I. OFFICES, DIRECTORSHIPS, AND EMPLOYMENT

Disclose each business of which you or a member of your immediate family is an officer or director and receives remuneration, benefits, or compensation for such service as an officer or director.

Disclose each employer paying you or a member of your immediate family salary or wages in excess of $5,000 annually.

DO NOT INCLUDE any salary you receive from the governmental or advisory agency for which you are completing this disclosure statement.

II. BUSINESS INTERESTS

Disclose each business owned by you or a member of your immediate family, separately or together, with a value in excess of $5,000 or in which you or a member of your immediate family has an interest with a value in excess of $5,000.

If the business is owned or operated under a trade, partnership, or corporate name, list that name. If the business is not owned or operated under a trade, partnership, or corporate name, describe the nature of the business.

DO NOT INCLUDE stocks and bonds unless your interest in that business exceeds more than three percent of the total equity of the business.

IV. BUSINESSES TO WHICH SERVICES WERE FURNISHED

Part One

Disclose each business that you represented before any state governmental agency during the prior calendar year for which you received compensation in excess of $5,000 for such representation.

When calculating the amount of compensation you received from a business, DO NOT INCLUDE any compensation for the performance of other services unrelated to the representation before the state governmental agency. If you have job responsibilities other than those involving such representation, you should prorate your salary to determine the portion attributable to your representation.

DO NOT REPORT any business that you represented before a court or judicial officer or any business where the representation consisted solely of filing mandatory papers and subsequent representation regarding those mandatory papers.

For each business, identify the type of business, the name of the state governmental agency before which you appeared on behalf of the business, and the purpose of the representation.

Part Two

Disclose each business that, to your knowledge, persons with whom you have a close financial association represented before any state governmental agency during the prior calendar year for which compensation in excess of $5,000 was received for such representation.

DO NOT INCLUDE members of your immediate family when determining with which individuals you have a close financial association, unless you and your immediate family member are employed by or work for the same business or organization.

When calculating the amount of compensation received from a business, DO NOT INCLUDE any compensation for the performance of other services unrelated to the representation before the state governmental agency. If your associate has job responsibilities other than those involving such representation, you should prorate his salary to determine the portion attributable to his representation.

DO NOT REPORT any business that such persons represented before a court or judicial officer or any business where the representation consisted solely of filing mandatory papers and subsequent representation regarding those mandatory papers.

For each business, identify the type of business, the name of the state governmental agency before which you appeared on behalf of the business, and the purpose of the representation.

Part Three

Disclose each business that operates in Virginia to which you furnished services during the prior calendar year pursuant to an agreement between you and such business and for which the total compensation received for such representation was in excess of $5,000.

For each business, identify the type of business and the type of service rendered. DO NOT INCLUDE any business disclosed in Part One or Part Two of this section.