BALTIMORE ETHICS BOARD 626 City l-{all Baltimore, Maryland 21202 Phone: 4 I O-396-4730 Fax: 4lG-396-8433 baitimarecitjv. aspx IMPORTANT: LATE Fee: Rim: DIRECTIONS FINANCIAL DISCLOSURE STATEMENT FOR AND Emmovees GTLNERALLY NOTE: Bott!-itulictzed terms are defined in the accompanying Financial Disclosure Directions. which should he reviewed carefully before completing this Statement. PART A. IDENTITY OF MAKER All lilcrs: . Lust Name First and Middle Names Q. Principal Residence . Nt. r3 - 10 Residence Telephone All lilers except candidates lor elected ofticc; Agency (Dept Division, Bureau} Position with Agency Office Address Office Email Address: Candidates elected ntiice: Office Sought PART B. Twt; or Penton Covtaman All filers must check the applicable type of Statement and specify the year for which it is tiled: Statement Entry Statement Departure Statement Candidates Statement For Calendar Year NL, Pcrsons tiling a Dcpartun: Statement must also complete the following {see Directions at Part This Statement also covers the period oflanuary 1. 20_ through 20% PART C. RECEIPT BY ETHICS BOARD NOTE: To be completed only by Ethics Board. this Statement and accompanying Schedules were received tiling on A t2 2 hor Board ol Foam Rt:v?nt1rtl PART U. IN REAL lluring Lhe reporting period ooyered by Lhis Statement, did any ol' iioiluv-'ing have any inreres! in any real property property purchased or teased us your or their personal residence), whether located in or outside Baltimore City? [fy-nu answer "yes" to any eom plete and attach Schedule 1. a. 'ies ta. A _.Family member {il`yeu directly or indirectly controlled that Jrittmily membefs Yes e. An nuribulnbfe entity 'ies 2?_No d. A palinership, limited llehiliry partnership. limited liability unineorpemtect entity in as-'hich you. afomilj-f member lilyou tlircetly or controlled that family inleresil. or an aoriburoble enriljr held an interest _'Kes I-. IN BUSINESS During l.l1|: reporting period covered by this Statement, did any of the following have any inreresr in any business surrey? lf you artswer "y es" me any of these. eomplete and attach Schedule I. e- You LND li. A fum-ily member [if you directly or indirect] controlled that membefs interest! Yes 130 C- An entity yes ima E'l1llL`5 Pom-I TIE-GUFL Revo I .lu WITH BUHHEFS DOING IWTH During the rfporring per-lon' covered by this Statement. did any ofthe following hold an ofiiee. directorship. satan-led employ ment. or similar position with any business entity that does business wok the Cin- lor is regulated by or lobbies betbre the answer "yes" to any of these, complete and attach Schedule 3. a. "r'ou 't"es Ho lt. Your spouse or child 'ties Ho c. "t"ou.r parent or Sibling tflo the extent lcnown to you) Yes 4. must Pensotvs Home During the reporting period covered by this Statem ent, did any of the foliowing accept. directly or indirectly. any ggi* [including payment of travel expenses] from any person that [il does business with nite Fig: lor is regulated try or lobbies before the or [ii] is an owner, oflieer, director, trustee. employ ee. or agent of any person that does ousiuess with the Cin' {or that is regulated by or lobbies before the Ctryi? Ifjrou answer "y es" to any ofthese. complete and attach Schedule 4. a. You No ln. member or other person at your direction Yes x_ Ho 5. Detrrs To Psnsonts WTFH During the rqzrordng period' covered by this were any ofthe lbllowing indebted to any person that does business with the {or is regulated by or lobbies before the Note: The following debu need not be reported: utility accounts telephone, gas., electric accounts); or tiil retail credit or installment sales accounts leg.. credit card purchases or advances: car or applianoc tinaneitlg through dealer or established lender). lfyou answer to any oflhese. complete and attach Schedule 5. il. Yes No b. member were involved in the transaction givirig rise to the debt; 'ret ,tg no ETHICS FtJ|tn>>1 tht'-f'o1l-'ll FAJHILFJUEMBERS CITY During the reporting period' covered by this Stetem ent. were any of the following employed by the City? Ifyou answer "gf as" to any ofthese, com plelt.: and attach St: hldult 6. a. spouse or child Yes No b- parent or sibling Yes Ho UTHER EAILNED INCDHE Iluri ng the rqp-ortirlg period' covered hy this Statement, were any ofthe following tj) at compensated employee ol' someone other than tht: City; an owner (sole or partial) ofa business entity; or a recipient ofoamnd income tiom a basing: you answer "gf es" to any ofthese. complete and attach Schedule Your spouse or ehilcl Yes i Ho E. Is there any other interest or infomation that you would like to diselo se? lfyou answer "gf es". oomplete and attach S-uhedule E. 'res 2; no ETHICS FORM RT E. SIGNATURE AND 1.-. I, Eva* olemnly aftirm under the penalties ofpetj that the contents oflhis Statement and of' all accompanying Echeclules are true to best ofmy [f:11owicdge, information, and belief. PART F. NDTARIIATIDN STATE DF OF . {5ignat1.Lre] 1 thal,_ this day ol' Ir before me tary Public in and for the of personally appe ed ff' acknowledged that this Statement, the accompanying Schedules. and the preceding Afiirmalion were al] act- WITNESS, my haltd and Notarial Seal: .- (No uhlic]- M;-f Commission Expires: 2: ETIITCS I IFI I (PA GJ: BLANK) I REAL PROPERTY NOTE: Fur more than one property. make ad ditiunal eupies of this Schedule. l. AND DF PRDFE A er Legal Deseripliuni qn lc' iq' - il--1 BQ ul.. - up A ci of Frupemfi Improved Llnimpmved Residential Cum mereial Clther (explainHOLDER DF Name: A Re Relationship in Statement Maker: Self Fipnuee Child ?_Parent _Sibling Entity entity in which time held H11 interest ':llU Pl. n1_)L "1 . 3. DF of interest: Fee simple Lite Estate Leasehold Uther Flew held: Finlelgf' held _leintly held' lfjeinllg.-' held. Slate *I-it ef imetesl: E11-iles Foam l.1 -L PROPERTY Name: Address: _1 T'~IaJ'nc: i 5. CDN UR ENCUMBRANCE5 DH INTEREST Dcalzzribf: Lhv: uf any uundilluna ur on Ihr: interest and inicnliljf all parties E. HIJW From Whom .fum-es: gmc; "Em, Addrussz Dau: Acquired: ul' Acq uisitinnz Gif! Inhtritancc (Explain): Acquimd by Purchase: 211151 dollar amount [Gr '-fa1fu?} paid Fur imreresl: Than by FurChE15|:: Fair ma.rI>>: at \-"alum: of Insgrasr 3 3.2 T. TR.-U45 FEES - ifall ur any part ut' nh: Inter.-ss: Iran silerreci ua an other during the period by the - Perma tu Whom frlreresl Trdn5i?tn'?d: Narnt: A Nature and a.1'rmunl ul' th: fnleresl Nature and -Llullar amuu nl [ur valuefl received For . l.3 E-TH ICS IIFI1 {Pf| GE LEFT INTENTIQNALL BL.4fw<} SCH I EJVTITIET For more th an one business make additional copies of this Schedule. l. BUSINESS NaJ'ru:: Wi Address Uftice: I. HOLDER DF Name: Relationship lo Statement Self Epo use Child _Parent _Sibling Entity 3. AND GF Type Sole proprietor Genera] Partrler Limited Partner Joint Venturer Trust Beneficiary Truster Ret-'ersinnars' Interest Sluekhelder Either Lexplainfl: Amount For sr nun-equity Interest ieg.. netes er hon-:Isl in any business enriry, indicate - dollar value of the interest 2 For an eq uit); interest in a publicly traded co|'poration, specify eirher -- dollar value of :he Interest 5 or number |;1t`shares owned: 2.1 ETHICS Flu" rr I If I I For an equity interest in a or other #urinate 5-[1-Errify - either - dollar value ol' the interest: -'rr both - number of sharesfu wnership units uwned: mm' percentage ofcompanjr ownership rcpreacnted by the interest: CONDITIONS OR BRANCES Deacribe the terms cunditiu na or on the interest and all partica im' olvcd: l, S. HDW Nate: Complete the following, if the interest was acquired during the period cox-'ered by this Statement, {Exc~e'ptEnn_ Ifthe was acquired hy' dividend, [ii] ltunaials Solelgf' ol' tulditiuns to et-Listing publicly corporate interests. and has a value ofleas than SSDD, you need only complete the item below labeled "Manner ot` ui5ition".} Person From Whom Interest Acquired: Name: Dale Acquired: ol`A4:qui5itiun: Purchase Gilt Inheritance {`.lther (explain): _-'koquircd by Purchase: Hature and dollar amount [or aluc] paid for inrerexr: Ifhequired Than hy Fair market value when acquired: 5. TRANSFERS Tfall or any pan ol the interest was transferred lu anuthcr during the period by the Statement - Person to Whom Name: 2_2 E111 tes Fo:-Lvl Iltll Address: Nature and Bnmunt :rf the inreresr Dans ferred: 14 Falun: and dollar amount mr value) re1:>>:iv>>:L1 for Lhe lnreresz: 2.3 Rm-"n 111| I EE LEFT 3 FUSFFIDNS WITH BUSINESS DIJIHG HTTH For more than one business entity or more than one position holder, make additional copies of this Schedule. CIF Home: Gr mum-.s of Principal 4-- 4 1. Hi] LDER POSITION Herne: lv- -P Helalio nship- to Statement Maker: Self Spouse Chi]-tl _Parent _Sibling Address: 3. DF FDSITIUN Title: 55| in ig.) I U-a--cm fb Date Started: 1-'U'l 7- Geneml Dulles-I-. AG EHCIES BUSINESS Identify each agen cy of the with whi|:h business does business und, as to eat. h. the mature business at inlmum_ the business sudo' ii] is in sales or with the agency; Liit is regu ted. by the agency; nr (ii) is at lo bhyist with respect to matters hetore the U. s- E1-|-uns Fomn 3.1 BLA mfr) Eff -I FRU PHI DDIHG HUSIJVESS Provide the following information for meh gy! or series, of from the some person or en tity. If needed. male additional copies of this uit- lt ilJEi"4`I`lT"r' FEHSEIN MAKING GIFT HUTE: [-tlenliij' here the individual or entity hy or on whofae hehaltl whether directly or indirectly, the signyieanr gm was given- Nemo: 2. ENT GIFT Relationship to Statement Maker: Self member or other person, at your direction ddress: 3. UF GIFT Describe gm: Retail 5 4. TRAVEL EXPENSES ]t`thc gm' cntaiicd any ibr all or any pa-,tri ofa Lrip or tor meals. beverages, lodging, ment. or other .associated expenses, provide Lhe followilig iniomtotion For thot trip: [.oL:oliot17 Nurture ol' Iiveutti Ifuir el Value Entire Trip: lor by You: 5 Amount Paid for by P'er.rorr ldenlitiod in Eeellon l: 3 Emlcs Forum Ef'f'L. 4.1 Revo I l."J I JPA GE ur BLA 5 Tu Pettsonfs DUIHG twru nrt' NOTE: Fur more than one person bntSIrte.1i'.1i' wir# rite mallet additional Wpies ul' this Schedule. I. CREDITDR l"-lame: A Addrt:55 Office: I. DEBTDR Hatnc: Fl Reialiuntihip IU Statement Maker: Self Spouse* Child* Parent* Sibling* A ddress: *Describe your involvement in trattsactittn: 3. UF DEBT Dale Inctu-reti: A Terms of Payment: per [Jther texplaln (number) Quarters 'fears l. Uther (explain): 5- I Fmul Erv'L I I FUR DEBT fi None Real Propeny (address): Property {dE543ribe}: Either 5+ PRINCIPAL BALANCE AL 'Start of repurnng permd: PHT. and Di' peri'm:': 5 - ETHICS I-'nam 1 U1 I I. Name: I4 SCH El] ULE Ii AUEMBERT E31 PLDYEIJ BT CITY Address: Name of Agency: Ville and Nature Position: 7_ 2. Nalmrl Pi Nam: Title and Nature 0 f`Positiu|1 3. Marne: A A Nam: Title and Nature -1-. A Hume and Nature Position: E11 Ilfll LPA GE: LEFT 1/ l. 2. 3. 4. DE LE SIJIERCES DF EARN El] STATEMENT MAKER Nzarnf: Maker: lug' Business Nami: and Title Exrhd Nature . Name of Sp-muse: mi Business Ham: and Address: l`illc ami Tiaturc L1 t' Pusitiun: Name Business Enfigfs Hamm: and Address: Title and Nmurr: CI-IILIJ Timne nf Child: I4 Business Enriqfs Marne and Address: und Hurur: :1 1` Position: 7.1 FORM FH:v'n 11f1l 5+ CHILD Enrilj-"5 Ham: and -v :md Huturc 1:1 fPnsitic|n: Foam HI I L13 FDBM Flfi-G I Name: Address: tix. EE L. AJ Organ ization: 2"-15 I I Lf' Date: 2' 2012 Nam: ull Fnrm[.1) Inspected: -3 QGLE