File with: Seattle City Clerk SEEC FORM SEEC PO Box 94728 DOLLAR PERSONAL Seattle, WA 98124-4728 _1 CODE AMOUNT FINANCIAL ?magi.? Questions: (206) 684-8500 9 ELECTIONS (206) 615-1248 (7118) $0 $999 EFAIRS polly.grow@seattle.gov g; 2:333:13 (4) $10,000 -- $24,991?; fig. Deadlines: Incumbent elected and appointed officials -- by April 15. (5) $25,000 -- $99,999\ =47; Candidates and others within two weeks of becoming a (5) $100,000 $199,999: - candidate or being newly appointed to a position. (7) $200,000 ?999$; :33 (8) $1,000,000 -- $4,999,995: SEND REPORT TO Seattle Clty Clerk $5,000,000 or more C53 :3 3 "immediate family" means: a spouse or domestic partner, or a parent, parent of a spouse or domestic partner, child, chlidDOf sp partner, sibling, uncle, aunt, cousin, niece or nephew, if that person either resides with or is a dependent on the Covered lndividual's most recently filed federal income tax return. SMC 4.16.080 ouse or domestic Last Name First Palaeoli- Middle Initial Mailing Address (Use PO Box or Work Address) I752. ANA) [ft-30252 County if gaw- 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 them. Do identify your spouse or domestic partner. Filing Status (Check only one box.) lama An elected or appointed official filing annual report Final report as an elected of?cial. Term expired: ?andidate running in an election: month/[20V Newly appointed to an elective office year 20? 5 Office Office title: (bunCi/MCH&? Held or Sought Position number: Term begins: We emu 1 INCOME 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 immediate family member, received compensation, in any form, of $2,400 or more during the period. Include stock 33335303)? Name of [31-22% Source of Compensation OccupationW or HEow Campensation Dependenl(D) TF6 gr; as arne - - SB 0 3? %3e 6. engined Mala! J5, d?m'reBaso Seed-He, we (3) m? 35]an Abbi/012?! ale Cooled/r2 [19? dealt/e; WA Q8103 I Check Here if continued on attached sheet 2 REAL ESTATE 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 reporting period. (Show partnership, company, etc. real estate on F-?l supplement.) Property Sold or Interest Divested Assessed Name and Address of Purchaser Nature and Amount (Use Code) of Payment or Value Consideration Received n/A (Use 1?9 Code) Property Purchased or Interest Acquired Creditors Na (Address Payment Terms Security Given Mortgage Amount - (Use Code) "$31373 11.: mag, 20 at Original Current 29.3? . vi cg off? ?4 I 0 I All Other Property Entirely or Partially Owned ?Check here if continued on attached sheet CONTINUE ON NEXT PACE 3 List bank and savings accounts, insurance policies, stock, bonds and other ASSETS 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 financial 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 assetsfinvestments 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 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 origin? -) (eg.6years deco/law Imd?ve?w Z0 gas/5.04, Nana Check here if cont ued on attached sheet. Enter Dollar Amount 5 NET WORTH Enter your estimated net worth. 5 (0 7 9 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 of?ce filing your initial report, no F-1 Supplement is required. Incumbent elected officials ?ling 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 andlor an immediate family member (1) an officer, director, general partneror 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 andi?or an imme is 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 andfor an immediate family member own a business at any time during the reporting period?& 0 If yes, complete Supplement, Part A. Did you andi'or an immediate family member prepare, promote or oppose state islation, 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, andtor 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 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: (602) 7?0 Bl] I hold a local elected of?ce. I have read and am familiar SMC Email: babbf? . Came?) 2.04.300 regarding the use of public facilities in campaigns. Email: ,(Home) Option; CERTIFICATION: I certify under penalty of perjury that the information contained in this report is true and correct to the best of my knowledge. . 05/99/90:? Date Signature Do not use public agency addresses or telephone numbers for contact information. Report Not Acceptable Without Filer?s Signatl