XGR Coash SFI

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    .J " ~ .",

    NEBRASKA i \,

    POSTMARK U 'D;ACCOUNTABILITY AND

    DATE

    DISCLOSURE COMMISSION STATEMENT 1/1MICROFILM I, ~7 n ' t ~ 0

    11 th Floor, State CapitolNUMBER

    OF.o. Box 95086 OFFICJ;J JSE ONL YLincoln, NE 68509 FINANCIAL L.!:]C

    i\ t. L t \/ j .. : ;

    (402) 471 -2522 "1t l f"JE f~-f.~~/~.~..INTERESTS

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    BEFORE COMPLETING 2009 JAN 26 f lU 7: 41inREAD FILING REQUIREMENTS t' I" rC!'f)""""NADC FORM C-1 . ' c . '''' ''V\'i'ir'I'~!-'11 rrv''';iSrq i" ! ( ' $ ;;: ;;:-i '.I.:.f:,~....~ I ~ c ,

    . . . . ~ Ll_ .! " tu - r: L '~' , ~ 'c SI '~ ''. , "L. .- .. .f.~ :i I t tt-J Uf".

    Candidates for designated offices and holders of designated offices and positions must file this statement . See Sections 1A and1B of the instructions .

    Can didates (including incumbents ) subject to this filing requirem ent must f ile with the Comm ission and with the appropriat eelection off icial (See Instruct ions ).

    Designatedofficeholders and holdersof designated positionsmust file this st atementwith the Commissionannually . Dollar values need not be report for any item , except Item 11 . Personswhofailsto f ile as required is subj ect to a civil penalty of upto $2 ,000 .ITEM 1 I YOUR NAME, ADDRESS AND PHONE NUMBER

    Name Coa::hCdb~

    .v.. Telephone No. JfoL~'/-71P~1npLAST FI ST MIDDLE

    Address gz.~ M~vvt ~ytf-, Lt' I1t 8 / h A/ ;;[5 ' ;).,)STREET ADDRESS OR RURAL R OUTE CITY STATE ZIP CODE

    ITEM 2 IOCCASION FOR FILING (Check Appropriate Box)

    o A candidate for elective office o Left office or position~ Annual officeholder's or state employee 's report o Newly app ointed to office or p osition

    ITEM 3 IOFFICE HELD & TERM OF OFFICE (Incumben t elected/appointed officials and state employees. SeeIB of instructions)

    List the office or position you currently Z WhiC~;ZS this filing ; tO Uhave left of fice, list the office you held .( } ' ( ) / 2ffice or Position : 5?;ic ~ .I . ~ JJ T ;OJ ;) :J Te rm : ;2 0 /}9BEGINS ENDS

    Nam e o f City, County, District, or State Age ncy:-,

    ITEM 4 IOFF ICE SOUGHT (Candida tes only. See 1A of instructions) // ~List t he office s ought which requires th is filing.Office:

    Name of City, Cou nty, District, or Stat e O ffice :

    ITEM 5 I PERIOD COVERED BY THIS STATEMENT

    This statement must cover a ll financial interests for the entire "preceding calendar year" and notjust as of year-end. Ifyou haveleft office, th is statem entmustcover all f inancial interestsfrom the end of the cal endaryear for which you previouslyfiled up to andinc luding the date y ou left office.

    ]& f This statement covers the preceding calendar year January1 thr ough December 31, :J60 r P-0 Left office , this statem ent covers the peri od January 1, to

    (DATEYOULEFTOFFICEORPOSITION)

    I Revised August 2007

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    . r- "=-"';"O;:.....,- _ _ -- ............_ ~'--.'- .. . ..... .... ._ - __ ....----r: rrEM '8 I REAL PROPER .TY OF 1\, _}FILER IN NEBRASKA (Real property v ~ ,~d at less than $1,000 and your

    personal residence need not be reported.)

    List all real property in your name or in which you have a direct ownership interest. The description required must be sufficient to identifythe location of the property. Exceptions: You need not report real estate owned by a business listed in Item 6 or 7, your personalresidence of real property valued at less than $1,000. Personal residence refers to your principal dwelling-house and adjacent land usedfor house-hold purposes , such as lawns and qardens .

    Location of Property Nature of Property(Description or Address (such as : agricultural, commercial, industrial, residential-rental)

    ITEM 9 IOTHER FINANCIAL INTERESTS AND PROPERTY HELD DURING THE PERIOD OF THIS STATEMENTWHICH EXCEEDED A FAIR MARKET VALUE OF $1,000 AT ANY TIME DURING THE REPORTING PERIOD

    Address

    (a) List the names and addresses of the inst itut ions in which you had checking and savings accounts and cert ificates of depos it.

    Financial Institution

    W eJLs ~ g zwJ< . . ,

    We-cJG6-.~f ';) ~

    R r~N,~~~

    ~~~ ~oU~ L~~)

    /(p,R .> O P~. L-I"'-C-D/n /lJE ~XSDJ '

    [aOO'S 0 Id..c....~ ~ Ljf 'l(~Jj-. j.)G fs;StCp~G..C :;C; 'S.. ~ --rrh U t '\..Ld", f\.JE.. ~$/)..

    IrD1 3 q ,'5 to f!.ock-L~ ~~ 6:1'::>70

    (b) List the names of the issuers of all stocks, bonds, and government securities, not otherwise listed under Items 6 or 7.

    (c) Describe other property owned or held for the production of income not otherwise disclosed in Items 6, 7, 8 or 9(a)(b). Includeleaseholds and other interests in real es tate, promissory notes and other obligat ions owed to you, beneficial interests in trus ts andestates, cash value life insurance, IRAs, deferred income and retirement plans . Exception: Do not include accounts receivable ,inventory, fixtures and equipment owned or used by a business listed in Items 6 & 7 or household goods , personal automobiles andother tanoible personal property unless such property was held primarily for sale or exchange .

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    ~ )ITEM 10 ICREDITORS TO WHOM $1,000 OR MORE WAS OWED OR GUARANTEED BY YOU OR A MEMBER OF

    YOUR IMMEDIATE FAMILY.Exception : Loans from a relat ive and land contracts which have been recorded with the County Clerk or Register of Deeds need not bereported . Accounts payable , debts arising out of retail installment transactions or loans made by a financial institution in the ordinarycourse of bus iness need not be reported .

    Name Address

    ITEM 11 I SOURCES OF GIFTS OF A VALUE OF MORE THAN $100 RECEIVED EXCEPT GIFTS FROM RELATIVES.(See definitions)

    Name and address of Donor O ccupation or nature of business of Value of Gift Description of Gift andDonor (See Key Below) Circumstances or Occasion for

    Gift

    Choose Value:

    Choose Value:

    Choose Va lue :

    Choose Value :

    Choose Value:

    Choose Value :

    Choose Value :

    Choose Value :

    The monetary value of each gif t shall be categorized based on the good faith est imate of the filer . For each reported gift insert in theValue column the let ter which corresponds to the value category of the gift . The value categories are :

    A) $100.01 to $200; B) $200.01 to $500; C) $500.01 to $1 ,000; D) $1 ,000.01 or more.

    ITEM 12 I SIGNATURE OF FILER AND DATE .I hereby s tate that I have used all reasonable diligence in the preparat ion of this Statement and that to the best of my knowledge it is trueand complete.

    C;ft;L~ I/JlYdC4(Siqnature OfF 'C - (Da te) / ( l

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