State Of Georgia Financial Disclosure Statement Page 6
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7SECTION VI
EMPLOYMENT AND FAMILY MEMBERS
Filer’s Occupation
Filer’s Employer
Employer’s Address
Employer’s Principal Activity
Filer’s Spouse’s Name
Spouse’s Occupation
Spouse’s Employer
Address of Spouse’s Employer
Principal Activity of Spouse’s Employer
SECTION VII
INVESTMENT INTERESTS
List the name of any business or subsidiary thereof or investment (do not list individual stocks and bonds that are held by mutual
funds), in which the filer (either individually or with any other legal or natural person or entity) owns a direct ownership interest that:
1. Is more than 5 percent of the total interests in such business or investment, or
2. Has a net fair market value of more than $5,000.00.
Business or Investment Entity #1
Name
Business or Investment Entity #2
Name
Business or Investment Entity #3
Name
Business or Investment Entity #4
Name
SECTION VIII
KNOWN BUSINESS OR INVESTMENT INTERESTS OF SPOUSE AND DEPENDENT CHILDREN
Identify any business or investment known to the filer in which the filer’s spouse or dependent children have a direct ownership
interest (either individually or with any other legal or natural person or entity) which interest:
1. is more than 5 percent of the total interest in the business or investment,
2. has a net fair market value exceeding $10,000.0
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3. is one in an entity for which the filer’s spouse or a dependent child serves as an officer, director, equitable
partner, or trustee.
(Do not list individual stocks and bonds that are held by mutual funds.) *
Business or Investment Entity #1
Name
Business or Investment Entity #2
Name
Business or Investment Entity #3
Name
Business or Investment Entity #4
Name
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