File with: Seattle City Clerk SEEC FORM SEEC PO BOX 94728 DOLLAR PERSONAL Seattle, WA 93124-4723 _1 CODE AMOUNT FINANCIAL Questions: (206) 684-8500 9 stmanscuumssruu (206) 615-1248 (7)13) $2 $33: AFFAIRS . polly.grOW@seattle.gov :5?333 :3?999 STATEMENT (4) $10,000 -- $24,999 Deadlines: Incumbent elected and appointed officials -- by April 15. (5) $25,000 $99,999 Candidates and other within two weeks of becoming a (6) $100,000 -- $199,999 candidate or being newly appointed to a position. (7) $200,000 $999,999 (8) $1,000,000 -- $4,999,999 -- SEND REPORT TO Seattle City Clerk (9) $5,000,000 or more '43 "immediate family" means: a spouse or domestic partner, or a parent, parent of a partner, sibling. uncle, aunt, cousin, niece or nephew, if that person either resides with or is federal income tax return. SMC 4.16.080 pouse or domestic partner, child. child-of sp?gse ordor?estic a dependent on the Covered Individuals mQatIecent_lyj?ad Middle Initial Last Name First 7 a .714", Names of immediate family mem?e?rs. lhgierelis?g: reportable information to disclose-jg dep??ndenLchildren, or other dependents living in your ho?eho?do qotjidentify them. Do identify your spouse or domesti?g partner. Mailing Address (Use PO Box or Work Address) LC) 5760?? 7% /4l/C?l City Se?wg? County .. Zip+4 fir/r] Filing Status (Check only one box.) El An elected or appointed of?cial ?ling annual report Final report as an elected of?cial. Term expired: Candidate running in an election: month i El Newly appointed to an elective of?ce year Of?ce Held or Sought Office title: e? ends: 2; Position number: Term begins: 1 INCOME immediate family member, received compensation, in any options received during the reporting period that had a value of more than $2,400. (Report interest and dividends in Item 3.) List each employer, or other source of income (pension, social security, legal judgment, etc.) from which you or an form, of $2,400 or more during the period. include stock Show Sell (5) Spouse (SPID P) Dependent (D) 4b.. Name and Address of Employer or Source of Compensation W7 5 Check Here if continued on attached sheet OCCU[Station or How Compensation In a 6? 3.2 7v. Mar. ,sq/ 75% iv Amount: (Use Code) Aer(? Was Earned ?4 asp List street address, assessor's parcel number, or legal description AND county for each parcel of Washington real estate with value of over $12,000 in which you or an immediate family member held a personal ?nancial interest during the reportingperiod. (Show partnership, company, etc. real estate on F-1 supplement.) 2 REAL ESTATE 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 NamefAddress Payment Terms Security Given Mortgage Amount - (Use Code) (eg. 20 at Original Current .- 31,3 i A- All Other Property Entirely or Partially Owned 3 j; Lu,- 1, ., I :1 dinol ill?if] it: ill?.- I. Check here if continued on attached sheet i i I CONTINUE ON NEXT PAGE 3 List bank and savings accounts, insurance policies, stock, bonds and other ASSETS I intangible property (including but not limited to stock options) held during the reporting period. 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 ?nancial institution in which you 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 financial interest worth over $2,400. Include stocks, bonds, ownership, retirement plan, IRA, notes, stock options, and other intangible property. If you or your immediate family member had decision making authority regarding individual assetsrinvestments 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 CODE) in Item 2. Creditor's Name and Address Terms of Payment Security Given original current (eg. 6 years at 5.25%) Check here if continued on attached sheet. Enter Dollar Amount 5 NET WORTH Enter your estimated net worth. 6 All filers answer questions Athru 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 office 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-1 Supplement is required of these officeholders unless all answers to questions A thru are NO. A. At any time during the reporting period were you andr?or an immediate family member (1) an officer, 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, complete Supplement, Part A. B. Did you andior an immediate 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 and/or an immediate family member own a business at any time during the reporting period? If yes, complete Supplement, Part A. Did you andlor 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 office) 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 andior an immediate family member to travel or to attend 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: 5L. ?2 5/23 I hold a local elected office I have read and am familiar with SMC - . gathd r} J) 153' C5371 2.04.300 regarding the use of public facilities in campaigns. Email. I d/ ?4 (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. /7 a, .. If," {cul-rfuL/ ii? Dang I ?i?BI??nature Do not use public agency address/es or telephone numbers for contact information. Report Not Acceptable Without Filer?s Signature