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20. Did a Council of State member appoint you to or recommend you for appointment to a board covered by the Ethics Act? Council of State members are:
<br />► Governor ► Lt. Governor ► Secretary of State
<br />► State Auditor ► State Treasurer ► Superintendent of Public
<br />Instruction
<br />► Attorney General ► Commissioner of Agriculture ► Commissioner of Labor
<br />► Commissioner of Insurance
<br />❑ Yes ❑ No
<br />If "Yes ", list all contributions you (not immediate family members) made during the preceding calendar year with a cumulative
<br />total of more than $1,000 to
<br />the Council of State member who appointed you.
<br />No. Contributions are defined in N.C.G.S. 163 - 278.6(6) and include, but are not limited to, "any advance, conveyance,
<br />deposit, distribution, transfer of funds,
<br />loan, payment, gift, pledge or subscription of money or anything of value whatsoever."
<br />Date
<br />Amount
<br />Contributed to
<br />❑ No contribution(s) with a cumulative total of more than $1,000
<br />21. Are you now, or are you a prospective appointee to:
<br />a. the head of a principal state department (e.g. cabinet secretary) appointed by the Governor; or
<br />b. a North Carolina Supreme Court Justice, Court of Appeals, Superior or District Court Judge; or
<br />c. a member of any of the following boards:
<br />• ABC Commission
<br />• Coastal Resources Commission
<br />• State Board of Education
<br />• State Board of Elections
<br />• Employment Security Commission
<br />❑ Yes ❑ No
<br />• Environmental Management Commission
<br />• Industrial Commission
<br />If "No ", proceed to question 22.
<br />• State Personnel Commission
<br />• Rules Review Commission
<br />• Board of Transportation
<br />• UNC Board of Governors
<br />• Utilities Commission
<br />• Wildlife Resources Commission
<br />d. If so, were you appointed to, or are you being considered for, appointment to your public position by a
<br />❑ Yes ❑ No
<br />Council of State Member (Governor, Lt. Governor, Secretary of State, State Auditor, State Treasurer,
<br />Superintendent of Public Instruction, Attorney General, Commissioner of Agriculture, Commissioner of
<br />Labor, or Commissioner of Insurance)?
<br />If "No ", proceed to question 22.
<br />e. If so, you must indicate whether during the preceding calendar year you (not immediate family
<br />members) engaged in any of the following activities with respect to or on behalf of the candidate or
<br />campaign committee of the Council of State member who appointed you to your public position:
<br />i. Collected contributions from multiple contributors, took possession of such multiple contributions,
<br />and transferred or delivered those collected contributions to the candidate or committee?
<br />Contributions are defined in N.C.G.S. 163 - 278.6(6) and include, but are not limited to, "any
<br />El Yes F] No
<br />advance, conveyance, deposit, distribution, transfer of funds, loan, payment, gift, pledge or
<br />subscription of money or anything of value whatsoever."
<br />ii. Hosted a fundraiser at your residence or place of business?
<br />❑ Yes ❑ No
<br />iii. Volunteered for campaign - related activities, which include, but are not limited to, phone banks,
<br />event assistance, mailings, canvassing, surveying, or any other activity that advances the campaign
<br />❑ Yes ❑ No
<br />of a candidate?
<br />This entire document and any attachments are public record.
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<br />Attachment number 4
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