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Home My WebLink About1997-023 Stmt of Econ Interest - Almquist STATE OF OREGON r 4\(\'11 1997 ANNUAL VERIFIED STATEMENT OF ECONOMIC INTEREST [INFORMATION FOR THE CALENDAR YEAR 1996] INSTRUCTIONS: Please read carefully!! 1. You MUST file this statement with the Oregon Government Standards and Practices Commission (GSPC) if you will hold office on April 15. 1997. This applies even if you did not hold office during the calendar year 1996. 2. The information you report must reflect the economic interests you held at any time during the calendar year January 1,1996 through December 31,1996. 3. You may use and attach additional sheets if necessary to provide complete information. 4. Do not leave any spaces blank. Please indicate "N/A" if the requested information does not apply to you. 5. Please provide your daytime telephone number in the space provided on page 6. 6. Please sign and date this statement at the bottom of page 6. 7. MAKE AT LEAST ONE COpy AND RETAIN IT FOR YOUR OWN RECORDS. It is strongly recommended that you return your completed Statement of Economic Interest to the GSPC by U.S. Mail, certified, return receipt requested. Items sometimes become lost in the mail. Certified mail receipts will assure that you will not be penalized if your statement is not received by the GSPC. 8. Please return this form to the Oregon Government Standards and Practices Commission as soon as possible. It must be postmarked no later than April 15. 1997. Fax transmissions are not acceptable in lieu of this original document. NOTE: Failure to accurately complete and file this form by the final date for filing will make you subject to an automatic civil penalty of $5.00 for each day this statement is not filed up to a maximum of $1,000. (ORS 244.050(7)) Name Ah."Q0,SIj ~e\Ai0. \-- Last First DEFINITIONS Plea.se use the following definitions to assist you when completing the form: 1. "Business" means any corporation, partnership, proprietorship, firm, enterprise, franchise, association, organization, self- employed individual and any other legal entity operated for economic gain. This does not include income-producing not- for-profit corporations that are tax-exempt under section 501 (c) of the Internal Revenue Code with which a public official is associated in a non-compensated capacity. 2. "Honorarium" means a payment or something of economic value given to a public official in exchange for services, upon which custom or propriety prevents the setting of a price. Services include, but are not limited to, speeches or other services connected with an event where the public official appears in an official capacity. 3. "Income" means gross, pre-tax income of any nature derived from any source, including but not limited to, any salary, wage, advance, payment, dividend, interest, rent, honoraria, return of capital, forgiveness of indebtedness, income from government sources (i.e., social security, your public salary, etc.), retirement income, real estate transactions, inheritance income, or anything of economic value received as income. 4. "Legislative or Administrative Interest" means an economic interest, distinct from that of the general public, in one or more bills, resolutions, regulations, proposals or other matters subject to the action or vote of the public official. 5. "Person" means an individual, corporation, partnership, joint venture, and any other similar organization or association. 6. "Relative" means the spouse of the public official, any children of the public official or of the public official's spouse, and brothers, sisters or parents of the public official or of the public official's spouse. 7. "Member of Household" means any relative who resides with the public official. 1. BUSINESS OFFICE OR DIRECTORSHIP; ASSUMED BUSINESS NAME A. If you or a member of your household was an officer or director of a business (see definition of "business" above) during 1996, please indicate the following: Title of Office/Directorship Name of Business Business Address Description of Business W ~\,,<;.C"'-\~ ~\( ~c I.Q POU+> 1~C.f"Q.\o..O -lJ--c(A. ~,)re( lJ",~~ ~~(;:y::\Q. \'cv+s, lAc lA\ WOS\(I"~~I\ ~r-. k;.~\al\c(.. e.... c-\1<;z.o 2. 1997 SEI Namel\....~\ST,~:,A.~. L Last First B. If you or a member of your household did business (see definition of "business" on p. 2) under an assumed business name during 1996, show the following information: Name of Business Business Address DescriDtion of Business 1. (<;:Q IY\ Q OI.S cJoo ~ ) / 2. 2. HONORARIUM: If you received an honorarium (see definition of "honorarium" on p. 2) of more than $50 during 1996, please list all such honoraria: Received from Address Description of Appearance or Service 1. ~Ol\.e- 2. 3. SOURCES OF INCOME: (Be specific as to identity and description of each source.) A. Identify the income (see definition of "income" on p. 2) source(s) which produced 10% OR MORE, BUT LESS THAN 50% of the combined total gross household income received by you or a member of your household during the 1996 calendar year. If you receive compensation for being a public official, include such compensation as a source of income. Name of Source Address of Source Description of Source Household Member Who Received 1.l'~T"y or- AS\-\ I-..A 9 ~c.J c:::. "'N\ .f00 . I PuRI-...\c... OFf'LIAI..... ,~F 2. UN \1<:3' ~ IC'YC.\..."=" 1(f\e..'T5j 6~ \ Wf\St\,N(TTON nwNGd2.. w\~ B. Identify the income source(s) which produced 50% OR MORE of the combined total gross household income received by you or a member of your household during 1996. Please include the name, address, and a brief description of the source(s) of income. If you receive compensation for being a public official, include such compensation as a source of income. Name of Source Address of Source Description of Source Household Member Who Received 1. C.~T1' Or Pt-~~)) ~ ~. "A(~ ~lJR.....\ c- 0(1....'( tAL. C;;:e:. I.... t: 2. 1997 SEI r Namef:\\......\1.~ \<;'\' Last ~P\A~ L First C. Does an income source listed above do business or could it reasonably be expected to do business with the public body you serve or over which you have authority? Yes. No D. Does an income source listed above have a legislative or administrative interest (see definitions, p. 2) in the public body you serve or over which you have authority? Yes* No 4. REAL PROPERTY: List all real property (residential, commercial, vacant land, etc.) in which, during 1996, you or a member of your household had any ownership interest, any option to purchase or sell or any other right of any kind in real property located within the jurisdictional boundary of the public entity you serve. (Describe in general terms, i.e., size, location, boundary and use designation.) You are not required to list your principal residence. Descriotion Address 1.~~ ~SV>~Ck. \~~ WI'18Z..~. F\s~~ 2. ~ vC\C.A..:J'T L..oTS' SuSF\~ l..A~ ~i-\L~ I ~ 5. SHARED BUSINESS WITH LOBBYIST: If you or a member of your household shared a partnership, joint venture, or similar substantial economic relationship with a paid lobbyist during 1996 or were employed by or employed a paid lobbyist . during 1996, list: (NOTE: Owning stock in a publicly traded company in which the lobbyist also owns stock Is not a relationship which requires disclosure.) Name of Lobbyist Name of Business Tyoe of Business 1. ~o~ 2. 6. VALUE OF OFFICE RELATED EVENT: If, during 1996 you participated in any event related to your office, and you appeared at such event in your official capacity, and the aggregate value of food, lodging and travel which was provided for your expenses by the host or sponsor of the event exceeded $118, list: (NOTE: Do not list if such expenses were reimbursed by your public employer.) Name Date of Event Name and Address of Organization ThatP~d Expenses AmounWalue of Expenses 1. t\)() N~ 2. 1997 SEI "" Name.kn&0\~Tgl~\ L Last First PROVIDE THE INFORMATION REQUESTED IN ITEMS 7, 8, 9 and 10 ONLY IF: A. It involves an individual or business that did business with, or reasonably could be expected to do business with the public body you serve or over which you have authority; or B. The information requested involves an individual or business with a legislative or administrative interest (see definitions, p. 2) in the public body you serve or over which you have authority. 7. INCOME OF MORE THAN $1,000: List each source (not amounts) of income over $1,000, other than a source listed under question 3 on this form, that you or a member of your household received during 1996. Income Source Address Descriotion 1. NCNf= 2. 8. DEBT OF $1,000 OR MORE: If you or a member of your household owed to a person (see definition of "person" on p. 2) during 1996 a debt of $1,000 or more, list: (NOTE: DO NOT LIST LOANS FROM STATE OR FEDERALLY REGULATED FINANCIAL INSTITUTIONS (BANKS, ETC.) OR RETAIL CREDIT ACCOUNTS AND DO NOT LIST THE AMOUNTS OWED.) Name of Creditor Date of Loan Interest Rate of Loan 1. t-J 0 r0E:.. 2. 9. BUSINESS INVESTMENT OF MORE THAN $1.000: If you or a member of your household had a personal, beneficial interest or investment in a business (see definition of "business" on p. 2) during 1996 of more than $1,000, list: (NOTE: DO NOT list the amount of the investment. . DO NOT list individual items in a mutual fund or blind trust, or a time or demand deposit in a financial institution, shares in a credit union, or the cash surrender value of life insurance.) Business Name Address Brief Descriotion of Business 1.0~\Tcy ~\C :-teLC- PA-e...TS 6'1\ W f\$ ~,t\)(j.-7o,\:) 5:7, W \-\o~,g,-,= K i C yc..L.C.- PAe.:r.s 2. 1997 SEI Name A...... 'nGu \ ~-r Last ~~ AN L..,. . First I 10. SERVICE FEE OF MORE THAN $1,000: List each person (see definitions. p. 2) for whom you performed a service for a fee of more than $1,000 in 1996. (NOTE: DO NOT list fees if you are prohibited from doing so by law or professional ethics including professional ethics for attorneys, physicians, psychologists, certified public accountants, etc.) Name Name 1. ~\o "-~ 4. 2. 5. 3. 6. 11. VERIFICATION Under penalties for false swearing/false affirmation, I declare that the information submitted in this document is, to the best of my knowledge and belief, true, accurate and complete. ~\\'"r (Date) 1997 SEI