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COPY 2 Amendment to Statement of Economic IpferestvED APR 15 2003 CONTACT INFORMATION ‘STATE ETHICS COMMBSION Name of Person Filing Nelson Dollar Preferred Mailing Address! PO Box 1352 Gary, NG 27512 Job Title/Employer Principal J.N. Dollar and Associates Daytime Phone Number 919.233.8309 E-Mail Address nelsond@ncleg.net If you are filing because you are serving on or being considered for appointment to a State board, commission, task force, authority, or similar public body (“board”), please list the full name(s) of all State boards on which you are serving or to which you are being considered for appointment: NA Please provide the following information concerning your spouse and other members of your immediate family.” If the information requested does not apply, please indicate “none.” Name (First, Last)* Occupation Employer Business Lorrie Dotiar lAttorney _ Lone Dollar, Atorney lattomey ( Mediator lan Dollar Student NA _iNa on " With the exception of judicial officers (including Justices or judges ofthe General Court of Justice, district atfomeys, ond clerks of court), persons holding or secking an elected office witha residency requirement must provide a home address. * Immediate family includes your spouse (unless legally separated) and members of your extended family (your and your spouse's children, grandchildren, parents, grandparents, and siblings, and the spouses of each of those persons) that reside in your household, ° Judicial officers and candidates for those offices may use the initials of unemancipated children instead of those children’s names. If initials are used, the children’s names should be provided on a supplemental form available on the Commission's website 1. $10,000 PLUS DISCLOSURES ¥ Ifyou, your spouse, or other members of your immediate family have assets or liabilities with a market value of at least $10,000 in the following categories, please provide the requested information as of 12/31/08 unless another time period is specified in the question. > Do not list the value of those assets or liabilities. > Do not list assets or liabilities held in a blind trust" established by or for the benefit of you or an immediate family member. REAL ESTATE 1. Do you, your spouse, or members of your immediate family have an ownership interest in North Carolina real estate with a market value of $10,000 or more? [J¥es [] No _Ifso, please list below. Owner of Real Estate Location by County and City % Ownership Interest 2. Do you, your spouse, or members of your immediate family rent North Carolina real estate with a market value of $10,000 or more to or from the State? [] Yes [] No If so, please list below and identify the State agency involved in the property lease. Identity of Lessor Identity of Lessee (Renter) Location by County and City PERSONAL PROPERTY 3. Within the preceding two years, have you, your spouse, or members of your immediate family sold ‘or bought personal property with a market value of $10,000 or more to or from the State? L] Yes [] No If so, please list below and identify the State agency involved in the purchase or sale. Identity of Purchaser Identity of Seller Nature and Location of Property “A “blind trust” is a trust that meets all ofthe following criteria: (a) the owner of the trust's assets is unaware of the trust’s holdings and sources of income, (b) the individual or entity managing the trust's asses (“the trustee”) is not a member of the covered person's extended family and is not associated with or employed by the covered person or his or her immediate family, and (c) the ttustee has sole discretion to manage the sts assets. G.S. 138-31). Page 2 of 10 4. Do you, your spouse, or members of your immediate family rent personal property with a market value of $10,000 or more to or from the State? [] Yes [] No If so, please list below and identify the State agency involved in the property lease. _Mdentity of Lessor Identity of Lessee (Renter) Nature and Location of Property INTERESTS IN PUBLICLY OWNED COMPANIES 5(a). Do you, your spouse, or members of your immediate family own interests in a publicly owned company valued at $10,000 or more? []Yes [J No Ifso, please list below. Do not list ownership interests in a widely held investment fund (including mutual funds, regulated investment companies, or pension or deferred compensation plans) if (i) the fund publicly traded or its assets are widely diversified and (ii) neither you nor an immediate family member are able (o control the assets held in the mutual fand, investment company, or pension or deferred compensation plan. > Do not disclose the value of your interests. Owner of Interest f ‘Name of Compan; 5(b). Do you, your spouse, or members of your immediate family hold stock options in a publicly owned company valued at $10,000 or more? []¥es [1No ClListed Above _ Ifso, please list below. > Do not disclose the value of the stock option(s). > Do not list companies disclosed in response to previous questions. Owner of Stock Option ‘Name of Company in which Option is Held Page 3 of 10 INTERESTS IN NON-PUBLICLY OWNED COMPANIES OR BUSINESS ENTITIES 6(a). Do you, your spouse, or members of your immediate family have financial interests valued at $10,000 or more in a non-publicly owned company or business entity (including interests in partnerships, limited partnerships, joint ventures, limited liability companies, limited liability partnerships, and closely held corporations)? _[] Yes []No Ifo, please list below. Specify if the owner is an officer, employee, owner, director, or partner of the company, or a member or manager of a limited liability company or Business Entity Owner of Interest identified in question 6(a) 6(b). For each of those non-publicly owned companies or business entiti (the “primary company”), please list the names of any other companies in which the primary company ‘owns securities or equity interests valued at over $10,000, if known. Non-Publicly Owned Company Other Companies in which the Primary Company (the Primary Company) Owns Securities or Equity Interests 6(@). If you know that any company or business entity listed in 6(a) or (b) above has any material business dealings, contracts, or other involvement with the State, or is regulated by the State, provide a ity. brief deseription of that business acti Identify Company or Business Entity Nature of Business Relationship with the State Page 4 of 10 VESTED TRUSTS 7. Are you, your spouse, or members of your immediate family the beneficiaries of a vested trust with a value of $10,000 or more that is created, established, or controlled by you? C]Yes CINo If so, please list below. > Do not list blind trasts. Please see footnote 4 on page 2 for the definition of blind trust. Name & Address of Trustee Deser ‘Your Relationship to the Trust LIABILITIES 8. Do you, your spouse, or members of your immediate family have a liability (debt) of $10,000 or more, excluding indebtedness on your primary personal residence? [Yes [No If so, please list below. ‘Type of Creditor Name of Debtor (You, Spouse, Family Member) __(Commereial Bank, Credit Union, Individual, te.) ‘State Employees Credit Union Lottie Dollar, spouse Bank of America Page 5 of 10 Ui. OTHER DISCLOSURES 9. At anytime during 2008, were you, your spouse or other members of your immediate family a director, officer, governing board member, employee, independent contractor, or registered lobbyist of ‘a nonprofit corporation or organization operating in the State primarily for religious, charitable, scientific, literary, public health and safety, or educational purposes? [] Yes [] No If so, provide the following information. > Do not list State boards or entities, or entities created by a political subdivision of the State. P-If the listed nonprofit corporations or organizations do business with the State or receive State funds, please provide a brief description of the nature of that business, if known, or which with due ditigence could reasonably be known. Identify Person Name of Nonprofit Nature of Business Describe State Business and His/Her Position _Corp. or Organization acd or State Funding 10. List the name of each source of income (not specific amounts) of more than $5,000 received by you, your spouse, or other members of your immediate family during 2008 if that source was not previously listed in response to questions 1-9. Include salary, wages, professional fees, honoraria, interest, dividends, rental income, and business income. Please do not include income received from the following soure > Capital gains > Federal government retirement > Military retirement > Social security income Recipient of Income __Name of Souree Business or Industry Type of Income Page 6 of 10 11. Are you are a practicing attorney? [] Yes C1 No If so, cheek each category of legal representation in which you or the law firm with which you are associated has earned legal fees of $10,000 or more during 2008. (.) Administrative (_) Admiralty (Corporate (_) Criminal ( )Decedents’ Estates (_) Environmental ( ) Insuranee — (_) Labor ( ) Local Government (— ) Real Property ( ) Securities () Tax (_ ) Tort litigation (including negligence) (_) Utilities regulation 12. Are you a licensed professional (other than an attorney) or do you provide consulting services individually or asa member of a professional association? [Yes [JNo If so, provide the following information for those services for which you charged or were paid over $10,000 during 2008. ‘Type of Business Nature of Services Render 13. As of December 31, 2008, were you or your employer, or your spouse or other members of your immediate family, or their employer, licensed or regulated by, or have a business relationship with your State board or employing entity? [] Yes [] No Ifso, provide the following information. You are not required to complete this question if you are currently a legislator or a judicial officer (“judicial officer” is defined in footnote 1) or you are filing as an appointee to those offices. Please indicate if this is the ease. jentify Employer (if applicable) _ Business or Regulatory Relationship Page 7 of 10 14. As of December 31, 2008, were you, your spouse, or other members of your immediate family a director, officer, or governing board member of any society, organization, or advocacy group which has ‘an interest in issues over which your agency or board may have jurisdiction? C1 Yes CO] No Ifso, provide the following information. > You are not required to complete this question if you are a legislator or a judicial officer or you are filing as an appointee to those offices. Please indicate if this is the case. > Do not list organizations of which you are only a member. Identify Name of Society, Leadership Position Identify Person Organization, or Advocacy Group (Director, Officer, Board Member), 15. Have you ever been convicted of a felony for which you have not received either (i) a pardon of innocence or (ii) an order of expungement regarding that conviction? [Yes O No If so, please provide the following informati Offense Date of Convietion County and State of Convietion 16. During any calendar quarter in the preceding year (but only the time period after you were appointed, employed, or filed or were nominated as a candidate), did you receive any gifts while both you and the donor were outside North Carolina and under circumstances that would lead a reasonable person to conclude that the gifts were given for the purpose of lobbying? C] Yes C1 No Ifso, and the total value of those gifts from a person or a group of persons acting together exceeds $200 per quarter, please provide the following information, P Do not report gifts given by members of your extended family. > Do not report gifts that have previously been reported by you to the Department of the Secretary of State on the “Expense Report for Exempted or Persons Not Covered.” Date Item Received Name and Address of Donor(s) Describe Items Received Estimated Market Value Page 8 of 10 17. During the preceding year (but only the time period after you were appointed, employed, or filed or were nominated as a candidate), have you accepted a “scholarship” (a “grant-i to attend 2 conference, meeting, or similar event”) from a donor outside North Carolina and that was related to your public position? [7 Yes CINo If so, and the value of that scholarship from a person or group of persons acting together exceeds $200, please provide the following information. > Do not report gifts that have previously been reported by you to the Department of the Secretary of State on the “Expense Report for Exempted or Persons Not Covered.” > You are not required to complete this question if you are a judicial officer or you are filing as a judicial officer appointee. Please indicate if this is the case. P Legislators are mot required to report scholarships paid by a nonpartisan legislative organization of which the legislator or the General Assembly is a member or participant, or an affiliate of that organization. Date of Scholarship Name and Address Describe Event Estimated Market of Donor(s) Value 18. Are you or a member of your immediate family currently registered as a lobbyist or lobbyist principal or have you been registered as such during 2008? [Yes []No If so, please provide the following information, Name of Lobbyist __Lobbyist’s Principal __Date of Registration _ Registration Expiration PLEASE NOTE: Former Question 19 has been revised due to legislative changes made in 2008. The Oath or Affirmation and the attached optional “Additional Disclosure Addendum” reference the information sought by that question. Page 9 of 10 Please ensure that you have provided a complete response to all questions that required updating. **North Carolina law establishes a fine of $250 for failure to timely file a Statement of Economic Interest. In addition, it is a Class 1 misdemeanor to knowingly conceal or fail to disclose required information, and a Class H felony to provide false information on a Statement. Such actions can also subject you to disciplinary aetion in connection with your employment.** Qath or Affirmation Thereby swear or affirm, under penalty of perjury and other penalties established by North Carolina law, that I have read this Amendment to Statement of Economic Interest and any attachments thereto and that the information provided on the Statement and any attachments is true, correct, and complete to the best of my knowledge and belief. Unless otherwise noted on this Amendment, there have been no changes to the information provided on my most recently filed 2008 SEI. I also certify that I have disclosed any additional information that J believe may assist the State Ethies Commission in advising me concerning my compliance with the State Government Ethics Act on the attached Additional Disclosure Addendum. STATE OF NORTH CAROLINA COUNTY OF Wake Signed and sworn to or affirmed before me this day by Nelson Dollar (Name of Person Filing) fa vA) L Ddéve 4 Official Signature of Notary Public Notary’s printed or typed name: Vel FF Page 10 of 10 Statement of Economic Intere: (Long Form) Condiditey tur attices subject to IS jes ACE nyt Ti a the same attnier uy tele net Mh SU RS val ethies.commissinn @nenail.net, CONTACT IXFORMATION Name of Person Fit Eu ollas Mailing or Home Address! 2. Bo 372 AR fo oy Job Title/mploye Princ AMAT sAssoctancs Daytime Phone Number 252, peels Es Ber AP re ky E-Mail Addvess helsont@ne leg net If you se you are serving on or b »nsidered for appointment to a State board, commission, task foree, authority, or similar public body Cho:ard”), pleve list the fal nie(s) of all h you are serving or a are being considered for appointme M/A and other members of y none,” ation concerning your spo quested does not apply, ple: ing into indies __Name (First, Last) Loerie Dolla, Aor ney/Hfedi Zant Dotlar Ste Det With the eveeption af judicial afficers ciichosin urd, persons hoting 0 scehi 1. $10,000 PLUS DISCLOSURE. If you. sour spouse, or nther members of your immediate family have assets or liabilities with a market vahue of at least $10,000 in the following categories, please provide the eequesied information as of December 31” of the preceding seur, unless another time period is specilied in the question > Do not fist the value of those assets ur liabilities, > Do not list assets or Hiabilities held in a “blind trust. REAL ESTA pouse, or other menthers of your immediate rolina real estate in which you, your, hip interest with a market value of $10,000 ar more, J. List all North Ci family have an ownel 2. List all North Carolina real estate with a market value of $10,000 or more that is rented to or from the Slate by you, your spouse; or other members of your immediate family. Please identify the State agency involved in the property lease. __Location by County and City Identity wf Lesso _Mdentily of Lessee (Renter * A ine rant” is tnst chat meets all of te fae vite: (aL eke owner pf the HUH Sassels fs EWU OF He ST feu. th the individaaberemity managing the Hust's axel Che shislee” is ot A member oF the cow ‘sid oe eriployed by tne eos ered porno hs 6 fer atin family ai 6c he Lal nisl seve i's esieided Enily al is wot soe: othe tasty asweis, C8. taster fas soe deretioa to Hu IF YOU DO NOT HAVE INFORMATION TO DISCLOSE LY RESPONSE TOA PARTICULAR QUESTION, PLEASE EXDICATE “NONE” Page PERSONAL PROPERTY 3. List personal pruperty with a market value of $10,000 or more that yay suld to oF purchased front the State by you, vour spouse, oF other members af your immediate family within dhe prucading tu years, Please identily the State agency invelsed in the purchase or sale of the peuperts. Identity nf Setter Identity of Purchaser ——- property with a market value of $10,000 or more that was teased or rented to or from ite hy you, your spouse, or other members of your immediate family. Please identify the State agency involved in the property lease, INTEREST Y OWNED COMPANID N PUBLIC 1), List the name of cach publicly owned company in which you, your spouse, or other members of fe family own interests valued at $10,000 or more. your inunedi > Do not list ownership interests in a widely held investment fund (including mutual funds, regulated investment companies, or pension or deferred compensation plans) if (i the fund is publicly traded or its assets are widely diversified and (i) neither you nor an immediate fantily member are able to control the assets held in the mutual fund, invesiment company, or pension or deferred compensation plan, > Do not diselase the value of your int uneot Company IF YOU DO NOT TAVE INFORMATION PO DISCLOSE IN RESPONSE TDA PARTICULAR QUESTION, PLEASE INDIC VTE “NONE” Page 300 LU) mbers of your immediute Sibi, List the name af each company in which you, your spnuse, or other 1 fantily hold steek options vatued at $19,009 or more, > Do not disclose the valne of the stock option(s). > Do not list companies disclosed in response to previous questions. Owner of Swek Option Name of Company Ale ‘SIN NON-PUBLICLY OWNED COMPANIES OR BUSINESS ENTITIES, Gia). 1 imme non-publicly ow ships, limited partnerships, joint v rinerships, and closely held corporations). ares, limited =f a | Ward Associ anes) “Pritaus wo “Metso Dalla | IP YOU DO NOT HAVE INFORMATION TO DISCLOSE IN RESPONSE TOA PARTICULAR QUESTION, PLEASE INDICATE "NONE Page bot 1 6ib), For each of those (the “primary eompan ‘fon-publiely owned companies or business entities identified in question bras "), please fist the names nf any otter companies in which the primary company owns securities or equity interests valued at over $1IL00N, ifkanwn, Non-Pulbiicty Owned Company Other Companies ia whieh the Primary Company - _ithe Priniary Company) Oy ©). If you Know that any company or business entity listed in Gla) or (h) above has any material business dealings, contracts, or other involvement with the State, or ix regulated by the State, provid brief description of that business activity. Identify Company or Business Entity PED, RUST. 7. It you, your spouse, or other members of your iminediate family are the beneficiaries of a vested Irust with a value of $10,000 or more thal ited, established, or coatrolled by you, provide the following information, > Do not list blind (rusts. Please see footnote Fon page 2 for the definition of “blind trust.” Relationship fo tet IY YOU DO NOT HAVE INFORMATION TO DISCLOSE IN RESPONSE TO PARTICULAR QUESTION, PLEASE INDICATE “NOME” Page So 10 LIABILITIES 8. List each liability of $19,000 9¢ more incurred by you, your spouse, or other mm immediate family, excluding indebtedness on your primary personal resi ners of your Type of Creditar Family Member) 1 IL, OTHER DISCLOSURE: 9. If you, your spouse, or other members of your immediate family were at any time during the preceding calendar year (uot just on December 31) a direetor, officer, governing board member, employee, independent contractor, ot registered lobbyist of a nonprofit corporation or organization operating arta > Do nol list Slate boards or entities, or entities created by a political subdivision of the State. Pf the listed nonprofit corporations or organizations do business with the State or receive State funds, please provide a brief description of the nature of that business, if known, or which with due difigence coutd reasonably be known. Identify Person Name of Nonprofit Nature of Business Deserile Sia walla 2 _ Business i IF YOU DO NOP HAVE INFORMATION TO DISCLOSE IN RESPONSE TO.\, PARTICULAR QUESTION, PLEASE INDICATE “NONE” Page 6 at 10 {0. List the name of eucls source of income (not specific antounts) of more than $3,000 euceived by sou. Sour spouse, or other members of your immediate family during the preceding year if that souree was not previvesty tisted in response to questions 1-9, [oclude salary, waxes, professiunal fees, horas interest, dividends, rental income, anil husiness income, Please do not include income received from the following sources: > Capital gains > Federal government retirement » Military retirement > Social seeurity income Recipient _Name of Source Business or Endustey Type of tncomne _ NevsoaQollat. JA Dolane Acree, Comsourmte “Bosouss Eon! ce GB late | ant “AatonDelat, shane dc. Lorrie Dollaa on oes LL. Are you area pructicing attorney? __Yes No If'so, please check each category of legal representation in which yout or the kaw firn with whiel you associated has earned legal fees of $10,000 or more during the preceding year. ( ) Administeative () Admiralty ( ) Corporate () Criminal () Decedents? Ss ( ) Environmental (©) Insurance ( ) Labor ‘ Government ( ©) Secu () Tax c (cH) ation 12. Ave you a licensed professional (other than an attorney) or do you provide consulting seeviees individually or as member of a professional association? Yes No If so, provide the following information for those services for which you charged or were paid over $10,000 during the pres Type of Bi Meora Ars Tress ae ana theo Serums | I | | IF YOU DO NOY HAVE INFORMATION TO DISCLOSE IN RESPONS: PARTICULAR QUESTION, PLEASE INDICATE “NONE i: row 13. I as of Decomber 31° of the preceding year, you or your employer. ar your spouse or other mecibers of your immediate family icensed or regulated by. or fad a business relationship with, a board or employing entity with the following information, or their emploser, we which you are or wilt be associuted, pl se provide: > You are not required to complete this question if you are u legislator ora judicial officer (judicial officer” is defined in footnote {). Please indivate il this is the ease. able) Busine [entity Person entity Employer (iFapp! 14. If, as of December 31 of the preceding year, you, you spouse, or other members of your immediate family were & direetor, officer, or governing board member of any societies, organizations, groups which had aun interest in iss cy or board may h please provide the following info: Please © not required (o complete this question if you are a legislator or a judicial off twif this is the case. > Do not list organizations of which you are only a member. Leadership Position Meatity Name of Society, d ofa feluiay for which you have not received either (i) a “pardon of innocence or (i) an order of expungement regarding that conviction? —_ Yes No IF yes, please provide the following, __ Offense County State of Consietion HP LOU DO NOT HAVE INFORMATION “LOSE IN RESPONSE TOA PARTICULAR QUESTION, PLEASE INDICATE» we 3 oC 10 16. During any calendac quarter ia the preceding year (but only the time period after sun were appointed. employed. or filed or were nominated as 2 candidate; did you receive any gifts while duel you and the donor were outside North Carotiaa and under ciccumstaaees that would lead a reasonable person to conclude drut the gitts were given for the purpose af lobbying? If sn, and the total value of those gifts from a person ora group of persons acting logether exceeds 82M per quarter, plea the fallossing infeemation > Do not report gifts given by members of your extended fantity, > Do not report i Secretary nf SI s hal have previously been reported by you to the Departavent of the rile. Pate Item Received Name and Address of Donveis} Describe [ems Received Fstionated Market ——- Yale 17. During the preceding year (hut only the time period after you were appointed, employed, or fled or were nomin: indidate), have you accepted a “scholarship” (a “grantin-aid to attend a conference, meeting, or similar event”) from a donor outside North Carolina and that was related to your public position? Hf so, and the value of that scholarship from a person or group of persons acting together exceeds $200, please provide the folowing information, Due of Scholarship Cla me and Address Deseribe Event of Donor(s) Hed Market _Yalue her of yout immediate an registered ay stich within the preee vide the following information, amily currently registered as a lobbyist or lobbyist 312 months? Yes K No Lobbyist Prinei 19. Are you aware of any other economic or financial information necesss etna or potential eoufliets of interest you may have had during the preceding year or have currentiy? Yes & No Iso, please provide that information, Please indicate “none” if you do not have any dditional iffornmation to dixctos Mosk = ry to Fully disclose any a IF YOU DO NOT HAVE INFORMATION TO DISCLOSE IN RESPONSE TO. PARTICULAR QUESTION, PLEASE INDICATE °NONE” Paye 9 of 1D Please ensure that you have responded to all questions, specifieully including question auanber 19, and that you have stated “None" in response to those questions in whieh you have nothing to discluse. In the event you fail to answer a question, sour disclosure statement will be returned and you will be required to correct any deficiencies, reaffirm the content of the form, and have the reaffirmation notar ** North Carolina kos establishes a fine of $230 for failure Lo timely file a Statement of Econninic Interest. In addition, itis a Class f misdeme: to knowingly conceal or fail to diselose required information, and a Class Hf felony to provide false information on a Statement. Such actions can also subject you to disciplinary action in connection with your employment. umplete nor Oath or Affirmation 1 hereby swear or affirm, under penalty of perjury and other penalties established hy North Carolina lay, that have read this Statement of Economic Interest and any attachments thereto and that the information provided on the Statement and any attachments is true, correct, and complete to the best of my knowledge and belief. [also certify that I have not transferred, and will not transfer, for the purpose of conce: asset, interest, or propert interes ing it from disclosure while ret halure offPersou Filing STATE OF NORTH CAROLINA COUNTY OF __WAK Signed and sworn to oy affirmed before me this day by __I-_ NELSON Dow Ae (Name of Person Filing) AU of Notary Public Date: __3-1o-08 (Onticiat Seat Notary’s pri Hor (yped name: My Commission Expires: ee IEYOU DO NOT HAVE INFORMATION TO DISCLOSE IN RESPONSE TU PARTICOL AR QUESTION, PLEASE INDICATE “NONF”