File with: Seattle City Clerk SEEC FORM PO BOX 94728 Seattle, WA 98124-4723 _1 CHF Questions: (206) 684-8500 (206) 61 5-1 248 (7,18) polly.grow@seattle.gov Incumbent elected and appointed officials -- by April 15. Candidates and others -- within two weeks of becoming a candidate or being newly appointed to a position. Dead?nes: SEND REPORT TO Seattle City Clerk SEEC DOLLA CODE (1) (2) (3) (4) (5) (6) (7) (8) (9) PERSONAL AMOUNT FINANCIAL $0 -- $999 AF RS $1,000 -- $4.999 $5,000 -- $9,999 ST MENT $10,000 -- $24,999 :o $25,000 -- $99,999 .2, $100,000 .- $199,999 ~77: $200,000 -- $999,999 (r2 gr! $1,000,000 -- $4,999,999 27:: 3 $5,000,000 or more as Lg? vv "immediate family" means: a spouse or domestic partner, or a parent, parent of a spouse or domestic partner, child, child of spo 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 mo?cently filed federal income tax return. SMC 4.16.080 Last Name First git/av 5 A Middle Initial 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. Mailing Address (Use PO Box or Work Address) (a 00 Paar/W Ada ?F/om/ City 'County Zip 4 (Katha?4* aft/? ?7625 Filing Status (Check only one box.) An elected or appointed of?cial filing annual report Final report as an elected of?cial. Term expired: Candidate running in an election: month year Newly appointed to an elective of?ce Office Held or Sought Office title: Se ect Office S'Lm??c ((47 Gwd( Position number: No. 6 Term begins: L101 203,0 ends: Dec. 1 INCOME (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 options received during the reporting period that had a value of more than $2,400. Show Sell (8) Spouse Dependent (D) 5 Name and Address of Employer or Source of Compensation 6?le of 5:61 (90 Am Slut HM Wd?r Said 5h) was Check Here if continued on attached sheet Occupation or How Compensation Was Earned $1151?: ?tffimwad 1am (ii-Lh??vhf-L (3) Car Amount: (Use Code) 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 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) I . all AM Property Purchased or Interest Acquired Creditor?s Name/Address Payment Terms Security Given Mortgage Amount - (Use Code) (eg. 20 at Original Current i N/rir WA WA vU/f?i r) All Other Property Entirely or Partially Owned fit/(K r) M/ri N/ri (r Check here if continued on attached sheet CONTINUE ON NEXT PAGE 3 List bank and savings accounts, insurance policies, stock, bonds and other ASSETS INVESTMENTS intangible property (including but not limited to stock options) held during the reporting period. Type oi Accouni or Description of Asset Asset Vaiue Income Amount . (Use int) (Use 1-9 Code) A. Name and address of each bank or ?nancial institution in which you . i: Code) or an immediate family member had an account over $24,000 .7, time during the report period. )Zoji'i?teW WA . (5 (3 w, vat/M mp . to B. Name and address of each insurance company where you or an 3 immediate famiiy member had a poiicy with a cash or loan vaiue 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 ?nancial interest worth over $2,400. include stocks, bonds, ownership. retirement pian, notes, stock options, and other intangible property. if you or your immediate family member had decision making authority regarding individual assets/investments list [k 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 famity 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.6yearsat5.25%) N/n Check here if continued on attached sheet. 5 Enter Dollar Amount NET WORTH Enter your estimated net worth. 1 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 your initial report, no F-1 Supplement is required. incumbent elected officiais filing an annual financial affairs report also must answer question E. An F-'i Supplement is required of these officeholders uniess 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 trustee of any corporation, company, union, association, ioint venture or other entity or (2) a partner or at of any limited partnership, limited liability partnership. limited company or similar entity including but not limited to a professional limited liability company? if yes, complete Supplement. Part A. 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 business at any time during the reporting period? trim? if yes, complete Suppiement, Part A. Did you and/or an imme iate family member own a business at any time during the reporting period? fit yes. complete Suppiement, Part A. 5 Did you andior an immediate family member prepare, promote or oppose statejggisiation, rules. rate standards for compensation or deferred compensation {other than pay for a currently-held pubiic office) at any time during the reporting period? if yes, complete Suppiement. Part B. E. Only for Persons Filing Annuai Report. Regarding the receipt of items not provided or paid for by your 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 occasionroe 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? '33 if yes to either or both questions, complete Supplement, Part C. . 1 7 ALL FILERS EXCEPT CANDIDATES. Check the appropriate box. Contac, Telephone, 7M, 3 i hold a local eiected office. have read and am familiar with SMC -. . ,c 2.04.300 regarding the use of public facilities in campaigns. Ema'l' Dom Se 3/0 (work) Email: (Home) Optionai CERTIFECATION: I certify under penalty of perjury the information contained in this report is true and correct to the best of my knowledge. I it have .q . Date Sig?ajm'? Kwy? Do not use public agency addresses or ielephone numbers for contact information. Report Not Acceptable Without Filer?s Signature File with: Seattle City Clerk PO BOX 94728 SEEC FORM Seattle, WA 98124-4728 SUPPLEMENT PAGE 684?35? PERSONAL FENANCIAL AFFAIRS STATEMENT EtEcrimis (205? 61 5'1 248 SUPPLEMENT . Poliy.Grow@Seattle.gov (7/18) PROVIDE FOR YOU AND ANY IMMEDIATE FAMILY MEMBERS Last Name First Middle tnitial DATE OFFICE Provide the following information if, during the reporting period, you or any immediate family member A BUSINESS (1) were an officer, 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, timited 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 Iegat 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 office 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 seek/hold office) 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 reat estate owned by the business entity if the quali?cations referenced below are met. ENTITY no.1 Reporting For: Self El Spouse Registered Domestic Partner Dependent LEGAL NAME: ?vijL/K LL POSITION OR PERCENT OF OWNERSHIP . a . 5 . . '5 TRADE OR OPERATING NAME: {gzterLogg belt/MJVK My) ID ADDRESS: 311%; 57?? 5f? DESCRIPTION OF THE Ft??vek?tb? ?Ewe rm 3 earns PAYMENTS RECEIVED FROM GOVERNMENTAL UNIT IN WHICH YOU SEEKIHOLD OFFICE: Purpose of payments Amount (actual dollars) N/e 9 PAYMENTS ENTITY RECEZVED FROM OTHER GOVERNMENT AGENCIES OF $12,000 OR MORE: Agency name: Purpose of payment (amount not required) 9? PAYMENTS ENTITY RECEIVED FROM BUSTNESS CUSTOMERS OF $12,000 OR MORE Customer name: Purpose of payment (amount not required) Iii/A (2 WASHINGTON REAL ESTATE IN WHICH ENTITY HELD A DIRECT FINANCIAL INTEREST (Complete onty 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): [kl/h A Check here it continued on attached sheet CONTINUE PARTS AND ON NEXT PAGE Page 2 Supplement Name ENTITY NO. 2 Reporting For: Self [j Spouse Registered Domestic Partner Dependent El LEGAL NAME: OR PERCENT OF OWNERSHIP TRADE OR OPERATING NAME: ADDRESS: PAYMENTS ENTITY RECEIVED FROM GOVERNMENTAL I Purpose of payments HICH YOU OFFICE: Amount (actual dollars) PAYMENTS ENTITY RECEIVED FROM OTHER GOVERNMENT AGENCIES OF 93 000 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 owners in the ENTITY is 10% or more and assessed value of property is over $24,000. List street address, assessor parcel number, or tegal description and county each parcel): Check here In if continued on attached sheet List persons for whom you, or any Immediate famiiy member, iobbied or prepared state legislation or state rules, rates, or standards for compensation or deferred compensation. Do not list pay from government body in which you are an elected official or professiona! staff member. Person to Whom Services Rendered Description of Legislation. Rules, Etc. Compensation (Use Code 1? 9) I Check here if cont?nued on attached sheet FOOD Complete this section if a source other than your own governmental agency paid for or otherwise provided all or a TRAVEL portion of the foiiowing 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 Codei-Q) . i it A: Check here CI if continued on attached sheet