OCC Thompson SFI

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NEBRASKAACCOUNTABILITY AND

DISCLOSURE COMMISSION11 th Floor, State Capitol

P.O . Box95086Lincoln, NE 68509(402) 471-2522

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'NADC FORMBEFORE COMPLETING

READ FILING REQUIREMENTS

Individuals listed under Sections 1-A & B of the General Information - Filing Requirements on page 5 must file this form. Dollarvalues need not be reported for any item , except for Item 11 . File with the Nebraska Accountability and Disclosure 'Commission and with the election commissioner or clerk of the county of yourresidence.

Persons who fail to file this re ort or otherwise do not com I with the re ortin rovisions of the law are subiect to enalties.ITEM 1 YOUR NAME, ADDRESS AND PHONE NUMBER

Name

Address

ITEM 2 OCCASION FOR FILING (Check Appropriate Box)

~ candidate for elective office. D Annual officeholder 's or state employee 's report

D Left office or positionD Newly appointee to office or position . '

ITEM 3 OFFICE HELD & TERM OF OFFICE (for incumbent elec ted or appoillted officials..and state emp loyees)

List.the office ~ r.position yo .urrent~ hold Whi~h reqUire "rthisfiling. , 1 1you have left office , list the office you heJd. ~Office or Position: ' ' C , LDL4V:, L.- Term : 0.. .. - 2CO~

BEGINS ENDS

Name of City, County, Distr ict, or State Agency :

ITEM 4 OFFICE SOUGHT ( for candidate on ly)

LiS.~th~ OffiC~SO .U9ht whiC~ ,r~qUire~:his fil ~r1fl'Office. iV. " CO t,;Jv ' L

Name of City, County, District, or State Office:

ITEMS PERIOD COVERED BY TH IS STATEMENT

This statement mustcoverall financial interests for the entire "preceding calendar year" and not just as o f year-end. If you haveleft office, this statement must cover all financial interests from the end of the calendar year for which you previously filed up to andincluding the date you left office .

.p ( This statement covers the preceding calendar year January1 through December 31, _ '2___ ' _'.1.0' '- -------1

D Left office, this statement covers the per iod January 1, to----- (DATEYOU LEFTOFFICEOR POSITION)


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ITEM 6 I SOURCES OF INCOME OF OVER $1,000

IList the nature of the source's business and the nature of the services yourendered or the CirCUlJlstanc~sunder which income was received.

. I I /A

Income includes monev or anv other form of recompense constitutina income under the Internal Revenue Code. (See definitions)Name and address of any source' (inclqping an individual, business,body of government. political subdivision or body corporate) fromwhom income of over $1 , 000was received. _ '

1a.) ( ' n1 J . .P, .p rn " '" J) u. AIa ~

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1 .) l 'IAJI \,I; U~~; t; IV~4w,': . \ ~ (h v)l,,, r; \-'1"\~ ~. '0 ' Il . !J \,in..!JIC

2.) ~ (~_. __ 2a.)

3.) iM ~ ~ - -= - - - - i_3a.)4.) 4a.)

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

'NOTE: IF INCOME RESULTED 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, OCLIENTS HIEREOF.

ITEM 7 I BUSINESS ASSOCIATIONS (See definitions)Name and address of all bus inesses, organizations, or associations (profit and non-profit) with which you held a position of Officer , director, limited liabcompany member, partner, or stockholder and any entity in which you held a posi tion of trustee. Such reporting is required based on the posit ion held ,on whether income was received . You need not report business associations which are otherwise listed under Item 6.

Name and Address of Business or O[gani~ation I f\ f\ 1 f'lature pf Association

" ," , , " /2.) 2a.)

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

3.) 3a.)- - - - - - - - - - - - - - - - - - - - - - - - - - ~ - - - - ~ - - -

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ~ - - - - _ 4

Sa.)

4.) 4a.)- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ~ -

6a.)

5.)

7a).

6.)

7.)


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ITEM 8 IREAL PROPERTY OF THE F IL ERIN NEBRASKA (Real property valued at less than $1,000 and yourpersonal residence need not be reported.

List all real property in your name or in which you have a direct ownership interest. The description required must be sufficient to identifythe location of the property . Exceptions: You need not report real estate owned by a business listed in Item 6 or 7, your personalresidence or real property valued at less than $1,000. Personal residence refers to your principal dwelling-house and adjacent land usedfor house-hold purposes, such as lawns and qardens.

Location of Property Nature of Property(Description or Address (such as: agricultural, commercial, industrial , residential-rental)

~(~ N '~

ITEM 9 IOTHER FINANCIAL INTERESTS AND PROPERTY HELD DURING THE PERIOD OF THIS STATEMENTWHICH EXCEEDED A FAIR MARKET VALUE OF $1,000 AT ANY TIME DURING THE REPORTING PERIOD

(a) List the names and addresses of the institutions in which you had checking and savings accounts and certificates of deposit.

Financial Institution Address

y B~Nl~iW-W v r J'7t~i.~~I f ~ ~ J ~ Wl'Uf

/' J W ~ ~tJ \t~l r 9 l 8 PO~CV JLJ~ N e I . 9 t l " t.> ~ ~~~IIL wl

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O r v V J A jN E

(b) List the names of the issuers of all siPcks, bonds, and government securities, not,otherwise listed under Items 6 or 7.

O)W ~.m~ J1~. ,J (.)v)~j,0 U l.,~~!f)~)f~ ~ . ~, ~3b . . wi

C o )j S~~ ~\k IN~11 o v JJ J4Vt.. (M y OwtJ / ' I II . \JIt(c) Describe other property owned or held for the production of income not otherwise disclosed in Items 6, 7, 8 or 9(a)(b) . Includeleaseholds and other interests in real estate, promissory notes and other obligations owed to you, beneficial interests in trusts andestates, 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 andother tancible personal property unless such properly was held primarily for sale or exchanqe.

L, ' k J 1 v 'J U A AM ..l 6b i ~ ~ ~Jl 1?M)~~~

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ITEM 10 ICREDITORS TO WHOM $1,000 OR MORE WAS OWED OR GUARANTEED BY YOU OR A MEMBER OFYOUR IMMEDIATE FAMILY.

Exceptio n: Loans from a rela tive and land contracts which have been recorded with the County Clerk or Regis ter of Deeds need not bereported . Accounts payable , debts arising out of ret a il installment transactions or loans made by a financial institution in the ordinarycou rse of business need not be repo rted ,

Name Address

-

\ W ~ iliff~

"

ITEM 11 ISOURCES OF GIFTS OF A VALUE OF MORE THAN $100 RECEIVED EXCEPT GIFTS FROM RELATIVES.(See defin itions) ,"

Name and address of Dono r . Occupation or nat ure of b us iness of Va lue of Gift Descripti on of Gift andDonor (See Key Below) Circumstances or Occasi on for

GiftCho ose Value : "

, ,

r- ( ( Choose Value :

~1 -"-- - - Choo se Valu e:

V. '

\J , Choose Valu e:

\ "

- , Choose Value : ",

" Choos e Value :

Cho o s e Value : ' '. . ; ,

. Choose Valu e :Choos e Value :

. ChooseV alue :..

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-- --;"

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The monetary value of each gift shal l be categorized based on the good fa ith est imate of the f iler. For each reported gift lnsert 'ln theValue column the letter which corresponds to the value ca tegory of the gift . The value categories are :

A) $100 .Q1to $200; B) $200 .Q1 to $500 ; C) $500 .01 t o $1, 000; D) $1 ,000 ,01 or more .ITEM 12 I SIGNATURE OF FILER AND DATE.I hereby state that I ha ve used a ll rea so nable dili gence in the preparatio n of this S tatement and that to the best of my knowledge it is trueand complete .

1 ' , .'

~Ywl~w/ / - d 1 J -D1(Signa!preof Filer) I U (Date )

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OCC Thompson SFI