar event, including tuition, travel, lodging, meals, and other similar expenses. 0 Yes (ff util Officer - You re nt required o complete this question you are dic officer or you ae: fing a5 2 judical officer appointee. > 00 not report gifs that have previously been reported by you to the Department of the Secretary of State on the “Expense Report for Exempted Persons.” > Legisiotors are not required to report scholarships paid by a nonpartisan legislative organization of which the legislator or the General Assembly i a member or participant o an afflate of that organization. Dateof | Name and Address of Donor(s) Describe Event Estimated Market Senolarship | Value 1 16. Were you appointed or are you being considered far an appointment to 3 covered board by the Governor or another Counc of State member? | Council of State members are: » Governor » Le Governor » Secretary of State » state Auditor » State Treasurer > Superintendent of Public Instruction » atone Generel > Commissioner of Agriculture » Commissioner of Labor » Commissioner of insurance: Oves Aho 1 "Yes", list ail contributions you (NOT immediate family members) made during 2016 with a cumulative total of more than $1,000 to the Governor or other Council of State member who appointed you. | | > Contributions are defined in N.C.G.S. 163-278.6(6) and Include, but are not Imited to, “any advance, conveyance, deposi, distrioution, transfer of funds, Ioan, payment, OI, pledge or subscription of maney or anything of value whatsosver.” Date Amount Contributed to (110 contrbution(s) with 3 cumulative tata of mare than $1,000 | [Ln nh 2 comune SE | The SEI and any attachments, excluding the Confidential Form, are public records. Page 8 of 10 17. Are you an appointee or prospective appointee to: 5. the head of a principal state department (e.q. cabinet secretary) appointed by the. Govemor, or b. a North Carolina Supreme Court Justice, Court of Appeals, Superior or District Court Judge; or a member of any of the following boards: + AEC Commission + Coestal Resources Commission + State Soar of Education ves No + State Baar of Sections. | + Division of Employment Security I “Nos proceed to + Environmental Management Commission question 1. + Industrial Commission + Human Resources Commission + Rules Review Commission + Board of Transportation | + UNC Board of Governors 1 i + lites Commission | + viidife Resources Commission | | 4d. If so, were you appointed or are you being considered for appointment to that TiYes No | Publ postion By a Counci of State member? Counc of State members are 15156 | 11 onion proceed to | in question 16. question 18. | If so, you must indicate whether during 2016 you (not immediate family | meriers) engage n any of he following oetlies with respect o or on behalf of ! the candidate or campaign comimiiee of the Counc of Stae member who | Spain you to your public po3ON | Ove fhe | i. Colected contributions from multiple contributors, took possession of uch | multiple contrtions, an transferred or elered those colectad Contritons to the candida or committee? Contributions are defined n | Svestion 16, i. Hosted a fundrarsar at your res dence or place of business? ives vo i. volunteered or campaign-related activites, whieh include, but are not imied to, phone banks, event assistance, maiings, canvassing, surveying, or any | [1¥es No ther actly that advances the campaign of » cand date? 15. Hove yau ever been convicted of a felony for which you have no received sither: () 3 pardon of innocence; or i) an | oder of expungament regarding that conviction? Oves [fo offense Date of Conviction | County of Conviction | _ State of Conviction 15. Ave you aware of any other information that you believe may assist the State Ethics Commission in aaNising you Concerning your compliance wih the State Government Etncs Ac Dives (fo 11 yes, please provide such information below. The SEI and any attachments, excluding the Confidential Form, are public records. Page 9 of 10 pr— Fr A MA OA SH knouiete on ot en and mn CGS 8A repealing oe Blt dicks trl AA SE Fate " IE ee Vso) fo L == TPcenda Fozenus a sui one, omen dove nty, go we towor oma ip tm. oo Ine Sex anc any attachment, exciting th Confidential Form, ar publi records, rage 100110 T oo o For Office Use Only iy NORTH CAROLINA STATE ETHICS COMMISSION tg SUPPLEMENT TO THE he wn ps 2017 STATEMENT OF ECONOMIC INTEREST { or = Lod Te Name of Person Filing Supplement: T>¢ ena MTT Soi Name of Agency or Board: [PITA RIAN YY Date: 1 iol? PROFESSIONAL AND CIVIC RELATIONSHIPS - - A gg PAfr frm rp | receive State funds, ploase provide a brief description of hc ature of that business, f Known or with which due chigence Could reasonably oe known | Name of Nanprafit Corporation or Organization Describe State Business or State Funding Rone or et kon ~ AFFIRMATION Ll tho the ormtion provided ti Stems of Econo ten ae any ach Hee rs, coves and secure to he bes ny knowledge and belie. al entity that ave: nortan, and wil no ante, any awe, inert, o propery for the purpose of cancel t | understand hat my Satan of comic Interest and any aachnents o supplements het (wih the exception of the Confident Foran regain Unermaspated Chen) ae pbb recon acknowledge that hve ead and understand N.C... 13326 regarding concealing o ling 0 disclose materia Infomiton snd NCS. 1387.37 regarding providing Ge formation mp a py. mit is eo a Cis mmr aa St nipinars acon ander 45. TVA § 1387.27 Penal or fs informatio. FY SH TE — Es wtoane G5 1s inane > oy So and oll Mme {/30/12 Senne we = 3 \ Soop 1 Fea Rame Submit SIGNED, ORIGINAL documents only. Do not fax or email this form. This entire document and any attachments are public record.