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22. Are you aware of any other information that you believe may assist the State Ethics Commission in advising you concerning your compliance with the <br />State Government Ethics Act? <br />❑ Yes ❑ No <br />AFFIRMATION <br />I affirm that the information provided in this Statement of Economic Interest and any attachments hereto are true, complete, and accurate to <br />the best of my knowledge and belief. <br />I also certify that I have not transferred, and will not transfer, any asset, interest, or property for the purpose of concealing it from disclosure <br />while retaining an equitable interest. <br />I understand that my Statement of Economic Interest and any attachments or supplements thereto are public record. <br />I acknowledge that I have read and understand N.C.G.S. 138A -26 regarding concealing or failing to disclose material information and <br />N.C.G.S. 138A -27 regarding providing false information: <br />§ 138A -26. Concealing or failing to disclose material information. <br />A filing person who knowingly conceals or knowingly fails to disclose information that is required to be disclosed on a statement of <br />economic interest under this Article shall be guilty of a Class 1 misdemeanor and shall be subject to disciplinary action under G.S. <br />138A -45. (2006 -201, s. 1.) <br />§ 138A -27. Penalty for false information. <br />A filing person who provides false information on a statement of economic interest as required under this Article knowing that the <br />information is false is guilty of a Class H felony and shall be subject to disciplinary action under G.S. 138A -45. (2006 -201, s. 1.) <br />❑ I Agree <br />* *Notarization is no longer required ** <br />Printed Name <br />Signature Date <br />Submit SIGNED, ORIGINAL documents. <br />This entire document and any attachments are public record. <br />Page 9 of 9 <br />Attachment number 4 <br />F -2 Page 85 <br />