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1 et seq. and Ethics Manual to complete this statement. 1. NAME OF FILER: (No nicknames, please) REV . 2 /0 8 BIRTH DATE: FILER'S COMPLETE MAILING ADDRESS AND WORK PLACE TELEPHONE NUMBER: Mailing address Work place telephone number City 2. FILING STATUS: State Zip Number Assigned by Ethics Commission YEARLY Calendar Year Covered: FINAL (required w ithin 60 days of end of service) Date Service Ended: Chief administ rative officer or first deputy Date of appointment emplo.

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