. File with: Seattle City Clerk SEEC FORM SEEC PO Box 94728 DOLLAR PERSONAL seame, WA 98124-4728 _1 CODE AMOUNT FINANCIAL Questions: (206) 684-8500 I 24 g; .3333 ?gyms/*4 poliy.grOW@seattie.gov (3) $5,000 $9399 STAE (4) $10,000 $24,999 CL Deadlines: Incumbent elected and appointed officials - by April 15. (5) $25300 $99,999 Candidates and others within two weeks of becoming a (6) $100,000 $199399 0 candidate or being newly appointed to a position. (7) $200,000 $999,999 Ca 9/ $1,000,000 $4,999,999 SEND REPORT TO Seattle City Clerk (9) 55.000.000 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 lndividual's 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 I 61 other dependents living in your household, dovnqt identify Mailing Address (Use PO Box or Work Address) them. Do identify your spouse or domegttijc partner. . A I g3 illz E. 51?, f: .. City 4: 5 LE Kiel 9312/; .4. . .v County Zip 4 Filing Status (Check only one box.) Of?ce Held or Sought El An elected or appointed of?cial ?ling annual report Office title: (T (U I C: Final report as an elected of?cial. Term expired: . . .I . Posrtion number: 3 Candidate running in an election: month 0 (f1 year elm eglnS023 Newly appornted to an elective of?ce 1 Show Self (S) Spouse (SP-DP) Dependent (D) 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. 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: Was Earned (Use Code) .. . We zqug ((12.5 PIKE, 9T. 9W2), EVEL- Dl'kt'n" (5.) ., ., . 5 . .ck'Pii?vL Han} 0F Mitt/?De (?ll 3 text; Fin?i ate-me wA 90ml . . . . res-mt wt) Mill 5 Check Here if continued on attached sheet 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 duringthe reporting period. (Show Jartnership, company, etc. real estate on F-1 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 All Other Property Entirely or Partially Owned f. . . 262.35le PM ?jaws :r 1? (l - (900 ?new WW I m" WILL - -. (u (1) Check here it continued on attached sheet AS CONTINUE ON NEXT PAGE -- List bank and savings accounts, insurance policies, stock, bonds and other 3 ASSETS I INTEREST, 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 - . L. (Use 1-9 (Use 1-9 Code) A. Name and address of each bank or financial institution in which you at 975 A I Code) or an immediate family member had an account over $24,000 at any b?t?NlC A A time during the report periodMTLC WA it? I '11 B. Name and address of each insurance company where you immediate family member had a policy with a cash or loan value over -, . . $24,000 during the period13W MAD IKDN . . Mme WA in C. Name and address of each company, assocratlon, government agency, etc. in which you or an immediate family member, owned or . . . had a ?nancial interest worth over $2,400. Include stocks, bonds, ??941 SEAT ownership, retirement plan, IRA, notes, stock options, and other DI 4 intangible property. If you or your immediate family member had i fl) Ct? p! 5 decision making authority regarding individual assets/investments list 2? ?t . C, . - each asset or Investment, the value and any income amount. .i ?1 0" EXAMPLE: If you self-directed an investment account identify each 1 stock or other asset in that account. Stock shall be reported by 4? (1.017;. A i} market value at the time of reporting(3) OVER $7"ch 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. L.) 9?0" 0 0 L7 I 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 of?ce tiling your initial report, no F-1 Supplement Is required. Incumbent elected officials filing an annual ?nancial 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 and/or an immediate family member (1) an of?cer, director, general partner or tmstee of any corporation, company, union, association. joint venture or other entity or (2) a partner or member of any limited partnership, limited liability partnershi limited liability company or similar entity including but not limited to a professional limited liability company? If yes, complete Supplement, Part [-CALLED. Wt DMREE LU.) B. Did you and/or an Immediate family member have an ownership of 10% or more in any company, corporation, partnership, Joint venture or other busmess at any uni dunng the reporting period? ?1 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 and/or 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? I: If yes, complete Supplement, Part B. E. Only for Persons Filing Annual ReporL 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 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: 20? Sf 7-9 . 5' Lff? El I hold a local elected office. I have read and am familiar with SMC . - . - on 2.04.300 regarding the use of public facilities in campaigns. Ema?: 9?61 A 3 8' ?kf l6 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. ul-lgnwia 94k, 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 5 PO BOX 94728 SEEC FORM 7 ,7 Seattle,WA93124-4728 SUPPLEMENT PAGE sums ETHICS r. PERSONAL FINANCIAL AFFAIRS STATEMENT chMIssmII SUPPLEMENT Polly.Grow@Seattle.gov (7,18) PROVIDE INFORMATION FOR YOU AND ANY IMMEDIATE FAMILY MEMBERS Last Name First Middle Initial DATE BUSINESS (1) were an of?cer, director, general partner, trustee, or 10 percent or more owner of a corporation, non?pro?t organization, union, partnership, joint venture or other entity; and/or (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. OFFICE HELD, Provide the following information if, during the reporting period, you or any immediate family member . 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 andlor percent of ownership held. . Brief Description of the Business/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. 0 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 seek/hold 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 N0. 1 Reporting For: Self Spouse Registered Domestic Partner CI Dependent I: LEGAL NAME: 0 If I) Ill: LC TRADE OR OPERATING NAME: A g? ADDRESS: 91? 96mm NA BRIEF DESCRIPTION PAYMENTS ENTITY RECEIVED FROM GOVERNMENTAL UNIT IN WHICH YOU OFFICE: Purpose of payments Amount (actual dollars) PAYMENTS ENTITY RECEIVED FROM OTHER GOVERNMENT AGENCIES OF $12,000 OR MORE: Agency name: Purpose of payment (amount not required) A PAYMENTS ENTITY RECEIVED FROM BUSINESS CUSTOMERS OF $12,000 OR MORE Customer name: Purpose of payment (amount not required) WW FMKL BREWINL to gf?owgo ?15 FERN 0? (UGA PD 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/Wit continued on attached sheet CONTINUE PARTS AND ON NEXT PAGE Page 2 F'l Supplement Name ENTITY NO. 2 Reporting For: Self Spouse El Registered Domestic Partner El Dependent LEGAL NAME: POSITION OR PERCENT OF OWNERSHIP TRADE OR OPERATING NAME: ADDRESS: BRIEF DESCRIPTION OF THE PAYMENTS ENTITY RECEIVED FROM GOVERNMENTAL UNIT IN WHICH YOU SEEKIHOLD OFFICE: Purpose of payments Amount (actual dollars) PAYMENTS ENTITY RECEIVED FROM OTHER GOVERNMENT AGENCIES OF $12,000 OR MORE: Agency name: Purpose of payment (amount not required) PAYMENTS ENTITY RECEIVED FROM BUSINESS CUSTOMERS OF $12,000 OR MORE Customer name: Purpose of payment (amount not required) 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 (Use Code 1- 9) A Check here if continued on attached sheet FOOD Complete this section if a source other than your own governmental agency paid for or othemise 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) -- Pr Check here if continued on attached sheet AVE PARTNERS, LLC. 219 FIRSTAVE. SOUTH, SUITE 320, SEATTLE, WA 98104 1- .- A- . . 4?1. .5 ?no pun. ed. ?anppm; an} .?Ju 2 .5. 31.}