COMMISSION ON GOVERNMENTAL ETHICS AND ELECTION PRACTICES

MAIL: 135 STATE HOUSE srArIOIv. AUGUSTA. MAINE 04333
OFFICE: 45 MEMORIAL CIRCLE, AUGUSTA, MAINE

WEBSITE: 

PHONE: 207-287-4179

FAX: 207-287-6775

STATEMENT OF SOURCES OF INCOME FOR EXECUTIVE EMPLOYEES
2017 Calendar Year: January 1. 2017 - December 31, 2017

 

CI Check here if this statement is an update or amendment of a previously filed statement.

 

 

Name - Job Title
52/7941 Mom? was?
Depa ment gigeqio?gq 3 

 

E-mail Address (work)

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Mailing Address (work)

2:20 Nazi/Ia 

 

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GENERAL INSTRUCTIO 5 c9? 0 3' 

Complete all sections. If a section is not applicable. check the box marked ?None.?

0 A glossary is located in the back of this form.

0 If completing this form by hand. please write Iegibly. N0 RED 

- Report the sources of income for you. your spouse or domestic partner. and your dependent children.
0 Report only speci?c sources Of income. Dollar amounts need not be listed.

If April 15 falls on a weekend or holiday, this statement ls due on the next business day.

6,

Please keep a copy of this statement for your recordsl

REPORTING DEADLINES

Constitutional Officers and the State Auditor

Newly elected constitutional of?cers and the state auditor must ?le the ?nancial disclosure statement within 30 days of
election and by April 15 of each year they are in of?ce. unless a report for that year has already been ?led.

Appointed Executive Employees
Newly appointed executive employees who are appointed by the Governor and con?rmed by the Legislature must ?le the
?nancial disclosure statement prior tO their con?rmation and by April 15 Of each year of their employment, unless a report
for that year has already been ?led.

Executive Employees in Major Policy-In?uencing Positions
Executive employees in major policy-in?uencing positions must ?le the ?nancial disclosure statement by April 15 of each
year Of their employment.

Leaving Of?ce or Terminating Employment

Constitutional of?cers and the state auditor and all other executive employees must ?le a ?nal ?nancial disclosure
statement within 45 days of leaving Of?ce or terminating employment that covers the calendar year of leaving of?ce or
terminating employment.

REQUIREMENT TO FILE AN UPDATED STATEMENT

Executive branch employees are required to update their ?nancial disclosure statement within 30 days of a substantial

change in income. reportable liabilities or positions of the executive branch employee or an immediate family member

(except dependent children) that occurs in the current calendar year. (5 M.R.S.A. Substantial changes

include but are not limited to:

A new employer or other source of income that has paid the executive branch employee or immediate family member
$2,000 or more in the current year;

a A new reportable liability Of $3.000 or more Obtained during the current calendar year;

0 A new contract or other arrangement between the executive branch employee. immediate family member or associated
organization and a State agency. board or commission for the lease or sale Of goods or services with a value of more
than $10,000 during the current calendar year; and

A new position in a political action committee. ballot question committee. party committee. or non-pro?t or for pro?t
organization.



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2 None. Check this box if you did not have income from employment by another.

 

 

 

 

[3 None. Check this box if you did not have Income from serf-employment.

     
  
 

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arf?g Lowe?g 2921/.

3 77%? Az?ul??r/DAJ omP/f?y 
900.? ?fc ct 5c. 

 

 

 

[3 None. Check this box if you and your Immediate family did not own or control more than 5% of any business.

 

   

 

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None. Check this box if you did not have income from the practice of law.

 

 

 

 

 

 

 

 

 

5 None. Check this box if you did not have income from any other source.

 

 

 

 

 

 

 



[3 None. Check this box if no members of your immediate family received income of $2,000 or more from
employment or compensation.

 

 

    

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QR Dyazf 
1am Eff/9715 ?ap/m3 ??f/H?tf

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5! None. Check this box if no members of your Immediate family received income of $2,000 or more from any

other source.



 

 

 

 

 

 

 

 

 

 

 

 

 

 

a None. Check this box if you not have reportable liabilities.

 

v. None. Check this box if you did not receive any gifts.

 

 

 

 

 

None. Check this box if you and your immediate family were not a treasurer, or principal of?cer, decision-maker
or fundraiser of a PAC. 300. or Party Committee.

 

 

    

 

 

 

 

 

 

 

E1 None. Check this box if neither you nor your immediate family did business with any State agency.

    

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Whig, $77.72 P047
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Cr: 550,47 4?

 

 

 

 

 

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None. Check this box if neither you nor your immediate family represented another before a State agency.

 

 

 

 

13 None. Check this box If you and members your immediate family did not hold positions in any for-pro?t or

non-profit organizations.

 

 

    

 

 

 

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m? Self
6:59,? 9 far mouse NO
)7 CI Dependent
a Self
I: Spouse
0 Dependent

 

 

 

 

I CERTIFY THAT I HAVE EXAMINED THIS REPORT AND TO THE BEST OF MY KNOWLEDGE IT IS TRUE.
CORRECT, AND COMPLETE.

03x 7/ij

Signs ?Date

THE INTENTIONAL FILING OF A FALSE STATEMENT IS A CLASS CRIME (1 M.R.S.A