TOWN OF SMITHTOWN ANNUAL
STATEMENT OF FINANCIAL DISCLOSURE
FOR ELECTED AND APPOINTED OFFICIALS AND 

4 

1. Name GLWM :raflfiflg/

z. Tifleanosiflon Mm ac 


OffiDcTehphancNumber z" 7.5-1;

3. mam sums fl "marriedmlaase 
Including maiden mine, applicable'

Away 319799};

List an ma") Ind ngc(s) of (all of) the  individual's dcpandanl
child(ren).

M:

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3mm handed, much additional mu numbn um um gummy.

 

m: Fm questions Nquiring mpomng mm, dn nul lin List values
awarding m: following categories only:

mam A: undet $5,000

Clugory a: under ?20,000

Caugory c: ?20,000 -- under $60,000

Category D: $60,000 - mammoao

Cmgory B: 3100.000 -- undm $250,000

Cmegmy 17: 3250.000 7 Wu



 

 

 

 

 

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List any position the teporting individual holds, as an of?cer or committee ?emon, of any political party-as de?ned in the'
New York State Elec?on Law. I . - 

    

State wheth'erl the repm?pg  is licensed to practice law, is licensed by the New York $tat_e Depmtne?t of State as
real estate broker or agent, or pm?i?es a profession licde by its Department of Education, or is licensed to sell securities as? that term is
de?nedin item .  - . . .

License-
1

 

 

5. FINANCIAL INTERESTS
List any ?nancial interest in excess of $1,000 held by the reporting individual,'such individual?s spouse or unemancipated
(dependent) child(ren), in any contract executed by a NewYork State or local agency; . .

Nature-of Interest Nature 

  
   

 

Name of Member

List the source and amountof gi?s in excess of $1 ,000 received by the  individual or such individual?s spouse or
unemaneipated (dependent) child(ren), excluding gi?s ?-om relatives. 
of Donor

 

Member

Name of - Name ofljonor--' I

     
   

Identify the source and amount of any feimbursement for expenditures in excess of $1 ,000, in connection with of?cial duties,
not reimbumed by the Town. The term ?Teimbmsement? does not include gifts as reported under item - -

Source of Reimbursement

 

 

 

 List/deSc?be any contract, promise or other agreement between the reporting individual and any person, ?rmor-
. corporation with respect to the ?Jtuane employment of such individual a?er leaving Town of?ce or employment.

GenemITerms of

   

Name-ofrumr'e Nature of

        
 

. (6) List the nature, source and-.amount-of any income, including salary income from the Town for. the reporting individual and
such individual?s spouse. - . -

Name of Address of Source

 
  
 
      

 

Nature of Source

In

 

    
  
 

  
  
 
 

  



   



 

    

?9960 1,940. 50K far-rml-v My M527

(0 List any assignment of income for less than fair consideration, by the reporting-individual and such individual?s spouse.

 

J'Wew1/

. Nature of Name of Address of

 

 

 

 

(3) List securities held in the name of the reporting individual or such individual?sspouse, with a market value in excess
of $1 ,000 or 5% of the value in any business entity. For the purpose of this item the'term ?securities?-?shall mean bonds, mortgages,
notes, obligations, warrants and stocks, investment interests in limited or general partnerships and certi?cates of deposit and such other
evidences of indebtedness and certi?cates of interest as are commonly referred to as securities.

of

Name of Member I Name of

  

 

(11) List the address and acquisition date of any real property owned by the reporting individual or such individual?s spouse,
excluding the reporting individual?s or such individual?s spouSe?s primary and/or secondary residence. 

Date of - Names of 

  
  

- Address of

List all liabilities of the reporting individual and such individual?s spouse in'exoeSS of $5,000, other than those owed to a
relative, those relating to a mortgage(s) for the reporting individuai?s- or such individual's spouse?s primary and/or secondary 
alimony and/or child support, and loans made in the  'course of business for education, ?home 
and personal automobilefs). . - .

- Address of Creditor Nature of Debt

 

Name of Member Name of Creditor

 
 

 

 

 

NOTICE TO REPORTING INDIVIDUAL

 



 befor? m?ipcil?sp?a?y on this

  

 

Date

 

439/!9/3?

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SERVICE HISTORY Sex-Em? can 

Name I 
JORGEN GLENN 
No. A . Tale 0! Position Juris. J.C. Amber. for Pets. Action Eff.