EFTA00624859.pdf

SF2ig (Rev. 011000) 5 CFRPart 2634 Form Approved Executive Branch Personnel PUBLIC FINANCIAL DISCLOSURE REP US Once of Government Ethics ORT OMB No. 3209.0001 Date of Appointment. Candidacy. Election Reporting Status or Nomination (Month. Day. Year Calendar Year Pea ❑ Incumbent Covered by Report lamination Date (IfAvon- Fee for Late Rine New Entrant, Nominee. Termination Coale )(Mona [Jay, tear) Any individual who is required to 1/20/09 4graP7ON bMeS) last Name 2008 Ij or Candidate Filer file this report and does so more than First Name andSAiddle initial 30 days after the date the report is Reporting Individual's Name required to be filed, or. Jan extension Zichal Heather R is granted, more than 30 days after the Title of Position last day of the filing extension period Position for Which Filing Department or Agency I if Applicable) Deputy Assistant to the President shall be subject to • $200 foe. Address (Number. Street, Om State, and ZIP Reporting Periods Location of Present Office Code Telephone No /Include Area Code) (or forwarding address) tea) grosqlticulk Mt , Lek Aar,47 tistrt Lei Incumbents: The reporting period is the preceding calendar year except Pan II of Schedule C and Part I of Position(s) Held with the Federal Title ofPositionfs) and Dalt:all-kid Schedule D where you must also Government During the Preceding include the filing year up to the date 12 Months (If Not Same as Above) Legislative Director, US Senator John Kerry 12/200 7 - 772008 you file. Part El of Schedule D is not applicable. Presidential Nominees Subject to Name of Congressional Committee coniiderineNominatton Do You ffitend to Create a Qualified Diversified Trust'' Termination Filers: The reporting Senate Confirmation period begins at the end of the period temptation ON° covered by your previous filing and ends at the date of termination. Part II I CERTIFY that the statements I have ut ate in .mival ofSchedule D is not applicable. Vale fmanm- LAN. I COT I made on this form and all attached schedules are true, complete and correct Nominees. New Entrants and to the best of my knowledge. W - 6 1617( nIak zelzi t oc) Candidates for President and Vice President: Signature ot Other KeneiWK Schedule A—The reporting period for Date (Month Year) Other Review (If desired by agency) //tact-6 Az 34 9al/efr income (BLOCK C) is the preceding calendar year and the current calendar yeas up to the date of filing. Value assets as of any date you choose that is Agency ethics Official's Opinion within 31 days of the date of Mint Signal' of Designated ARMICV Ethics OfficialfReviewing Official On the basis of information contained Date (Month Day. Year) in this report, 1 conclude that the filer is Schedule B--Not applicable. in compliance with applicable laws and regulations (subject to any comments Schedule C. Part I (Liabilities)— in the box below). 3/11709 reporting period is the preceding calendar year and the current calendar I lignanne year up to any date you choose that is Office of Government Ethics Date (Month Day Year within 31 days of the date of filing. Use Only tomments of Reviewing Officials Ofadditional Schedule C. Part II (Agreements or space Is required we the reverse side ofthis sheer/ Arrangements)— Show any agreements arrangements as of the date of (Check box flitting extension granted & indicate number ofdays filing. p Schedule 1)-The reporting period is the preceding two calendar years and the current calendar year up to the date of filing. Agency Use Only (Check bar yfcomments are continued on the reverse rude) Q OGE Use Only Supersedes Prior Editions. Which Cannot Be Used. 278412 Form Designed Microsoft Excel 2000 NSN 7540-01-0704444 EFTA00624859  5 C F.R Pat 2634 U.S. Office of Gownimem Edu.., 'Locoing individual's Name Zichal Page Number • SCHEDULE A Assets and Income Va :ration of Assets at close of Income: type and amount. If "None (or less than $201)" is checked, no other entry is needed in Block C for cporting period that item. BLOC% A For you, your spouse, and dependent child BLOCK 8 _I ren, BLOCK C report each asset held for investment or the Type production of income which had a fair Amount value exceeding S1.000 at the close of market the report- ing period or which generated more than 5200 in income during the mooning period None (or less than STOOD together Excepted Investment Fund with such income. Other ...., Date For yourself, also report the source amount of earned income occeedimtand &mud 2 gEE 4 2- 4Iy., §viR R § ,.,..,— 1 Income (Spoei6, ale.. Day. Yr.) 0 Rent and Royalties c Tyre Bc than from the U.S. Govemmemt). For5200 (oda, E c -- am?- ;I 6. c report the source but not the amount ofyour spouse. ,,, ..!c 0 § 1 gr. .• Actual Excepted Trust 44 Z / if, rel `4,' cc . Only if Over 35,000,000 in wi 7, g tame income of more than SI ,000 (except moo d n the i; , 'n ' ' • ez . - g — 2-- c„ & ,f g g :a : v' Amount) Honoraria actual &count of any honoraria over $200 I — — — - "g. S q 4 IN zi4 E-8 4g- ri'ilA 6 VI ...1— . .‘ VI 4,4) , 0 a .., • cp ,y your spouse). of ct iff g g .9 .—4 :2c ..„ V) fel V) l e C 0 re,- rn• cl 7) cn, fvi :Z.r. ci; .4 .,, r. E- 1-' 4- „- — ' k —§is A•' E. .7). °- 3 .e. - c- c C) — —^ g None❑ 4A 4'4 ti 0' CZ — g cr 4 g c.: C. ° Z V, N N 1 49) r.; ZOI 7) 6 ;74 Central Airlines Common Examples Doe Jones& Smith, Hometown, State x x x x Kengistar Etritioilluid _ _ _ _ _ , _ ..x . . _ i s.I.I. I...am IRA: Heartland 500 Index Fund 1 x c i x 2 Obama for America Pal, 3 Obama-Biden Transition 7 .34i 9 (23-46 ,,4 4,, Liiiik.. 4 7030 .1 7 5 /Err 7 Cr2 ) 6-- k.-- il,. , f• 6 . aims category applies only it the a5ScUmethric is solely that ot'thc mark the other higher categories of value tile spouse or depend= children. lithe , as ar propriate. ay,. ., iconic i. ,. .•.. or the tiler or jointly held by the liter w th Poor Editions Cannot be Used the spouse or (lepend in children. EFTA00624860  SF 278 (Rt.. 03/2000) SCFRPan 2634 Do not Complete Schedule I.1 s Office orGovernment Ethics B if you are a new entrant, nom inee, Vice Presidential or Pre reporting Individuars Name sidential Candidate Page Number SCHEDULE B Part I: Transactions Report env purchase, sale. or excha nge by ow spouse, None or dependent children during the reportingYOU, report a transaction involving property used solely as your period of any real personal residence, or a transaction solely Transaction Amount of Transaction (x) property, stocks. bonds, commodity future., between you. securities when the amount of the transa and other your spouse. or dependent child Check the "Certificat (x) e of siboo. Include transactions that resultedction exceeded divestiture" block to indicate sales made pursu ant to a Date Dia . . in Do not k g.. §. 4- k 8- g. Exchange certificate of divestiture from OGE. Day. Yr.) lg. § Example: Central Airlines Common Identification of Assets a ll i l e 1 i 8° E• gai i 1 az1§§a»Illiagzaggrea§t. I.gO " 1 NOT REQUIRED FOR NOMINE ES x 211/99 x . ,g § 84 I 2 3 4 5 • This category applies only if the under lying asset is solely that of the fda's spous by the files or jointly held by the fda with e or dependent children. If the underlying the spouse or thaa.nduit children, use the asset is either held other higher categories of value, as Part II: Gif ts, Reimbursements, and Tra appropriate. For you, your spouse and depe vel Expenses lion, end the value of: (1) giftsnden t children. report the source, a brief descrio- (such as food. or entertainment) received from tangible items. transnortation. lodging. the U.S. Govenunent given to your agency in one source totaling more than $260: and received from relatives: received by your connection with official travel: (2) travel-related cash reimbursement mou se than $260. For conflicts analysis, it isshelpf received from one source totaling more independent of their relationship to you: provi or dependent child totally as personal friend, agency approval unde ul to indicate a basis for receipt, such the donor's residence. Also. for purposesor ded as personal hospitality at authority. etc. For travel-related gifts r S U.S.C. 4 4111 or other statutory total value from one source, exclude itemsofworth aggregating gifts to determine the $104 or less. See instructions dates. and the nature of expenses provand reimbursements. include travel itinerary. ided. Exclude anything given to you for other exclusions. by None mu Source Dame and Address) Examples: Nit Assn. of Rock Colinas:its. BriefDeseription NN. NY_ _ _ Ail Me ticket, bpi room & meals incide Flank Tones, Son Francisco, CA nt to among confsreoce6/15199 (fienonal vial anre_la Value UliWtiiirefaamepao7aligaTer ------ ted_to MIN_ _ _ __ _ _ __ s ----- __ __ __ Ss® — 2 3 4 5 nor ENuons Cannot Be Used EFTA00624861  SF VS (Rev. 0312000) CRS Pert 6634 U.S. Office • Goventreace Ethics Wig individuals Name Zictial SCHEDULE C Part I: Liabilities Report liabilities over $10,000 owed to any one creditor at personal residence unless it is rented out; any time during the reporting period loans secured by you, vow spouse. by automobiles, household furniture or appli or dependent children. Chock the highe ances; and Category of Amoimi or Valve• st amount owed liabilities owed to certain relatives listed during the repotting period. Exclude in instnictions. a mortg age on your See instructions for revolving charge accou nts. Date Interest Term if Creditors (Name and Address) Incurred Rate cable n a§ fi §. Examples: Firsi Distpet ItanSyashin.copac John lones,12.11St. Washington, DC - - - Type of Liability Morsagesventai topers,petante_ -114 / 0111iSSOly note _ _ _ 1991 5 2 >n _ 0 VI tra a _x , 0 RI U s 1999 10% on demand r - - x 2 3 • This category applies only if the liabil ity is solely that oldie filers spouse Of with the spouse or dependent childr dependent children. if the liability is en, mark the other higher categories, as that ofte filer or a joint liability of the filer appropriate. Part II: Agreements or Arrangement s Report your agreements or arrangements for continuing participation in an emDloYee benefit Plan (e4t. 401k. deferred of absence; and (4) future employment. See instructio Dement by a former employer (including compensation; (2) continuation ns of negotiations for any of these arrangements or bene regarding the reporting severance payments); (3) leaves fits Status and Terms of any Agreement (wile pci E ample: Puma= to partnership agreement, will receiv or AnageraCOI calculated on service performed throne e limy awn payment of capital account Parties )) /100. & partnership share Date Doe Jones & Smith, Hometown, State 7/85 2 3 4 5 6 Prior Editions Cannot Be Used. EFTA00624862  SF 276 (Rev. 03,2000) C.F.R Pan 2634 U.5. Office of Cola:mama, Ethics Kooning Individual's Name Zichal - Page Number SCHEDULE D Part I: Positions Held Outs'de U.S. Governme nt Report any positions held during the applicable reporting compensate