File with: Seattle City clerk SEEC FORM SEEC PO Box 94723 DOLLAR PERSONAL Seattle. WA 913-124-4723 _1 CODE AMOUNT IN AN CI AL Questions: 206 684-8500 9 giggiirigi?i?ssm (205) 61 5-1 (243 8) (1) $0 - $999 AFFAIRS polly.grow@seattle.gov g; gigs: STATEM ENT (4) $10,000 -- $24,999 Deadlines: Incumbent elected and appointed officials -- by April 15. (5) $25,000 .. $99,999 Candidates and others within two weeks of becoming a $100,000 .. $199,999 candidate or being newly appointed to a position. (7) $200.01?) .. $999,999 (8) $1,000,000 - $4,999,999 SEND REPORT TO Seattle Clliy Clerk (9) $5,000,000 or more "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 ?led federal income tax return. SMC 4.16.080 Last Name First Middle Initial Names of immediate family members. if there is no 3 . reportable information to disclose for dependent children, or 0 0 other dependents living in your household. do not identify them. Do identify your spouse or domestic partner. Mailing Address (Use PO Box or Work Address) ion?M were? we: #4 Rpm? memsz City . County Zip 4 . at 23?) Filing Status (Check only one box.) Of?ce Held or Sought An elected or appointed of?cial filing annual report Of?ce title: Lab Carma LIA ?xtyleL/?P? )3 Final report as an elected official. Term expired: . ., Position number: 5 a Candidate running in an election: month Si l\ year . Term begins: 1 ends: Lu 1 3 Newly appointed to an elective of?ce 1 List each employer, or other source of Income (pension, social security, legal judgment, etc.) from which you or an INCOME immediate family member, received compensation, in any form, of $2,400 or more during the period. lnclude stock options received during the reporting period that had a value of more than $2,400. (Report interest and dividends in item 3.) gmsfilsf?sdm Name and Address of Employer or Source of Compensation Occupation or How Compensation Amount: Dependent Was Earned (Use Code) S. 31? ?9 (Ll) set-mt, WA 92m kuwnh.\ Creek Ml Am U. Brag 1?57: Coast-?Hun? (1) ali?tGS 9933?: ur Check Here El 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 ?nancial Interest during the reporting period. (Show partnership, company, etc. real estate on F-?i 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 NameiAddress Payment Terms Security Given Mortgage Amount - (Use Code) (eg. 20 at Original Current ?Am-r All Other Property Entirely or Partially Owned in! was: .. ~i 3: Check here if continued on attached sheet if a 1 CONTINUE ON NEXT PAGE List bank and savings accounts, insurance policies, stock, bonds and other 3 ASSETS INVESTMENTS INTEREST i 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 (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 3?9? time during the report period. 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 Ciph? L55 (if I had a financial interest worth over $2,400. Include stocks, bonds, . ownership, retirement plan, notes, stock options, and other i?J} .. be}: 6 lb? intangible property. If you or your immediate family member had bl decision making authority regarding individual assetslinvestments list ME Map {tiff}. I wt.- each asset or investment, the value and any income amount. ?LL-dt 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. AFN CM Rd Check here El 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 1; (eg. 6 years at 5.25 Check here if continued on attached sheet. Enter Dollar Amount 5 NET WORTH Enter your estimated net worth. 3 ago 6 All ?lers 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 answors are NO and you are a candidate or an appointee to a vacant elective of?ce ?ling your initial report, no F-l Supplement is required. Incumbent elected of?cials ?ling an annual ?nancial affairs report also must answer question E. An F-1 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 of?cer, director. general partner or trustee of any corporation, company, union, association, ioint venture or other entity or (2) a partner or other of any limited partnership, limited liability partnership, limited liability company or similar entity including but not limited to a professional limited liability companyf? I If yes, complete Supplement, Part A. B. Did you andfor an immediate family member have an ownership of 10% or more in any company, corporation, partnership, joint venture or other business at anytime during the reporting period? if yes. complete Supplement. Part Did you andlor an Immedlate family member own a busmess at any time during the reporting perlod? If yes, complete Supplement, Pan A. D. 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? a 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, andlor 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 andfor 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 EXCEPT CANDIDATES. Check the appropriate box. Contact Telephonehold a local elected of?ce. have read and am familiar with SMC 2.04.300 regarding the use of public facilities in campaigns. 1- Email: '3 i? (Home) Optional I certify under penalty of perjury that the information contained in this report is true and correct to the best of my knowledge. Uri/is (Ef?e ?an/Arm. Date {Signatgfe Do not use public agency addresWephone numbers for contact information. Report Not Acceptable Without Filer?s Signature COMPANY, ASSOC., GOVERNMENT AGENCY CONTINUED F-1 Name LOMBARD, JOHN Page 3 3 INVESTMENTS - DIVIDENDS C. Name and address of each company. association, government agency Capital Bank and Trust Company P.O. Box 6164 Indianapolis Capital Bank and P.0. Box 6164 Indianapolis Capital Bank and P.O. Box 6164 Indianapolis Capital Bank and P.O. Box 6164 Indianapolis Capital Bank and P-O. Box 6164 Indianapolis Capital Bank and P.O. Box 6164 Indianapolis Capital Bank and P.O. Box 6164 Indianapolis Capital Bank and P.O. Box 6164 Indianapolis Capital Bank and P.O. Box 6164 Indianapolis Washington State P.O. BOX 48380 Olympia Trust Trust Trust Trust Trust Trust Trust Trust IN Company IN Company IN Company IN Company IN Company IN Company IN Company IN Company IN 46206?6164 46206-6l64 46206-6164 46206?6164 46206-6164 46206-6164 46206-6164 46206-6164 46206-6164 Dept of Retirement WA Check here if continued on attached sheet. 98504-8380 Type of Account or Description of Asset American Balanced Fund Capital Income Builder The Growth Fund of America The Income Fund of America New Perspective Fund Capital World Growth and Income Fund Fundamental Investors The Investment Company of America Washington Mutual Investors Fund Pension Asset Value (Use Code) 2? 2/ 4 4% Income Amount (Use Code) John A. erzbam' 10724 81h Ave. NE Apt. 6 Seallie, WA 98125-7224 if? ar-vm-CLERK LO mi?: . --. 1. 1 *1 32?1??:gigigiluiliuii?i imiimhji Ii i; in?;