I Fni/ ': Statement of Financial Interests
I Fni/ ': Statement of Financial Interests
I Fni/ ': Statement of Financial Interests
-
-( ) 1 jPOSTMARK
NEBRASKA , -
DATE cjJJ!j
ACCOUNTABILITY AND !
• Candidates for designated offices and holders of designated offices and positions must file this statement See Sections 1A and
1B of the instructions.
• Candidates (including incumbents) subject to this filing requirement must file with the Commission and with the appropriate
election official (See Instructions).
I • Designated officeholders and holders of designated positions must file this statement with the Commission annually.
I • Dollar values need not be report for any item, except Item 11.
I • Persons who fails to file as required is subject to a civil penalty of up to $2,000.
ITEM 1 I YOUR NAME, ADDRESS AND PHONE NUMBER
I
I
f
Name Jjuba.S
LAST
A r\ Yl e.tte...
FIRST
Marie-
MIDDLE
Telephone No. 3D8' - 5 310 - d.O g a
!.
I
Address 54-Cicio N iso AVE J:"u. , \ e.r +un NE b~b3X'
STREETADDRESSORRURALROUTE CITY STATE ZIPCODE
List the office or position you currently hold which requires this filing. If you have left office, list the office you held.
Office or Position: J) istr ic t 3L.\- Stll.te.~ Term: dDo1 .. d.o4D
BEGINS ENDS
Name of City, County, District, or State Agency: TJ; + 3t.1--
_, IS'
This statement must cover all financial interests for the entire "preceding calendar year" and not just as of year-end. If you have
left office, this statement must cover all financial interests from the end of the calendar year for which you previously filed up to and
including the date you left office.
!Xl This statement covers the preceding calendar year January1 through December 31, ;)..OO~
3.) 3a.)
4.) 4a.)
*NOTE: IF .INCOME RESLJLTED FROM EMPLOYMENT BY, OPERATION OF OR PARTICIPATION IN A PROPRIETORSHIP, PARTNERSHIP,
CORPORATION OR OTHER PERSON, LIST THE SAME AS THE SOURCE OF INCOME, BUT NOT THE PATRONS, CUSTOMERS, PATIENTS, OR
CLIENTS THEREOF.
ITEM 7 T BUSINESSES WITH WHICH YOU ARE ASSOCIATED (See definitions)
Name and address of all businesses, organizations, or associations (profit and non-profit) with which you held a position of officer, director, limited liability
company member, partner, or stockholder and any entity in which you held a position of trustee. Such reporting is required based on the position held, not
on whether income was received. You need not report business associations which are otherwise listed under Item 6.
Name and Address oflBusiness or Organization Nature of Association
1.) 1a.)
2.) 2a.)
5-
3.) 3a.)
-
4.) 4a.)
5.) 5a.)
6.) 6a.)
7.) 7a).
J
rrEM 8
·" I REAL PROPERTY OF T~_)ILER IN NEBRASKA (Real property vdl,jd at less than $1,000 and your
personal residence need notbe reported.) ....
List all real propertyin your name or in which you have a direct ownership interest. The description required must be sufficient to identify
the location .of the property. Exceptions: You need not report real estate owned by a business listed in Item 6 or 7, your personal
residence of real property valued at less than $1,000. Personal residence refers to your principal dwelling-house and adjacent land used
for house-hold purposes, such as lawns and qardens.
Location of Property Nature of Property
(Description or Address (such as: agricultural, commercial, industrial, residential-rental)
NIP.
ITEM 9 I OTHER FINANCIAL INTEREST.$ AND PROPERTY HELODURINGTHE PE.RIOD OF THIS STATEMENT
WHICH EXCEEDED A FAIR MARKET VALUE OF $1,000 AT ANY TIME DURING THE REPORTING PERIOD
(a) Listthe names and addresses of the institutions in which you had checking and savings accounts and certificates of deposit.
(b) List the names of the issuers of all stocks, bonds, and government securities, not otherwise listed under Items 6 or 7.
(c) Describe other property owned or held for the production of income not otherwise disclosed in Items 6, 7,8 or 9(a)(b). Include
leaseholds and other interests in real estate, promissory notes and other obligations owed to you, beneficial interests in trusts and
estates, cash value life insurance, IRAs, deferred income and retirement plans. Exception: Do not include accounts receivable,
inventory, fixtures and equipment owned or used by a business listed in Items 6 & 7 or household goods, personal automobiles and
other tanolble personal property unless such property was held primarily for sale or exchance.
NJA
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I CREDITORS
"
ITEM 11 I SOURCES OF GIFTS OF A VALUE OF MORE THAN $100 RECEIVED EXCEPT GIFTS FROM RELATIVES.
(See definitions)
Name and address of Donor Occupation or nature of business of Value of Gift Description of Gift and
Donor (See Key Below) Circumstances or Occasion for
Gift
~iver'I+~ of Nwa.sl<o... Choose Value:
C. fCC+ ba.\ \ +-i c.kd-.s
l...I\'\U>\ .••• ~~CIoC' P"~S.llAl
Pl-\ys;C:;Q,1 1herAfY Choose Value: Pr'oteSrib11o..l C,aurti$ 'I '
I WillibMshW"u Vill4l.~
..J .. L\",,"ol,,, c Ph'l5iCA.i 1h<I-o.py ~($$ imS
Choose Value:
"
Choose Value:
, ,
Choose Value:
, "
Choose Value:
Choose Value:
Choose Value:
The monetary value of each gift shall be categorized based on the good faithestimate of the filer. For each reported gift insert in the
Value column the letter which corresponds to the value category of the gift. The value categories are: