Spreadsheet: 0074bc84-6d13-4d5b-8df5-6c78f3242a22
Sheet: PAGE-1

OGE Form 278 (Rev. 12/2011) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Form Approved:
5 C.F.R. Part 2634 |  |  | Executive Branch Personnel  PUBLIC FINANCIAL DISCLOSURE REPORT |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | OMB No. 3209-0001
U.S. Office of Government Ethics
Date of Appointment, Candidacy, Election, |  |  | Reporting Status | Incumbent |  |  | Calendar Year |  |  | New Entrant, |  |  |  |  |  | Termination |  |  | Termination Date (If Appli- |  |  |  | Fee for Late Filing
or Nomination (Month, Day, Year) |  |  | (Check Appropriate |  |  |  | Covered by Report |  |  | Nominee, or |  |  |  |  |  | Filer |  |  | cable) (Month, Day, Year) |  |  |  | Any individual who is required to file
 |  |  | Boxes) |  |  |  |  |  |  | Candidate |  |  |  |  |  |  |  |  |  |  |  |  | this report and does so more than 30
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | days after the date the report is required
Reporting Individual's Name |  |  | Last Name |  |  |  |  |  |  |  | First Name and Middle Initial |  |  |  |  |  |  |  |  |  |  |  | to be filed, or, if an extension is
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | granted, more than 30 days after the
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | last day of the filing extension period,
Position for Which Filing |  |  | Title of Position |  |  |  |  |  |  |  | Department or Agency (If Applicable) |  |  |  |  |  |  |  |  |  |  |  | shall be subject to a $200 fee.
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Reporting Periods
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Incumbents:  The reporting period is
 |  |  | Address (Number, Street, City, State, and ZIP Code) |  |  |  |  |  |  |  |  |  |  |  | Telephone No. (Include Area Code) |  |  |  |  |  |  |  | the preceding calendar year except Part
Location of Present Office |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | II of Schedule C and Part I of Schedule
(or forwarding address) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | D where you must also include the filing
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | year up to the date you file.  Part II of
Position(s) Held with the Federal |  |  | Title of Position(s) and Date(s) Held |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Schedule D is not applicable.
Government During the Preceding |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Termination Filers: The reporting
12 Months (If Not Same as Above)
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | period begins at the end of the period
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | covered by your previous filing and ends
Presidential Nominees Subject to Senate Confirmation |  |  | Name of Congressional Committee Considering Nomination |  |  |  |  |  |  |  | Do You Intend to Create a Qualified Diversified Trust? |  |  |  |  |  |  |  |  |  |  |  | at the date of termination.  Part II
 |  |  |  |  |  |  |  |  |  |  |  |  |  | Yes |  |  |  |  | No |  |  |  | of Schedule D is not applicable.
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Nominees, New Entrants and
Certification |  |  | Signature of Reporting Individual |  |  |  |  |  |  |  |  |  |  |  | Date (Month, Day, Year) |  |  |  |  |  |  |  | Candidates for President and
I CERTIFY that the statements I have |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Vice President:
made on this form and all attached |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Schedule A--The reporting period
schedules are true, complete and correct
to the best of my knowledge. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | for income (BLOCK C) is the preceding
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | calendar year and the current calendar
Other Review (If desired by agency) |  |  | Signature of Other Reviewer |  |  |  |  |  |  |  |  |  |  |  | Date (Month, Day, Year) |  |  |  |  |  |  |  | year up to the date of filing.  Value
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | assets as of any date you choose that is
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | within 31 days of the date of filing.
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Schedule B--Not applicable.
Agency Ethics Official's Opinion |  |  | Signature of Designated Agency Ethics Official/Reviewing Official |  |  |  |  |  |  |  |  |  |  |  | Date (Month, Day, Year) |  |  |  |  |  |  |  | Schedule C, Part I (Liabilities)--
On the basis of information contained
in this report, I conclude that the filer is |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | The reporting period is the preceding
in compliance with applicable laws and |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | calendar year and the current calendar
regulations (subject to any comments |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | year up to any date you choose that is
in the box below). |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | within 31 days of the date of filing.
Office of Government Ethics Use Only |  |  | Signature |  |  |  |  |  |  |  |  |  |  |  | Date (Month, Day, Year) |  |  |  |  |  |  |  | Schedule C, Part II (Agreements or
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Arrangements)--Show any agreements
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | or arrangements as of the date of filing.
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Schedule D--The reporting period is
Comments of Reviewing Officials (If additional space is required, use the reverse side of this sheet)
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | the preceding two calendar years and
(Check box if filing extension granted & indicate number of days _________ ) |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | the current calendar year up to the
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | date of filing.
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Agency Use Only
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | OGE Use Only
(Check box if comments are continued on the reverse side)
Supersedes Prior Editions.