UGF. l'mm 275 [Km ll?lm 1]
CFR. Part In.?



Executive Branch Personnel PUBLIC FINANCIAL DISCLOSURE REPORT

lurrn 

 

 

 

 

 

Run-"ling 1m?,me tialeml." Yr.? New hi1th 
or lurr! a In; Rem-n mulling?. El rm?
(tilled:Apprupriaiu 
limes]

 

Reporting
lndividual's Name

Lust Name

Hut and Middle lnilinl

 

Berlcau

 

Position for Which
Filing

Tillu Hf I?nsil'lml-

 

David

iJenJrIIm-nl App?: .rlTh'J

 

Fee fur Lille Filing

Any individual n'lru is required in 
this [quilt and rim-xx MI Inme than All day?
alter the dale lln' n-nnrt i5 required In he

than .in Lluyn nlu-r the Inn day an the
liling exit-mien In'riml. ?lm? he whim-I
l0 Ire.

 

Ass! Secretary of Defense (Legislics 5: Materiel Readiness)

 

Departmental Deiensc

 

Location of

Present Office
(or mum-m

Address. (Number. Street. {fir}: Sl?a?iv . and ZIP Cork?}

1616 Rhode- Ave NW. Washington. DC 20030

Frieplmne Nu. {Im'lmh- Arm 

 

 

(202) 

 

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(invernrnunl liming live I'm L-dillg
12 (If Nut Same .n :Umn')

 

Title (II I'nsllinnis) um! Ilnlulsl 

Denmlmenz oi Defense Consullanl 8(2013-912013

 

Presidential Nominees Subject
to Senate 

Name nl linmmitlee (innsirluring Nomination

 

Iin You Inn-ml in I?rmm .1 Qualiln-ri lliwnilivd Trust?

 

Cummiline on Armth Service;

El Tex

 

Nu

 

 

Certi?cation

Signature MAR-puf?ng Individual

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Other Review

agency)

Signature nl Other l?wvirwe

11.1w {My i'mr}

 

 

AgencyEthics?f?clai'sOplnlon

Signature n! nt'Ni?lIJIL'll lathlw. (illirinl/lim'ivwing ()Ilirlnl
A .. I

?.119 .?Mmrl'h. Univ. Harri

 

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?ill: applicable Im a and {subject in
any ornaments in lb: box bdrm-1



 

 

 

 

 

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Reporting Periods
henls: The repnriing period is
[he exempt l'.nl
ll ul (I and l'.nl nl Sr'ln-ilnle 
when.- you 111an .Ilm include the liling
year up In line (lulu: yam lile. l?nll ll nl
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'l?erminntinn repmting
pi-rlml lit-gins :11 [he end of the [Mimi
maven-d lay yum lirt'Yltlilh tiling :nnl i-rnls
nl llie {line HI lurminntinn. l'mi II 
SL'In-rlulz- is nu! npplimhlv.

Nominees. New iinlrants and
Candidates for l?resldenl and
Vice President:

Schedule he pt'riml
lur lln'mm' [he preceding
Lnlemlm yunr ill?! the 
up In Iln- ul ?ling. 
nny dare you rhnme Hm! is within
31 days nl 1110 (lulu nl 

Schedule ll- rim npplii?nhle.

Schedule (I. 1'an I (Halnlniesln?l?lw
repnrling pel Ind is the merrilng r'nlt-Inlnr
year and the LUHCIH year up in
any yon thran [lull in .il rhyr;
nl lln- rlnle nl liling.

St?liedillc (I. Part 
A1rnngemuntsl-me .Igrm'nu-nls nr
m. nl lln' dau- nl lillng.

Schedule Du?l'ln- u-Imliing Iwrimi in
the mere-dim} r?nlL-nnm' nnti
lln! nnrenl year up In line dale
nl tiling.

 

Agency llsr- uniy

 

 

0612 Use Only

 

 

 

I'rim millions.

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06E Form 278 (Rev. I)
5 CPR Pan 2634 
U.S. OiTioe Ethics

 

Reporting Individual's Name
Berteau, David J.

 

SCHEDULE A

 

Page Number

201

11

 

 

Assets and Income

at close of reporting period

ValuationofAssets

Income: type and amount. li"None (or less than $201)? is
checked. no other entry is needed in Block for that item.

 

 

 

 

 

 

 

 

 

 

 

University of Texas at Matin. TX

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HLOCKA BLOCKB BLOCKC
For you. your spouse. and dependent children.
report each asset held for investment or the Type Amount
production of income which had a fair market 
valueexccedlng $1.000 at the close ofthe regort- -I 8 A
in? period. or which generated more than 200 8 o- 5 8
in reportingperiod.together D.  8 8 Other Date
with such income. In 8 8 8 a income (HomerActual (inlyti
Amount) Honoraria
-- . . "3588 Singer:
Yomspous?' 
shag a 
Central Airlines Common 1? L.
Exampias 3? 

Kempslone Equity Fund it it L- it

Hm: Heartland 500 index Fund 3: at it
I Centerfor Strategic Salary-
Westington DC 
2 Johns Hopkins University. Applied Phyalca consumes:
Laboratory. Laurel MD 590.024
3 R. and Mandates. Come
Frederick MD (cultural resource group) ?155?
4 National SecurityStudies Program. Maxwell Pros-notation:
School. Syracuse University. Syracuse NY 05mm?
5 Georgetown University. Washington DC wastage.?
6 Lyndon B. Johnson School at PublicA?alra. odiprotonor

 

 

 

 

This category-applles only If the asset/income ls solely that of the ?ler's spouse or dependent children. if tht.I asset/income is either that ol' the ?ier or held
by the flier with the spouse or dependent Children. mark the other higher categories of value. as appropriate.

 

 

OGE Form 273 (Rev. l)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5 one Pan 2634
US. Of?ce Ethics
Reporting Name . Page Number
SCHEDULE A contmued
Be?eau.DavidJ.
(Use only if needed) 3 of 11
Assets and Income Valuationof'Assets Income: type and amount. If ?None (or less than $201)" is
at close of reportmg period checked, no other entry is needed In Block for that item.
BLOCK A BLOCK (2
Type Amount
a. 
8' 2 
8 . u. Other Date
Income lMo..Day,

3 
Engmago??m'dgg'? a 
lg 
:memil'qO8q
o?H??g oH?qumBBu UH J-ln
v~ee.8qme owaa 

as
NationalAeademyol Public Administration. 
Washingth
3 The SI Organization. Inc., ChantillyVA(System5 
engineering and integration ?rm) 
3 DC(pri-vate :3?me
broker-dealer ?nancial adviser ?rm)
4 
stock fund) 
5 .
Fldelrty Conlralund (401K Block fund) 
6 EatonVanoe Lama 

7 Fidelity Diversl?od lnlemallonal(401l( stock 
fund) FDWX
Relum Fund InstitutIOnal Class 
(401K bond fund) 
FidelitySlabloValue Fund (401K bond fund) 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

This category a?plles only if the asset/income is solely that of the ?ler's spouse or dependent children. If the asset/Into me is either that of the filer or held
by the ?ler wit the spouse or dependent children, mark the other higher categorles of value. as appropriate.

 

 

 

005 Form 278 (Rev 12/20! 
5 C.F.R. 2634
US. Ollie: ofGos-cmmenl Elhics

 

Reporting Name
Beneau. David J.

 

SCHEDULE A continued
(Use only if needed)

 

Page Nu mber

40111

 

 

Assets and Income

ValuationofAssets

at close of reporting period

Income: type and amount. If "None (or less than 3201)" Is
checked. no other entry is needed In Block for that item.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BLOCK A BLOCK BLOCK 
Type Amount


Other Date
Income (M0,,Day,
. ?If .
Egagag?b?neg?uu 3 5 oos?gsgaeih? 
.ocNmJavw'c-gaa 3- wo?quo?q?qnctuai Only"
a?ag?wmo?;gos uoqq do- ob

a5

2
CREF Slack (401K stock fund) 
3
CREF (401K slack fund) 
4
CREF Equity Index (401K stock fund) 

CREF Bond Market (401K bond fund) 

CREF In?ation-Linked Bond (401K bond fund) 
7 CREF 
5 Loidos Common Stock Fund. splilfrom 
Common below (401K) LDOS
SAID Common Stock Fund. aplitlolon-n Leidos 
Common above (401K) SAIC

 

This can: ury a?pllus only If the asset/Income ls soler that of the ?ler?s spouse or dependent children. If the asset/Income is either that of the ?ier or held

by the II er 

 

the spouse or dependent children. mark the other hlgher categories of value. as appropriate.

 

 

065 Form 27801?. I)
5 C.F.R. Part 2634
US. Of?ce ol'Govemntent Ethics

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Reporting lndivldual's Name . Page Member
Wm David SCHEDULE A continued
(Use only if needed) 5 at 11
Assets and Income Valuationof?ssets. Income: type and amount. if ?None (or less than $201)? is
at close of reporting penod checked. no other entry is needed in Block for that item.
BLOCK A BLOCK 3 BLOCK (2
Type Amount
A 
'5
q- 
S- 8 go lag- 8 8 Other Date
Income (Mo.,Day,
goquqg?aeeo oneQQOevmg 
8518-118, arena .9 acme
,o Nqu'm.D  a omoqol QActual 
??agamwg 
"sate?FFan ?gmeoee'ose
ism - :HHseqm'


I?l? Dm?dzm?namam 
Leidos CIosedSiockFund.splitfrom 
Closed below (401K lurid) Loos
sue CiesodSieek Fund. split to form Leldos 
Closed above (401K fund) 
3 Vanguard Prime MoneyMarkeiFund(401K) I 

4 Vanguard Short-Term Bondindex(401i<hond 
tundwelsx
5 VanguardTargat Retire 2015mm Pius (401K 
tundwavx . -. 
6 .
Dodge 8. Cox Sleek Fund (401K fund) DODGX 
7 Vanguard Institutional Index Fund(4D1Kiund) 
VINIX 
8 CenterforlheSiudyofihe Presidencyand I  04,3920?
Congress. Washington DC -. $1.000
Bordeion and Berteau LLC.0pebusasLA(oui 
of business Auto Body Shop) 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

This category a?piles only If the asset/income ls solely that of the nter's spouse or dependent children. if the asset/income is either that of the ?ier or Jointly held
by the ?ier wit the spouse or dependent children. mark the other higher categories of value. as appropriate.

 

 

 

06E Form 278 (Rev. 121201 I)
GER. Part 2634
U.S. Ul'?oe Ethics

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Reporting Name A . Page Number
HEDULE contmued
Beneau.DavidJ. .
(Use only 1f needed) a or 11
Assets and Income valuationofAssets Income: type and amount. lf"None (or less than $201)" is
at close of reporting period checked. no other entry is needed In Block for that Item.
BLOCK A BLOCK 3 BLOCK 
Type Amount
Other Date
8 8 c, Income (M0,,Day,
. -

a 8m89684.?f9.?tctual 
lg 
13-3 :H?nb?U?nI?toGQ

wHooqogwoogmuH g?maerH?tooqmom

Essng33QQ?dOo3?

Bordelon and BerteauLLC-Commert?al building 
(vacant) (40% share) - Opelomas, Louisiana
2 
3 DC 
grown son) (SOLD)
4 Western Mutual. MlustabbCompL'rfa . 
lnsurance (whole l?e)
5 NSISPrograrn. Maxwell Soho-0t. Syracuse 4,2320?
Syracuse NY (honoreda received)
6
7
a


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

This category at plles only if the asset/Income ls solely that of the ?ler's spouse or dependent children. If the asset/Income ls elther that of the fller or held
by the fller Wll? the spouse or dependent mark the other hlgher categories or value. as appropriate.

 

 

 

005 Penn 278 (Rev. lit/2M l]
5 C.F.R. Pan 2634

Do not complete Schedule if you are a new entrant. nominee. or Vice Presidential or Presidential Candidate

 

 

 

 

 

 

 

 

 

US. Of?ce or Government Ethics
Reporting Name  Page Number
Bet-teen. David J. 7 oi 11
Part I: Transactions
Report any purchase. sale. or exchange Do not report a transaction involving None 
by you. your spouse. or dependent Property used 5010'? as Your Personal
children during the reporting period of any residence. or a transaction solely between of 
real property. stocks. bonds. commodity you. your spouse. or dependent child. . ?3
futures. and other securities when the Check the "Certificate of divestiture block Date . . Jug  Mg "3
amount of the transaction exceeded 51.000. to indicate sales made pursuant to a gablncludetransactions that resulted in a loss. certi?cate of divestiture from 06E:29. no g? an as; E9. 
identification of Assets 8'5
Mple I CentralNrIinesCornmon 2/1/99 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*Thls category applies only if the underlying asset is solely that of the filer's spouse or dependent children. if the underlying asset is either held
by the ?ier or jointly held by the flier with the spouse or dependent children. use the other higher categories of value. as appropriate.

 

Part 11: Gifts. Reimbursements. and Travel Expenses

For you. your spouse and dependent children. report the source. a brief descrip-
lion, and the value of: gifts (such as tangible items. transportation. lodging.
food. or entertainment) received from one source totaling more than $350 and

(2) travel-related cash reimbursements received from one source totaling more
than $350. For con?icts analysis, it is helpful to indicate a basis for receipt. such
as personal friend. agency approval under 5 U.S.C. 4] i or other statutory
authority. etc. For travel-related gills end reimbursements. include travel itinerary.
dates, and the nature of expenses provided. Exclude anything given to you by

for other exclusions.

the US. Government; given to your agency in connection with of?cial travel;
received from rclativos; received by your Spouse or dependent child totally
indc oflhcir relationship to you; or provided as personal hospitality at
the onor's residence. Also. for purposes of aggro ating gifts to determine the
total value from one source. exclude items worth 140 or less. See instructions

None 

 

 

Frank Jones.San Francisco. on leather briefcase (personal friend}

 

Sourcn {Name and Address! Brief Description Value
?bump!? Airline ticket. hotel room 6: meals Incident to national conference (personal activity unrelated to dulyi $500

 

 

 

 

 

 

 

 

 

 

 

06E Form 278 (Rev. I)
5 C.F.R Part 2634

 

U.S. ofGoWInmcni Ethics
Reporting Name Page Number
Berteau. David J. SCHEDULE a or 11

 

 

 

Part I: Liabilities

a mortgage on your personal residence

None 

 

 

 

 

 

 

 

 

 

 

 

 

Report liabilities over $10,000 owed unless it is rented out: loans secured by
to any one creditor at a my time autumobiles. household furniture 0f Amount or Value It!
during the reporting period by you. or appliances: and liabilities owed to I .
Your 5901-159. 01? Children certain relatives listed in instructions. I . . .1. ?g  
Check the highest amount owed See Instructions for revolving charge during the reporting period. Exclude accountsDate Interest Term39.
Creditors (Name and Address) Type or liability incurred Railamp.? ??wmv?ww?m . JL . .. 
John Jones. Washington. DC Promissory note 1999 I096 on demand it
I St. Landry Bank and Trust, Opelousas LA Business Loan secured by real properly 2009 575% 3i"! 
2 Wale Fargo. Dos Moinos Mortgage on condo (paid ot? 2005 5.3255 ?0 t" 
3 Chase Bank. Wilmington DE Credit Card 2013 13.49% moMne 
Bani: oiAmerioo Mortgage on personal residence 2014 4 625% 30,1: 
5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*Thls category applies only lithe liability ls solely that of the l'ller's spouse or dependent children. if the liability is that of the filer or a joint liability of the ?ier
with the spouse or dependent children' mark the other higher categories, as appropriate.

 

Part II: Agreements or Arrangements

Report your agreements or arrangements for: continuing participation in an
employee bene?t plan pension. 401k. deferred compensation]: (2) continua-
tion of payment by a former employer [including severance payments): (3) leaves

of absence: and (4) future employment. See instructions regarding the report-

ing of negotiations for any of these arrangements or bene?ts.



 

 

 

 

 

 

 

 

 

 

 

Status and Terms of any Agreement or Arrangement Parties Date

Example Pursuant to pannership agreement. will receive lump sum payment of capital account or partnership share noe Jones it: Smith. Hometown. State 7/85
calculated on service performed through 1/00.

I wit continue to participate In the SAID 401 K. I have not received my contributions since my departure. SAic, Washington DC 9,93
2 lwlii continue to participate in the OmnioomiClarlt I. Weistock 401K. lheve not received any contributions since my departure. OmnioondCierltJI Wohloclt. DC 
3 lwil oontime tto pertlcipate in the plan with The company wil not make further contributions alter my resignation. CiiliiI Washington 00 3mg
4 I will continue to participate in tho Syracuse University I have not received any contributions since mydopartora. University at Syracuse. Syracuse NY 
5
6

 

 

 

 

0013 Form 275 (Rev. l2f2011i
5 C.F.R. Pan 2634
U.S. Ol'l'lco Ethics

 

Reporting individual's Name
Benoau. David J.

 

SCHEDULE 

 

Page Number

90! 11

 

 

Part 1: Positions Held Outside U.S. Government

Report any positions held during the applicable reporting period, whether compen-
sated or not. Positions include but are not limited to those of an of?cer. director.
trustee. general partner. proprietor. representative. employee. or consultant of

any corporation. firm, partnership, or other business enterprise or any non-profit

nature.

organization or educational institution. Exclude positions with religious.
social. fraternal. or political entities and those solely of an honorary

Home 

 

 

 

 

 

 

 

 

 

 

 

Organization {Name and Address) Type or Organization Position Held From (Md. To (Mont)
Nat'l Assn. of Rock Collectors. NY. NY rim-profit ulucttim 6/92 _l
Example? Doe Jonesdr Smith. Hometmm. State law ?rm 7/85 you
I
Center for Strategic and International Studies. Washington Dc Non-pro?t think tank SeniorVioo President and Director 11,2011 Present
2 .
R. Christopher Goodwin a Associates. Frederick MD Private sector archaeological services ?rm IBoard oi Duectors, and 0212001 Present
3 .
Prowrement Round Table. Washington Dc Non-pro?t public service Director (uncompensated) 11.1994 Present
4 I I - .
Georgetown Washington DC Prrvate. non-profit university AdleHCi Professor 01mm Present
5 . .
Lyndon B. Johnson School 01' Public Attalrs. University oi Texas. Austin TX Pubirc university Adjunct Professor 0612012 Present
5 National Academy of Public Administrotton. Washington DC non-pro?t congrassionaily-ehartsrad public service Foibw 11,2002 Present

 

 

 

 

business af?liation for services provided directly by you during any one
the reporting period. This includes the names of clients and customers 0

Report sources of more than 55.000 compensation received by you or your 
fyear 

corporation. firm. partnership. or other business enterprise, or any other

Part II: Compensation in Excess of $5,000 Paid by One Source

non-profit organization when
you directly provided the

services generating a fee or payment of more than 55.000. You
need not report the U.S. Government as a source.

any

Do not complete this part if you are an
Incumbent, Termination Filer. or Vice
Presidential or Presidential Candidate.

None 

 

Source (Name and Address)

Brief Description of Duties

 

Doe Jones 6: Smith. Hometown. State

 

Metro University [client of Doe Jones 6: Smith). Moneytolvn. Slate

[tanner-vices

Gamma?? 

 

Centerfor Strategic and into mational Studios. Washington DC

full time employment. program director and corporate officer. non-pro?t think tank

 

Georgetown University. Washington DC

Teaching graduate courses as an adjunct protessor

 

Lyndon B. Johnson School of PubiloMsirs. University at Texas. Austin TX

Teaching graduate worries as an adjunct professor

 

Applied Physics Laboratory. John Hopkins University. Laurel MD

Cumming services

 

R. Christopher Goodwin Associates. Frederick MD

Member. board of directom. and oomuiting services

 

continued on next page

 

 

 

 

 

 Form 278 (Rev. 
5 C.F.R. Part 26.14
US. Of?ce Ethics

 

Reporting individual's Name
Berteau.

David J.

 

Page Number

SCHEDULE 10 ct t1

 

 

 

Part I Positions Held Outside U.S. Government
Report any positions held during the applicable reporting period. whether compen-
sated or not. Positions Include but are not limited to those of an officer. director.
trustee. general partner. proprietor. representative. employee. or consultant of nature.
any corporation. ?rm. pa rtnership, or other business enterprise or any non~profit

social. fraternal. or political entities and those solely of an honorary

organization or educational institution. Exclude positions with religious.

None 

 

 

 

 

 

 

 

 

 

 

(Name and Address} Type of Organization Position ileld From (Me. i'r.i To (Mani-J
Hal?i Ann. of Rock Collectors. NY. NY hbn-pru?teducathn Pr?uitl?enl? 1159?;

mm!? lie-e Jones a Smith. Ilomelotm. state law firm Pam-la was 1/00

1 Applied Physics Laboratory. Johns Hopkins University. Laurel MD Unlversity-ai?iiated Research Center. non-profit. Contract for consulting 04,2011 Present
private university

2 Association of Defense Communities. Washington DC non-pro?t association at defense communities and Member. Federal OutreachAdvisory mum present
organizations Committee (uncompensated)

3 Beacon Capital Partners. LLC. Boston MA Consultant Consultant 07mg? 079012

4 LMI. McLean VA non-pro?t services ?rm Consultant {uncompensated} 12,2010 Present

5 The Si Organization. inc.. Chantilly VA private-sector systems engineering ?rm Advisory board. consultant 01,2012 [2014

6 Height Analytics. Washington DC Private ?nancial adviser ?rm Consuilteni 07,2011 05,2013

 

 

 

 

 

Part II: Compensation in Excess of $5,000 Paid by One Source

Report sources of more than 35.000 compensation received by you or your
business af?liation for services provided directly by you during any one year of
the reporting period. This includes the names of clients and customers of any
corporation. firm. partnership. or other business enterprise. or any other

you directly provided the
services generating a fee or payment of more than 55.000. You
need not report the us. Government as a source.

Do not complete this part if you are an
incumbent. Termination Filer. or Vice
non-pro?t organization when Presidential or Presidential Candidate.

None 

 

Source [Name and Address)

Briei' Description oi Uutles

 

Examples

 

Doe Jones 6: Smith. ilemetotm. Slate

Mr:er University (client at Dec Jones a Smith). Money-tom. State

Legal schism




 

The SI Organization lnc.. Chantilly VA

Consulting services. participation on advisory boards

 

Beacon Capital Partners. LLC. Boston MA

Consulting services (2012)

 

Height Analytics. Washington DC

Consulting services

 

 

 

 

 

 

 

 

Prior Editions Cannot Be Used.

0613 Form 278 (Rev I2120l i)
5 C.F.R. Part 2634
U.S. Office ofGovc-mmcni Ethics

 

Reporting Name
Berieau. David J.

 

SCHEDULE 

 

Page Number
11 at 11

 

 

Part 1: Positions Held Outside U.S. Government

Report any positions held during the applicable reporting period. whether compen-
sated or not. Positions include but are not limited to those of an officer, director.

organization or educational institution. Exclude positions with religious.
social. fraternal. or political entities and those solely of an honorary

 

 

 

 

 

 

 

 

 

trustee. general partner. proprietor. representative. employee. or consultant of nature. I 

any corporation. l?lrm, partnership. or other business enterprise or any non-profit 
Organisation {Name and Address) Type of Organisation Position Held From (Md. To ?roan-J

Nat'l Assn. of Rock Collectors. NY. ti? tho-profilnlucauon nutrient 6/92 Pnscot
Ramp!? Doe Jones 6: Smith. liometotm. State Law firm Partner 7/85 U00
I National Security Sludies Program. Maxwell School of Citizenship and Public Affairs. Non-profit university Member. Advisory Board 05,2003 prose.?
Syracuse University. Syracuse NY (uncompensated)

2

3

4



6

 

 

 

 

 

 

Part II: Compensation in Excess of $5,000 Paid by One Source

Report sources of more than 35.000 compensation received by you or your
business alfiliation for services provided directly by you during any one year of
the reporting period. This includes the names of clients and customers of any
corporation. ?rm. partnership. or other business enterprise. or any other

non-pro?t organization when
you directly provided the

services generating a fee or payment of more than 35.000. You
need not report the U.S. Government as a source.

Do not complete this part if you are an
incumbent. Termination Filer. or Vice
Presidential or Presidential Candidate.

None 

 

Source {Name and Address]

Brief DescriplIOn of Duties

 

Doe Jones 6: Smith. iiometotm. State

 

 

 

 

 

 

 

ma?a:Prior Editions Cannot lie Used.