APPENDIX A:  FINANCIAL INTERESTS STATEMENT
   In accordance with Ordinance No. 31:94, this statement of financial interests shall be filed with the Board of Ethics, or the administrative official designated as the custodian of its records by the Board, no later than 4:30 p.m. on March 15, 1995.  A newly appointed officer must file this statement no later than thirty (30) days after the date of appointment.  A candidate for city office must file this statement no later than thirty (30) days after the date on which the person becomes a candidate for elected city office.  (Nothing in this financial interests statement should be construed to require any officer or candidate to disclose any specific dollar amounts nor the names of individual clients or customers of businesses listed as sources of income.)
1.   Name:                                           
2.   Title of Office or Office Sought:                             
3.   Current Address:
   a.   Business (including telephone number):
                                           
                                           
                                           
   b.   Home (including telephone number):
                                           
                                           
                                           
4.   Occupation:
   a.   Filer:                               
   b.   Spouse:                               
5.   Please identify any source of income of the filer and the filer's immediate family members that exceeds $5,000 during the preceding calendar year, and the nature of the income (e.g., salary, commission, dividends, retirement fund distribution, etc.):
   a.                                                                                                                                      
   b.                                                                                                                                                                                                                
   c.                                                              
                                                                     
                                                                       
6.   Please list the name and address of any business located within the state in which the filer or any member of the filer's immediate family had at any time during the preceding calendar year an interest of ten thousand dollars ($10,000) at fair market value or five percent (5%) ownership or more:
   a.                                                              
                                                                     
                                                                     
   b.                                                              
                                                                     
                                                                       
   c.                                                              
                                                                                                                                             
7.   Please list the name and address of any business located outside the state, if the business has engaged in any business transactions with the city during the past three (3) years, or which is anticipated to engage in any business transactions with the city, in which the filer or any member of the filer's immediate family had at any time during the preceding calendar year an interest of ten thousand dollars ($10,000) at fair market value or five percent (5%) ownership interests or more:
   a.                                                              
                                                                     
                                                                     
   b.                                                              
                                                                     
                                                                     
    (Ord. 22:2006, passed 8-17-06)