File with: Seattle City Clerk SEEC FORM I SEEC PERSONAL PO BOX 94728 DOLLAR Seattle, WA 98124-4728 _1 CODE AMOUNT FIN CIAL - Questions: (206) 684-8500 (206) 615-1248 :73 :2 000 ?$333 6E . .. polly.grow@seattle.gov (3) $5:000 .. 59:999 33! Ag Eg (4) $10,000 $24,999 a .51er Deadlines: Incumbent elected and appointed officials -- by April 15. (5) $25,000 $99,999 37:: - Candidates and others -within two weeks of becoming a 5100.000 $199,999 candidate or being newly appointed to a position. (7) $200,000 $999,999 I: $1,000,000 .- $4,999,999 SEND REPORT TO Seattle City Clerk (9) or more :0 ?immediate family" means: a spouse or domestic partner, or a parent, parent of a spouse or domestic partner, child, child of spouse or domestic partner, sibling, uncle, aunt, cousin, niece or nephew, if that person either resides with or is a dependent on the Covered Individual's most recently ?led federal income tax return. SMC 4.16.080 Last Name First Middle Initial Names of immediate family members. If there is no reportable information to disclose for dependent children, or - other dependents living in your household, do not identify Campbell Elizabeth A them. Do identify your spouse or domestic partner. Mailing Address (Use PO Box or Work Address) 1) 3213 Wheeler Street Ste 271 City County Zip 4 123' . Seattle King 98199?1492 .3 :39 . . Filing Status (Check only one box.) Office Held 0r Sought ,elected or appomted of?cral ?ling annual report fflce if 9 Seattle City Cog?c?f Ni El Final report as an elected of?cial. Term expired: 74-? Posrtron number: District 7 fr", Candidate running in an election: month August year 2019 a U3 Term begins: anu ends: 2023 Newly appointed to an elective of?ce List each employer, or other source of income (pension, social security, legal judgment, etc.) from which you or an 1 INCOME immediate family member, received compensation, in any form, of $2,400 or more during the period. Include stock options received during the reporting period that had a value of more than $2,400. (Report interest and dividends in item 3.) Name and Address of Employer or Source of Compensation Occupation or How Compensation Amount: Dependent(D) Was Earned (Use Code) Discovery Park Community Alliance Executive Director 3 8 Amazon Fresh Level 1 Logistics 2) Social Security \Nidow's Benefit (4 Check Here if continued on attached sheet List street address, assessor?s parcel number, or legal description AND county for each parcel of Washington 2 REAL ESTATE real estate with value of over $12,000 in which you or an immediate family member held a personal financiai interest during the reporting period. (Show partnership, company, etc. real estate on F4 supplement.) Property Sold or interest Divested Assessed Name and Address of Purchaser Nature and Amount (Use Code) of Payment or Value Consideration Received (Use 1-9 Code) Property Purchased or interest Acquired Creditor?s Name/Address Payment Terms Security Given Mortgage Amount - (Use Code) (eg. 20 at Original Current i All Other Property Entirely or Partially Owned Check here if continued on attached sheet CONTINUE ON NEXT PAGE List bank and savings accounts, insurance policies, stock, bonds and other 3 ASSETS INVESTMENTS - intangible property (including but not limited to stock options) held during the reportingperiod. Type of Account or Description of Asset Asset Value Income Amount (Use 1-9 (Use 1-9 Code) A. Name and address of each bank or financial institution in which you A Code) or an immediate family member had an account over $24,000 at any time during the report period. B. Name and address of each insurance company where you or an immediate family member had a policy with a cash or loan value over $24,000 during the period. C. Name and address of each company, association, government agency, etc. in which you or an immediate family member, owned or had a ?nancial interest worth over $2,400. Include stocks, bonds, A ownership, retirement pian, IRA, notes, stock options, and other intangible property. if you or your immediate family member had decision making authority regarding individual assetslinvestments list each asset or investment, the value and any income amount. EXAMPLE: If you self-directed an inVestment account identify each stock or other asset in that account. Stock shall be reported by market value at the time of reporting. Check here if continued on attached sheet. List each creditor you or an immediate family member owed $2,400 or more any time during the AMOUNT 4 CREDITORS period. Don't include retail charge accounts, credit cards, or mortgages or real estate reported (USE 1-9 in Item 2. Creditors Name and Address Terms of Payment Security Given original current (eg. 6 years at 5.25%) 6) 6 U.S. Department of Education 20 years 79% None Check here if continued on attached sheet. Enter Dollar Amount 5 NET WORTH Enter your estimated net worth, ,3 $25,000 6 All filers answer questions A thru 0 below. if the answer is YES to any of these questions, the F-1 Supplement must also be completed as part of this report. If all answers are NO and you are a candidate or an appointee to a vacant elective of?ce filing your initial report, no F-1 Supplement is required. Incumbent elected officials filing an annual financial affairs report also must answer question E. An F-?l Supplement is required of these officeholders unless all answers to questions A thru are NO. A. At anytime during the reporting period were you andfor an immediate family member (1) an of?cer, director, general partner or trustee of any corporation, company, union, association, joint venture or other entity or (2) a partner or member of any limited partnership, limited liability partnership, limited liability company or similar entity including but not limited to a professional limited liability company? if yes. com plete Supplement, Part A. B. Did you andlor an imm 'ate family member have an ownership of 10% or more in any company, corporation, partnership, joint venture or other business at any time during the reporting period? If yes, complete Supplement, Part A. Did you andlor an immediate family member own a business at any time during the reporting period? If yes, complete Supplement, Part A. Did you andfor an immediate family member prepare, promote or oppose state legislation, rules, rates or standards for compensation or deferred compensation (other than pay for a currently?held public of?ce) at any time during the reporting period? If yes, complete Supplement, Part B. E. Only for Persons Filing Annual Report. Regarding the receipt of items not provided or paid for by your governmental agency during the previous calendar year: 1) Did you, and/or an immediate family member accept a gift of food or beverages costing over $50 per occasion? or 2) Did any source other than your governmental agency provide or pay in whole or in part for you and/or an immediate family member to travel or to atlend a seminar or other training? If yes to either or both questions, complete Supplement, Part C. ALL FILERS EXCEPT CANDIDATES. Check the appropriate box. Contact Telephone: 206 769-8459 I hold a local elected of?ce. I have read and am familiar with SMC - - - 2.04.300 regarding the use of Public facilities in campaigns. Ema?: (work? Email: {Home) Optional CERTIFICATION: I certify under penalty of perjury that the information contained in this report is true and correct to the best of my knowledge. December 20, 2013 Z- Date Signature Do not use public agency addresses ortelephone numbers for contact information. Report Not Acceptable Without Filer?s Signature File with: Seattle City Clerk SEEC FORM PO BOX 94728 mm. 981244728 1 UPPLEMENT PAGE Egg??gm?; Questions: (206) 684-8500 a ELECIIBIS cumssmu I205) 5" 5'12? SUPPLEMENT Polly.Grow@Seattle.gav [m 8) PERSONAL FINANCIAL AFFAIRS STATEMENT PROVIDE INFORMATION FOR YOU AND ANY IMMEDIATE FAMILY MEMBERS Last Name First Middle Initial DATE Campbell Elizabeth A 12-20?20 18 OFFICE HELD. Provide the following information if, during the reporting period, you or any immediate family member A BUSINESS (1) INTERESTS: (2) a Legal Name: Report name used on legal documents establishing the entity. - Trade or Operating Name: Report name used for business purposes ifdifferent from the legal name. - Position or Percent of Ownership: The office, title and/or percent of ownership held. . Brief Description of the Busineslerganization: Report the purpose, product(s), andlor the service(s) rendered. . Payments from Governmental Unit: If the governmental unit in which you hold or seek of?ce made payments to the business entity concerning which you're reporting, showthe purpose of each payment and the actual amount received. . Payments from Business Customers and Other Government Agencies: List each corporation, partnership, joint venture, sole proprietorship, union, association, business or other commercial entity and each government agency (other than the one you seekfhold of?ce) which paid compensation of $12,000 or more during the period to the entity. Briefly say what property, goods, services or other consideration was given or performed for the compensation. - Washington Real Estate: Identify real estate owned by the business entity if the qualifications referenced below are met. were an of?cer, director, general partner, trustee, or percent or more owner of a corporation, non-pro?t organization, union, partnership, joint venture or other entity; andlor were a partner or member of a limited partnership, limited liability partnership, limited liability company or similar entity, including but not limited to a professions! limited liability company. ENTITY NO. 1 LEGAL NAME: Campbell Food Company POSITION OR PERCENT OF OWNERSHIP TRADE OR OPERATING NAME: ADDRESS: 4027 let Avenue West Suite 205 Seattle, WA 98199 BRIEF DESCRIPTION OF THE BUSINESSIORGANIZATION: No business, registered only PAYMENTS ENTITY RECEIVED FROM GOVERNMENTAL UNIT IN WHICH YOU SEEKIHOLD OFFICE: Purpose of payments PAYMENTS ENTITY RECEIVED FROM OTHER GOVERNMENT AGENCIES OF $12,000 OR MORE: Agency name: PAYMENTS ENTITY RECEIVED FROM BUSINESS CUSTOMERS OF $12,000 OR MORE Customer name: WASHINGTON REAL ESTATE IN WHICH ENTITY HELD A DIRECT FINANCIAL INTEREST (Complete oniy if ownership in the ENTITY is 10% or more and assessed value of property is over $24,000. List street address, assessor parcel number, or legal description and county for each parcel): Check here if continued on attached sheet Reporting For: Self IE Spouse El Registered Domestic Partner El Dependent El 100% Sole Proprietor Amount (actual dollars) $0 Purpose of payment (amount not required) $0 Purpose of payment (amount not required) $0 CONTINUE PARTS AND ON NEXT PAGE Page 2 Supplement Name ENTITY N0. 2 Reporting For: Self IE Spouse Registered Domestic Partner Dependent LEGAL NAME: Democracy POSITION OR PERCENT OF OWNERSHIP 100W 't EX ti TRAOE OR OPERATING NAME: 0 N0 ecu V6 new? ADDRESS: 4027 let Ave West Suite 205 Seattle, WA 98199-1492 BRIEF DESCRIPTION OF THE Creates and Manages community interest websites PAYMENTS ENTITY RECEIVED FROM GOVERNMENTAL UNIT IN WHICH YOU OFFICE: Purpose of payments Amount (actual dollars) 0 PAYMENTS ENTITY RECEIVED FROM OTHER GOVERNMENT AGENCIES OF $12,000 OR MORE: Agency name: Purpose of payment (amount not required) 0 PAYMENTS ENTITY RECEIVED FROM BUSINESS CUSTOMERS OF $12,000 OR MORE Customer name: Purpose of payment (amount not required) 0 WASHINGTON REAL ESTATE IN WHICH ENTITY HELD A DIRECT FINANCIAL INTEREST (Complete only if ownership In the ENTITY is 10% or more and assessed value of property is over $24,000. List street address, assessor parcel number, or legal description and county for each parcel): Check here if continued on attached sheet List persons for whom you, or any immediate family member, lobbied or prepared state legislation or state rules, rates, or standards for compensation or deferred compensation. Do not list pay from government body in which you are an elected officiaI or professional staff member. Person to Whom Services Rendered Description of Legislation, Rules, Etc. Compensation (Use Code 1- 9) i Check here El it continued on attached sheet FOOD Complete this section if a source other than your own governmental agency paid for or otherwise provided all or a TRAVEL portion of the following items to you. your spouse, registered domestic partner or dependents, or a combination SEMINARS thereof: 1) Food and beverages costing over $50 per occasion; 2) Travel occasions; or 3) Seminars, educational programs or other training. Date Donor?s Name, City and State Brief Description Actual Dollar Value Received Amount (Use Code1?9) I Check here El ifcontinued on attached sheet Information Continued F-1 Supplement Nam 8 Elizabeth A. Campbell ENTITY N0. 3 Reporting For: Self l3 Spouse Registered Domestic Partner El Dependent LEGAL NAME: Discovery Park Community Alliance POSITION OR PERCENT OF OWNERSHIP 0 . . TRADE OR OPERATING NAME: 100 A: Executlve Dlrector ADDRESS: 4027 letAvenue West Suite 205 Seattle, WA 98199-1492 BRIEF DESCRIPTION OF THE BUSINESSIORGANIZATION: Community interest organization that advocates for park and recreation activities and park planning and development all related to Discovery Park PAYMENTS ENTITY RECEIVED FROM GOVERNMENTAL UNIT IN WHICH YOU OFFICE: Purpose of payments Amount (actual dollars) 0 PAYMENTS ENTITY RECEIVED FROM OTHER GOVERNMENT AGENCIES OF $12,000 OR MORE: Agency name: Purpose of payment (amount not required) 0 PAYMENTS ENTITY RECEIVED FROM BUSINESS CUSTOMERS OF $12,000 OR MORE Customer name: Purpose of payment (amount not required) 0 WASHINGTON REAL ESTATE IN WHICH ENTITY HELD A DIRECT FINANCIAL INTEREST (Complete only if ownership in the ENTITY is 10% or more and assessed value of property is over $24,000. List street address, assessor parcel number, or legal description and county for each parcel): LOBBYING: (Continued) Person to Whom Services Rendered Description of Legislation, Rules, Etc. Compensation (Use Code 1'9} FOOD TRAVEL SEMINARS (continued) Date 00110sz Name, City and State Brief Description Actual Dollar Value Received Amount (Use Code 1-9) Cf? Cl? $0.472 $0.470 ?3 31337933233 4004 01:11.: "-71 06280011440472 FROM 90199 3213 Wheeler Street #271 3?35?; WEE: ?75-'33 00230011440472 FROM 98199 Seattle WA 98199 PM .5 Seattle City CLerk Seattle, WA 98124?4728 51-31310 1113 Li?! ?25? I i 5 \l 1n