STATEMENT OF INTERESTS . v. ?rm. SECRETARY OF STATE ii 7 float higedjggi SFN 10172 (08-13) SEE BACK PAGE FOR INSTRUCTIONS References to the Statement of Interests are found in North Dakota Century Code, Chapter 16.1-09. Secretary of State State of North Dakota 600 Boulevard Ave Dept 108 Bismarck ND 58505-0500 Telephone 701-328-4146 Toll Free 800-352-0867 Fax 701-328-3413 Web Site: FILING REQUIREMENTS FOR STATEMENT OF INTERESTS 1. Every candidate for elective of?ce shall ?le a Statement of interests with the appropriate ?ling of?cer with whom the candidate ?led his/her Certi?cate of Endorsement SFN 17196 or PetitionlCerti?cate of Nomination SFN 2704. a. Candidates for President and Vice President of the United States shall ?le with the Secretary of State either a Statement of Interests as required by Chapter 16.1?09 of the North Dakota Century Code or a copy of the personal disclosure statement required by the Federal Election Commission. Candidates for statewide of?ce shall ?le with the Secretary of State. Candidates for legislative of?ce shall ?le with the Secretary of State. Candidates for District Judge shall ?le with the Secretary of State. Candidates for county of?ces shall ?le with therCounty Auditor. Candidates for city of?ces shall ?le with the City Auditor. Candidates for Garrison Conservancy and Soil Conservation district shall ?le with the County Auditor in their county of residence. Candidates for school district of?ces shall ?le with the School Business Manager of the school district. The Statement of Interests shall be ?led at the same time a PetitionJCerti?cate of Nomination or Certi?cate of Endorsement is ?led. Candidates ?ling a Statement of interests for the primary election need not re?le for the general election. 2. Every person appointed by the Governor to a state agency, board. bureau. commission. department. or occupation or professional licensing board shall ?le a Statement of interests with the Secretary of State no laterthan the announcement of the appointment. Please refer to the instnictions provided on back of the Statement of Interests for answering speci?c questions before completing this form. Please print Name (Name of candidate or appointee) Randy Boehning Telephone Number (T01) 799-0108 Spouse's name None Address City State Zip Code 1781 39th St #201 Fargo ND 58103 Of?ce which candidate is seeking OR Position to which appointed ND State House of Representatives Dist 27 ITEM A Name of business or employer: Boehning Construction Inc. PRINCIPAL OCCUPATIONISOURCE OF INCOME (Check One) Farmer Military El Investor or Retired Business Owner Laborer El Professional Other Clerical Sales Craftsman [3 Government Employee Student Name of business or employer: PRINCIPAL OCCUPATIONISOURCE OF INCOME (Check One) Farmer Military investor or Retired [3 Business Owner Laborer Professional Other Clerical 8. Sales Craftsman Government Employee Student SFN 10172 (08? 13) Page 2 Please print ITE Place an to indicate the interested party. List the name of each business or trust that is NOT the principal source of income, In which Specific dollar amounts you andlor your spOuse have a ?nancial Interest. not required. NAME OR TRUST NAME (list city and state where located? SELF SPOUSE Me A Lot of Money Investment Co. (Mutual Funds) Bismarck, ND ITEM 0 List below the associations or institutions with which you. andfor your spouse are closely associated, or serve as a director or of?cer. AND which may be affected by legislative action (for legislative Place an to indicate candidates), or action of the Officeholder of the of?ce to which you are a candidate or appointee. the interested party. ASSOCIATION OR INSTITUTION CAPACITY SELF SPOUSE American Legislative Exchange Councii Member SFN 10172 (08-13) Page 3 Please print ITEM Identify below by name, any business offices, business directorships, and fiduciary relationships that Place an to indicate you and/or your spouse have held in the preceding year. the interested party. 0R TRUST (list city and state where located)] CAPACITY SELF SPOUSE None AFFIDAVIT (Sign before a commissioned Notary) I, the undersigned. declare this Statement of Interests has been examined by me and to the. best of my knowledge is a true, correct. and complete statement of my ?nancial interests. I understand any intentional violation of the law requiring the ?ling of this statement shall result in my being deprived of my appointment or assuming the duties of the elective of?ce. Signature of candidafe'?r appointee State of WD County of We 6/ Subscribed and sworn to before me this day eat/L Signature of Notarial Of?cer HTMOLSM (NOTARY sr MPING bw?w Public State oi North Dakota My Commission Expires Sept. 20, 2018 - 7*