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17. During the preceding year (but only the time period after you were appointed, employed, or filed or were nominated as a candidate) have you <br />• accepted a "scholarship" exceeding $200 from a person or group of persons acting together and <br />• those person(s) were outside North Carolina and <br />• the scholarship was related to your public position? A "scholarship" is a grant -in -aid to attend a conference, meeting, or similar event. <br />❑ Yes ❑ No ❑ Judicial Officer - You are not required to complete this question if you are a judicial officer or you are filing as a judicial officer appointee. <br />► Do not report gifts that have previously been reported by you to the Department of the Secretary of State on the "Expense Report for Exempted Persons." <br />No-Legislators are not required to report scholarships paid by a nonpartisan legislative organization of which the legislator or the General Assembly is a <br />member or participant or an affiliate of that organization. <br />Date of Scholarship <br />Name and Address of Donor(s) <br />Describe Event <br />Estimated Market Value <br />18. Are you or a member of your immediate family currently registered as a lobbyist or lobbyist principal or were you registered as such within the preceding <br />12 months? <br />❑ Yes ❑ No <br />Name of Lobbyist <br />Lobbyist's Principal <br />Date of Registration <br />Registration Expiration <br />19(a). List the name of each business with which you are associated where you or a member of your immediate family is an employee, director, officer, <br />partner, proprietor, or member or manager. <br />Name of Person <br />Relationship to Filer <br />Name of Company <br />Role of Person <br />❑ No Business Associations - If "No Business Associations ", proceed to question 20. <br />19(b). If you know that any company or business entity listed in 19(a) above has any material business dealings or business contracts with the State, or is <br />regulated by the State, provide a brief description of that business activity. <br />Name of Company or Business Entity <br />Description of Business Activity with the State <br />❑ Not applicable (No entities listed on #19a) ❑ No relationship / Not known <br />This entire document and any attachments are public record. <br />Page 7 of 9 <br />Attachment number 4 <br />F -2 Page 83 <br />