File with: Seattle City Clerk SEEC FORM SEEC PO BOX 94728 DOLLAR PERSONAL Seattle, WA 98124-4728 _1 CODE AMOUNT FINANCIAL Questions: {206) 684-8500 3' a (205) 515.1243 (7118) (1) $0 -- AFF polly.grow@seattle.gov (ii :;'333 59?999 (4) $10,000 -. $24,999 53x Deadlines: Incumbent elected and appointed officials -- by April 15. (5) $25,000 $99,999 Candidates and others -- within two weeks of becoming a (6) $100,000 -- $199,999 t? candidate or being newly appointed to a position. (7) $200300 $999,999 v? (8) $1,000,000 -- $4,999,999 '03 SEND REPORT TO Seattle City Clerk (9) or more (J "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 Individuals most recently filed 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 gift) J). . other dependents living in your household, do not identify it! l) them. Do identify your spouse or domestic partner. Mailing Address (Use PO Box or Work AddressflrI (394 Smog galls Ci County Zip 4 Filing Status (Check only one box.) Of?ce Held or Sought - - - Of?ce titleelected or appomted ?IIng annual report L- i Li I it i (?it ?lb" Final report as an elected of?cial. Term expiredPosmon numberaneec Ion mon year I Term begins: ft, . 7" I, ends: 25 I: Newly appointed to an elective of?ce INCOME 1 List each employer, or other source of income (pension, social security, legal judgment, etc.) from which you or an immediate family member, received compensation, in any form, of $2,400 or more during the period. options received during the reporting period that had a value of more than $2,400. (Report interest and dividends in Item 3.) Include stock 3"??159" is) Name and Address of Employer or Source of Com ensation Occupation or How Compensation Amount: 0 5 Was Earned (Use Code) epen enl HRS S?caltlz aims? (5) SP SP SMML (?ght, Sbtt?g?i'j ball I200 ([er Ne SOHO 0? ?balm/0? 05A agent) (?His 25*?sz NE Swill/E, ?illo?S Check Here if continued on attached sheet Plastic Surgeon Plasrh?c. Surgeon (Q) 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 financial interest during the reportin period. (Show partnership, company, etc. real estate on F-1 supplement.) REAL ESTATE 2 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) In a. . vy/A Property Purchased or Interest Acquired Creditors NamelAddress Payment Terms Security Given Mortgage Amount - (Use Code) (eg. 20 at Original Current n/A. n/m All Other Property Entirely or Partially Owned FNQO 4., .. Moll Are. Ali; 00359614:ng Swim at 1 pi 2, 5X: . Check herem if continued on attached sheet W5 m5, 36" 7 ON NEXT PAGE 3 List bank and savings accounts, insurance policies, stock. bonds and other ASSETS I INVESTMENTS DIVIDENDS 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 .1 .. (Use 1-9 (Use 1-9 Code) A. Name and address of each bank or ?nancial institution in which you 54W 5 Code) or an immediate family member had an account over $24,000 at any Bat/i t9? (5. i time during the report period. Mos 3545mm M: So HILL 37 If . B. Name and address of each insurance company where you or an 51 immediate family member had a policy with a cash or loan value over n/m 524.000 during the period. C. Name and address of each company, association. government Sow/id agency. etc. in which you or an immediate family member, owned or 451$?; 2?5? AM (7 (7 had a ?nancial interest worth over $2.400. Include stocks. bonds, {arid WA ?goo?i ownership. retirement plan. IRA. notes, stock options. and other intangible property. If you or your immediate family member had Fl (7.) I decision making authority regarding individual assets/investments list 7 each asset or investment, the value and any income amount. 6100 31mm (i EXAMPLE: If you self-directed an investment account identify each Smithiliei?lf (CL OL??ilf?l? stock or other asset in that account. Stock shall be reported by market value at the time of reporting. l5 Detroi 5+ Check here? if continued on attached sheet Dirtv??r 3020 List each creditor you or an immediate family member owed 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 o?ginal current (25L (eg. 6 years at 5.25%) (5 (5- 4300 . {a . - . . ..i13nia imam Lay/{mar ?um, 6'11 Check hereE if continued on attached}B sheet. Enter Dollar Amount 5 NET WORTH Enter your estimated net worth. 3 7.00 1 D00 6 All filers answer questions A thru 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 of?cials ?ling an annual financial affairs report also must answer question E. An F-?i Supplement is required of these of?ceholders unless all answers to questions A thru are NO. A. At any time during the reporting period were you andlor an immediate family member (1) an officer. director general partner or thstee 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? #69 if yes, complete Supplement PartA. 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? #55 Ifyes. complete Supplement Did you and/or an immediate family member own a business at any time during the reporting period? its 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 of?ce) at any time during the reporting period? ii!) 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. andi?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 andlor an immediate family member to travel or to attend a seminar or other training? If yes to either or both questions. complete Supplement. Part 0. ALL FILERS EXCEPT CANDIDATES. Check the appropriate box. Contact Telephone: (209 l8(q . 3 (?il a: l:l i hold a local elected of?ce I have read and am familiar with SMC - . . . . -- e; r" . om . 2.04.300 regardIng the use of publIc facrlitIes In campaigns. Ema'l?ahh fl [3h 0 519? m? (work) Britilir?? {limm Com (Home) Optional CERTIFICATION: certify under penalty of perjury that the information contained in this report is true and correct to the best of my knowledge. I. 23, Ia K3 Date Signature Do not use public agency addresses or telephone numbers for contact information. Report Not Acceptable Without Filer?s Signature File with: Seattle city Clerk SEEC FORM 5 SUPPLEMENT PAGE Seattle, WA 98124-4728 Questions: (206) 684-8500 '1 5mm: muss 3. PERSONAL FINANCIAL AFFAIRS STATEMENT (205) 5154248 SUPPLEMENT Polly.Grow@Soattla.gov (7,18) PROVIDE INFORMATION FOR YOU AND ANY IMMEDIATE FAMILY MEMBERS Last Name First Middle Initial DATE ,f Brittle-r Arm I. Ia, OFFICE HELD: Provide the following information if, during the reporting period, you or any immediate family member A BUSINESS (1) were an of?cer, director. general partner, trustee, or 10 percent or more owner of a corporation, non-pro?t INTERESTS: organization, union, partnership, joint venture or other entity; andror (2) were a partner or member of a limited partnership, limited liability partnership, limited liability company or similar entity, including but not limited to a professional limited liability company. . Legal Name: Report name used on legal documents establishing the entity. . Trade or Operating Name: Report name used for business purposes if different from the legal name. . Position or Percent of Ownership: The of?ce, title and/or percent of ownership held. 0 Brief Description of the BusinessI?Organization: Report the purpose, product(s), and/or 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, show the 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 seeklhold of?ce) which paid compensation of $12,000 or more during the period to the entity. Brie?y 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 quali?cations referenced below are met. ENTITY No.1 Reporting For: Self IZI Spouse Registered Domestic Partner '3 Dependent LEGAL NAME: Func?omi I?jo?vi POSITION OR PERCENT OF OWNERSHIP 33(5, member TRADE OR OPERATING NAME: (S01 120.90% sioos, gear?IE, W/t Ohms ADDRESS: BRIEF DESCRIPTION OF THE BUSINESSIORGANIZATION: Ii?jai g5 PAYMENTS ENTITY RECEIVED FROM GOVERNMENTAL UNIT IN WHICH YOU OFFICE: Purpose of payments Amount (actual dollars) [5 PAYMENTS ENTITY RECEIVED FROM OTHER GOVERNMENT AGENCIES OF $12,000 OR MORE: Agency name: Purpose of payment (amount not required) Ito/h PAYMENTS ENTITY RECEIVED FROM BUSINESS CUSTOMERS OF $12,000 OR MORE Customer name: Purpose of payment (amount not requrred) WASHINGTON REAL ESTATE IN WHICH ENTITY HELD A DIRECT FINANCIAL (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): h/k Check here?if continued on attached sheet CONTINUE PARTS AND ON NEXT PAGE Page 2 Supplement Name ENTITY N0. 2 Reporting For: Self Spouse Registered Domestic Partner Dependent '3 LEGAL Sound Piq5+Izl PLLC POSITION OR PERCENT OF OWNERSHIP TRADE OR OPERATING NAME: mi W154i!? 655% ADDRESS: 25411 Ave 95,2}th \zd/jf 61.3 I03 IKE 305,; I BRIEF DESCRIPTION OF THE BUSINESSIORGANIZATION: W1 at 5 PAYMENTS ENTITY RECEIVED FROM GOVERNMENTAL UNIT IN WHICH YOU SEEKIHOLD OFFICE: Purpose of payments 0; Amount (actual dollars) I25 PAYMENTS ENTITY RECEIVED FROM OTHER GOVERNMENT AGENCIES OF $12,000 OR MORE: Purpose of payment (amount not required) A enc name: 9 h/a PAYMENTS ENTITY RECEIVED FROM BUSINESS CUSTOMERS OF $12,000 OR MORE Customer name: Purpose of payment (amount not required) Vy/e, 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, LOBBYING: rates, or standards for compensation or deferred compensation. Do not list pay from government body in which you are an elected official or professional staff member. Person to Whom Services Rendered Description of Legislation, Rules, Etc. Compensation (U59 Code 1- 9) I n/?L I Check here CI if continued on attached sheet FOOD Complete this section if a source other than your own governmental agency paid for or othenivise 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) h/?ke Check here if continued on attached sheet