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:�'��IN"I�:�C'��'����'vT �� 15 <br /> 2��� t ��q <br /> �� �ff� <br /> (`��y f���/' �'+ ^g� e��r'�('� ('`�}� [ ,_ <br /> �s'�r'�.�.� QF` �ry��T'3�£T�' ����I�`���'5������.ti! <br /> llE�l,�:�li1.71'.: �:.���'�� .{�3 .1\�1..lP���. i..`3���t.�� i ..�.� <br /> t�° 's` <br /> u�.�� ���a�t'� <br /> ���iV�� t✓��� 1 I ������.7�7����[1�aJ <br /> D��CL.t��SIJRE �TATE�IIENT <br /> Th� mirrirr�al requirerr��r�ts for ct�m�Jetior► c�� this €orm �r� that it be �c�mple#�d at c�r durinc� th� annual <br /> CC�rg�n�za#i�nal C�l�eiir�g c�f the �c�urtty �s�rnmissic�r�er� after tt�e e�ection r�e appointm�nt and ali <br /> sub�equent e4ecti�ns car a�apr�intm�r�ts to t�e cafFic� of �€�unty C�mmissic�ner �f �ach �€�mrrris�ir�r�er. <br /> Nc�vvever� it 'ss recon�rx�enc��� th�t com�i�sioners cc�rnplet� thi�form annuaC(y d�rirsg each t�rg�r�iza�i�nal <br /> �vleefiinc�. <br /> Pie�se ar�swer �11 c�uestit�r�s �nd �l�ere yc��tr ��$�r�r is nc�n� car r��t ap�licabl� �c� state. ANSWERS <br /> SMt�UL�? BE PR(P�TEC� C3R TYP�D. anci additi���l she�ts may ��: usecf if mare space is needed. For <br /> cl�rificati�r� �f ar�y q�restic�n, please ref�r tca tt��; Cc�unty Att€�rr�ey. Upc�n cc�m�(�ticrn #�i� Disc(c�sure <br /> �tatem�nt sh�i! k�e fileci w�th the Clerk tr�the Bc�arc� �f Cc�ur�t� Gr�rnmi�s�c�ners. <br /> Nr�t�: The faiiure tc�fi�e this C�is�los�r� St�ter�n�nt is � vic�E�tion �f tt�e �cade c�f Ethics �r�d rr�a� s�abj�ct ye�� <br /> t� censur� ar cath�r p�n�lt�es. � <br /> 1. <br /> � �t�Alt�� C��' ��Fi�l1�� {E}��T� �FIE��T} (1�IT��iL� T1TL� � <br /> 2, <br /> Ht��11E AL�C�F�ESS (STREET} {G1TYtTC�V'VN} �Z1P CC�DE} <br /> MAIL(N� At3DF;�S� (Cf diff�r�rat frorr� hcsme addee��} <br /> 3. 1 w�s elected on _ I w�s ap�ac�in�ed c�n - <br /> 4. �i�t the fc��l�v�rir�g: NA�IfE C)� Si�4l�S� • <br /> 5. List�f�e addr�;ss ar lec�a� efescriptic�n c�f any real estat�; includ�ng yaur principa! residence, �n whi�t� yc�u <br /> c�� �t�ur s�rous�, ��ve a financi�l i�ter�st. <br /> NATURE C)F INT�F�EST AQdRESS C7R C}E�CRIPTlQI� <br />