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-.T _
STTE O UT CROLN
CONTY SPRTNBRG))))M_E E N ICLE _T K __
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A NDRW SCOT PATK )Deda )
HUBND I FTER:Address PO Box 2267, Hilton Hea Ilan, C 29925Age
Ocupatio Sef Emoyed and ae Reesenave
Eloye
EloyeAddess
Gross Monthly Income
Pncipa Eigs fm Emplyent 1
SC use prsntaivs
Overtme, T Con Bnue 2
Penn Reten and Anute ncme
Addna Eyent ncme
Scia Secu ee (SSA) and VA Benet
Dab an Wrke' penan e ne
Unempme AFD
Su r hd Sppt m ter mae/eatnp
ividend Inte T nce and apta Gain
Reta nme d une tOer Spec: W2 so f t yea . Spedpayn mef A! 3
TOTA GROSS MONTHLY NCOME
Po Dutions fom Monthly nome
Feera ncme Ta 3
Sae ncme x
Sc Secu Medae a FA
Se-pment
Hea and Detal Iuance Adut
Heat and Dena Iuance d
nn Due
Vuntay Rete nbutn k Ianday Reeent nbun
avn PlOe Specy
'TOTA MONTLY DEDUCTONS
NT MONTHY IME 4
Adress
ge
Ocpa
ploye
poede
I THE FM COT O TE
EVE JDICIL CIRI
FINNCIAL DECLRTON
OF AW SCOTT TCK
ET . 2013-DR797
WFE MTHER
Huband Fath Wife oh
8
8
,09.5
Huban I the Wie Mohe'
$000
095
A 4.0 (/ 1 of
000
000
s 000
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Estae mol exeses: (Specify wh p s he usal ret lst m elonshp o l mmbes hosdse pes r l.)
SUBTOTAL:
Ceor
Disver mis
SCA 4.0 (2/009)
Installment Loan Payent Section
F Mnh Payment
169.00
of5
Balance
450000
Owed b 16
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Volunta Retirement Account and Penion Acco:. un S_e c=on, _ aluey ofn
Pubicl Hld StocG, Bond Secut Mutual Fund Section (Non-Retirement) 19N Cy N Shr/ cn
-Real Etate Section 20
Or d g Bn tg q
Othe Propety Secton 7Or ritn t
Swo to before me his 16 o Decembe,No r So
.ul Co:;
My comssn expes _ I Z/
SCA 4 (/2
(SEAL)
n B
Sigature
4 n5
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