Laserfiche WebLink
11. Are you a practicing attorney? <br />❑ Yes ❑ No ❑ Judicial Officer /State Attorney <br />If "Yes ", check each category of legal representation in which you or the law firm with which you are associated has earned legal fees of $10,000 or more <br />during the preceding calendar year. <br />❑ Administrative ❑ Admiralty <br />❑ Decedent's Estates ❑ Environmental <br />❑ Local Government ❑ Real Property <br />❑ Tort litigation (including negligence) ❑ Utilities Regulation <br />Corporate Criminal <br />Insurance Labor <br />Securities Tax <br />Other category not listed or did not earn legal fees of $10,000 or more during the <br />preceding calendar year <br />12. Are you (1) a licensed professional (other than an attorney) or do you provide consulting services individually or as a member of a professional <br />association and (2) did you charge or were you paid over $10,000 for those services during the preceding calendar year? <br />❑ Yes ❑ No <br />Type of Business <br />Nature of Services Rendered <br />9(b). If the listed nonprofit corporations or organizations do business with the State or receive State funds, please provide a brief description of the nature of <br />that business, if known, or with which due diligence could reasonably be known. <br />Name of Nonprofit Corporation or Organization <br />Describe State Business or State Funding <br />❑ None or Not Known <br />10. List all sources of income (not specific amounts) of more than $5,000 received by you, your spouse, or members of your immediate family during the <br />preceding calendar year. Include salary, wages, state /local government retirement, professional fees, honoraria, interest, dividends, rental <br />income, and business income. <br />Do not include income received from the following sources: <br />► Capital gains ► Federal government retirement <br />► Military retirement ► Social security income /SSDI <br />Recipient of Income <br />Name of Source <br />Type of Business /Industry <br />Type of Income <br />I had no reportable income over $5,000 in the preceding calendar year. <br />11. Are you a practicing attorney? <br />❑ Yes ❑ No ❑ Judicial Officer /State Attorney <br />If "Yes ", check each category of legal representation in which you or the law firm with which you are associated has earned legal fees of $10,000 or more <br />during the preceding calendar year. <br />❑ Administrative ❑ Admiralty <br />❑ Decedent's Estates ❑ Environmental <br />❑ Local Government ❑ Real Property <br />❑ Tort litigation (including negligence) ❑ Utilities Regulation <br />Corporate Criminal <br />Insurance Labor <br />Securities Tax <br />Other category not listed or did not earn legal fees of $10,000 or more during the <br />preceding calendar year <br />12. Are you (1) a licensed professional (other than an attorney) or do you provide consulting services individually or as a member of a professional <br />association and (2) did you charge or were you paid over $10,000 for those services during the preceding calendar year? <br />❑ Yes ❑ No <br />Type of Business <br />Nature of Services Rendered <br />This entire document and any attachments are public record. <br />Page 5 of 9 <br />Attachment number 4 <br />F -2 Page 81 <br />