AFFIDAVIT OF PUBLIC OFFICER

Transcription

1 AFFIDAVIT OF PUBLIC OFFICER Covering Calendar Year: 2012 Name of Public Officer: Title: KENNETH RAY BERNARD JR. Member Public Office: REGENTS OF THE UNIVERSITY SYSTEM OF GEORGIA, BOARD OF; 3420 STEMBLER RIDGE DOUGLASVILLE, GA (770) I confirm that I have taken no official action as a public officer (as defined in O.C.G.A (22)(E)) in the previous calendar year which had a material effect on my private, financial or business interests. Electronically filed with the Georgia Government Transparency and Campaign Finance Commission on 1/22/2013 2:11:21PM Confirmation #AFF The electronic filing of this document constitutes an affirmation that the statement is true, complete, and correct. CFC FormPubAffidavit 01/11 KENNETH RAY BERNARD JR.

2 AFFIDAVIT OF PUBLIC OFFICER Covering Calendar Year: 2012 Name of Public Officer: Title: RICHARD L. TUCKER Member Public Office: REGENTS OF THE UNIVERSITY SYSTEM OF GEORGIA, BOARD OF; 4021 ST. ANDREWS SQUARE DULUTH, GA (770) I confirm that I have taken no official action as a public officer (as defined in O.C.G.A (22)(E)) in the previous calendar year which had a material effect on my private, financial or business interests. Electronically filed with the Georgia Government Transparency and Campaign Finance Commission on 1/25/ :10:56AM Confirmation #AFF The electronic filing of this document constitutes an affirmation that the statement is true, complete, and correct. CFC FormPubAffidavit 01/11 RICHARD L. TUCKER

3 AFFIDAVIT OF PUBLIC OFFICER Covering Calendar Year: 2012 Name of Public Officer: Title: BENJAMIN JAMES TARBUTTON III Member Public Office: Board of REGENTS OF THE UNIVERSITY SYSTEM OF GEORGIA PO BOX 269 SANDERSVILLE, GA (478) I confirm that I have taken no official action as a public officer (as defined in O.C.G.A (22)(E)) in the previous calendar year which had a material effect on my private, financial or business interests. Electronically filed with the Georgia Government Transparency and Campaign Finance Commission on 1/22/2013 5:07:39PM Confirmation #AFF The electronic filing of this document constitutes an affirmation that the statement is true, complete, and correct. CFC FormPubAffidavit 01/11 BENJAMIN JAMES TARBUTTON III

4 AFFIDAVIT OF PUBLIC OFFICER Covering Calendar Year: 2012 Name of Public Officer: Title: KESSEL D. STELLING JR. Regent Public Office: University System of Georgia Board of Regents 370 CHERRY HILL DRIVE MARIETTA, GA (706) I confirm that I have taken no official action as a public officer (as defined in O.C.G.A (22)(E)) in the previous calendar year which had a material effect on my private, financial or business interests. Electronically filed with the Georgia Government Transparency and Campaign Finance Commission on 1/30/ :06:38AM Confirmation #AFF The electronic filing of this document constitutes an affirmation that the statement is true, complete, and correct. CFC FormPubAffidavit 01/11 KESSEL D. STELLING JR.

5 AFFIDAVIT OF PUBLIC OFFICER Covering Calendar Year: 2012 Name of Public Officer: Title: Neil L. Pruitt JR. Member of the Board of Regents Public Office: UNIVERSITY SYSTEM OF GEORGIA 1626 Jeurgens Court Norcross, GA (770) I confirm that I have taken no official action as a public officer (as defined in O.C.G.A (22)(E)) in the previous calendar year which had a material effect on my private, financial or business interests. Electronically filed with the Georgia Government Transparency and Campaign Finance Commission on 1/31/ :47:40AM Confirmation #AFF The electronic filing of this document constitutes an affirmation that the statement is true, complete, and correct. CFC FormPubAffidavit 01/11 Neil L. Pruitt JR.

6 AFFIDAVIT OF PUBLIC OFFICER Covering Calendar Year: 2012 Name of Public Officer: Title: DOREEN STILES POITEVINT Member Public Office: REGENTS OF THE UNIVERSITY SYSTEM OF GEORGIA, BOARD OF; 2001 TWIN LAKES DRIVE BAINBRIDGE, GA (229) I confirm that I have taken no official action as a public officer (as defined in O.C.G.A (22)(E)) in the previous calendar year which had a material effect on my private, financial or business interests. Electronically filed with the Georgia Government Transparency and Campaign Finance Commission on 1/3/2013 4:44:32PM Confirmation #AFF The electronic filing of this document constitutes an affirmation that the statement is true, complete, and correct. CFC FormPubAffidavit 01/11 DOREEN STILES POITEVINT

7 AFFIDAVIT OF PUBLIC OFFICER Covering Calendar Year: 2012 Name of Public Officer: Title: DONALD M LEEBERN JR. Member/Regent Public Office: Board of Regents of the University System of Georgia 100 GEORGIA CROWN DRIVE MCDONOUGH, GA (770) I confirm that I have taken no official action as a public officer (as defined in O.C.G.A (22)(E)) in the previous calendar year which had a material effect on my private, financial or business interests. Electronically filed with the Georgia Government Transparency and Campaign Finance Commission on 1/15/ :57:15PM Confirmation #AFF The electronic filing of this document constitutes an affirmation that the statement is true, complete, and correct. CFC FormPubAffidavit 01/11 DONALD M LEEBERN JR.

8 AFFIDAVIT OF PUBLIC OFFICER Covering Calendar Year: 2012 Name of Public Officer: Title: GEORGE B. HOOKS Member Public Office: REGENTS, BOARD OF; PO BOX 928 AMERICUS, GA (229) I confirm that I have taken no official action as a public officer (as defined in O.C.G.A (22)(E)) in the previous calendar year which had a material effect on my private, financial or business interests. Electronically filed with the Georgia Government Transparency and Campaign Finance Commission on 1/14/2013 3:58:17PM Confirmation #AFF The electronic filing of this document constitutes an affirmation that the statement is true, complete, and correct. CFC FormPubAffidavit 01/11 GEORGE B. HOOKS

9 FINANCIAL DISCLOSURE STATEMENT Original Statement Date of this Statement: 01/18/2013 Covering Calendar Year: 2012 Name of Public Officer or Candidate: RUTLEDGE AVALON GRIFFIN JR SKIPPER BRIDGE ROAD VALDOSTA, GA (229) (229) Financial Disclosure Statement -- Appointed Public Officer Electronically filed with the Georgia Government Transparency and Campaign Finance Commission on 1/18/2013 3:24:40PM Confirmation #F The electronic filing of this document constitutes an affirmation that the statement is true, complete, and correct. As per modifications of the Ethics in Government Act, filing a separate notarized affidavit is no longer required. See O.C.G.A (e) and (e). CFC Form FD 01/11 - F RUTLEDGE AVALON GRIFFIN JR. Page 1 of 5

10 SECTION I MONETARY FEES RECEIVED (This section to be completed by Public Officers only) Identify each monetary fee or honorarium accepted from speaking engagements, participation in seminars, discussion panels, or other activities that directly relate to the official duties of, or to the office of the public officer, with a statement identifying the fee or honorarium and the person or entity from whom it was accepted. Identify Fee or Honorarium No monetary fee or honorarium. Amount Accepted Identifying Information of of Person or Entity from Whom Accepted SECTION II FIDUCIARY POSITIONS Name all fiduciary positions held by the candidate for public office or the public officer at any time during the covered year.. (You may expand this section if necessary to include all positions.) A fiduciary position is any position imposing a duty to act primarily for another s benefit as officer, director, manager, partner, guardian, or other designations of general responsibility of a business entity. A fiduciary position may be a paid or unpaid position. A business entity is any corporation, sole proprietorship, partnership, limited partnership, limited liability company, limited liability partnership, professional corporation, enterprise, franchise, association, trust, joint venture, or other entity, whether profit or nonprofit. Title of Position Name, address, and principal activity of business entity No fiduciary positions in any business entity. SECTION III DIRECT OWNERSHIP INTERESTS IN BUSINESS ENTITY Direct ownership interest is the holding or possession of good legal or rightful title of property or the holding or enjoyment of real or beneficial use of the property by any person and includes any interest owned or held by a spouse of the person if such interest is held jointly or as tenants in common between the person and spouse. Identify the name, address and principal activity of any business entity and the office held by and the duties of the candidate for public office or public officer within a business entity any time during the covered year in which a direct ownership interest: (A) Is more than 5 percent of the total interest in the business; or (B) Has a net fair market value of more than $5, Name, address, and principal activity of business entity No direct ownership interests in any business entity. Office held by candidate or public officer Duties of the candidate or public officer Ownership Interests CFC Form FD 01/11 - F RUTLEDGE AVALON GRIFFIN JR. Page 2 of 5

11 SECTION IV DIRECT OWNERSHIP INTERESTS IN REAL PROPERTY Direct ownership interest is the holding or possession of good legal or rightful title of property or the holding or enjoyment of real or beneficial use of the property by any person and includes any interest owned or held by a spouse of the person if such interest is held jointly or as tenants in common between the person and spouse. Identify each tract of real property in which the candidate for public office or public officer has a direct ownership interest as of December 31 of the covered year when that interest has a fair market value in excess of $5, Fair market value means the appraised value of the property for ad valorem tax purposes. Check one box to show the applicable valuation range for each tract. County and State where property is located General description of property (give street address or location, size of tract, and nature or use of property) Value of tract No ownership interests with a fair market value in excess of $5, SECTION V SPOUSE'S DIRECT OWNERSHIP INTERESTS IN REAL PROPERTY Identify each tract of real property in which the filer s spouse has a direct ownership interest as of December 31 of the covered year when that interest has a fair market value in excess of $5, Check one box to show the applicable valuation range for each tract. County and State where property is located General description of property (give street address or location, size of tract, and nature or use of property) Value of tract No ownership interests with a fair market value in excess of $5, CFC Form FD 01/11 - F RUTLEDGE AVALON GRIFFIN JR. Page 3 of 5

12 SECTION VI EMPLOYMENT AND FAMILY MEMBERS Filer's Occupation: Filer's Employer: Employer's Address: Employer's Principal Activity: President Griffin Corporation 3821 Skipper Bridge Road, Valdosta, GA Family Office Investments Filer's Secondary Occupation: Filer's Secondary Employer: Employer's Secondary Address: Employer's Secondary Principal Activity: Filer's Spouse's Name: Spouse's Occupation: Spouse's Employer: Spouse's Employer's Address: Spouse's Employer Principal Activity: Spouse's Secondary Occupation: Spouse's Secondary Employer: Spouse's Secondary Employer's Address: Spouse's Secondary Employer's Principal Activity: Barbara Griffin Housewife NONE n/a n/a SECTION VII INVESTMENT INTERESTS List the name of any business or subsidiary thereof or investment in which the filer (either individually or with any other legal or natural person or entity) owns a direct ownership interest that: (1) is more than 5 percent of the total interests in such business or investment, or (2) has a net fair market value of more than $5, (Do not list individual stocks and bonds that are held by mutual funds.) Business or Investment Entity Name No investment interests that is more than 5 percent of the total interests in such business or investment, or with a fair market value of more than $5, CFC Form FD 01/11 - F RUTLEDGE AVALON GRIFFIN JR. Page 4 of 5

13 SECTION VIII KNOWN BUSINESS OR INVESTMENT INTERESTS OF SPOUSE AND DEPENDENT CHILDREN Identify any business or investment known to the filer in which the filer s spouse or dependent children have a direct ownership interest (either individually or with any other legal or natural person or entity) which interest: (1) is more than 5 percent of the total interest in the business or investment, (2) has a net fair market value exceeding $10,000.00, or (3) is one in an entity for which the filer s spouse or a dependent child serves as an officer, director, equitable partner, or trustee. (Do not list individual stocks and bonds that are held by mutual funds.) a. Name of Business or Investment Entity, b. Ownership (spouse/dependent children), c. Indicate if officer, director, equitable partner, or trustee (where applicable) No known business or investment interests of spouse and dependent children. SECTION IX ANNUAL PAYMENTS RECEIVED FROM THE STATE OF GEORGIA (This section to be completed by Public Officers only) Identify all annual payments in excess of $10, received by the public officer, or by any business entity identified in Section III above, from the State or any agency, department, commission or authority created by the State, and authorized and exempted from disclosure under O.C.G.A Name, address of state entity making payment, and general nature of the consideration for the payment Amount of annual payment No annual payments in excess of $10, from any State entity. CFC Form FD 01/11 - F RUTLEDGE AVALON GRIFFIN JR. Page 5 of 5

14 AFFIDAVIT OF PUBLIC OFFICER Covering Calendar Year: 2010 Name of Public Officer: Title: LARRY R ELLIS Regent Public Office: Board of Regents for the University System of Georgia 520 CARDONDELETT COVE SW ATLANTA, GA (770) I confirm that I have taken no official action as a public officer (as defined in O.C.G.A (22)(E)) in the previous calendar year which had a material effect on my private, financial or business interests. Electronically filed with the Georgia Government Transparency and Campaign Finance Commission on 2/15/ :59:25AM Confirmation #AFF The electronic filing of this document constitutes an affirmation that the statement is true, complete, and correct. CFC FormPubAffidavit 01/11 LARRY R ELLIS

15 FINANCIAL DISCLOSURE STATEMENT Original Statement Date of this Statement: 09/16/2010 Covering Calendar Year: 2009 Name of Public Officer or Candidate: CLARENCE DEAN ALFORD 1555 REAGAN CIRCLE CONYERS, GA (770) (770) Financial Disclosure Statement -- Electronically filed with the State Ethics Commission on 9/16/ :36:09AM Confirmation #F The electronic filing of this document constitutes an affirmation that the statement is true, complete, and correct. As per modifications of the Ethics in Government Act, filing a separate notarized affidavit is no longer required. See O.C.G.A (e) and (e). Form FD - F CLARENCE DEAN ALFORD Page 1 of 6

16 SECTION I MONETARY FEES RECEIVED (This section to be completed by Public Officers only) Identify each monetary fee or honorarium accepted from speaking engagements, participation in seminars, discussion panels, or other activities that directly relate to the official duties of, or to the office of the public officer, with a statement identifying the fee or honorarium and the person from whom it was accepted. Identify Fee or Honorarium No monetary fee or honorarium. Amount Accepted Identifying Information of of Person from Whom Accepted SECTION II FIDUCIARY POSITIONS Name all fiduciary positions held by the candidate for public office or the public officer at any time during the covered year.. (You may expand this section if necessary to include all positions.) A fiduciary position is any position imposing a duty to act primarily for another s benefit as officer, director, manager, partner, guardian, or other designations of general responsibility of a business entity. A fiduciary position may be a paid or unpaid position. A business entity is any corporation, sole proprietorship, partnership, limited partnership, limited liability company, limited liability partnership, professional corporation, enterprise, franchise, association, trust, joint venture, or other entity, whether profit or nonprofit. Title of Position Chairman of the Board Managing Member Name, address, and principal activity of business entity Miracle League Association 1506 Klondike Road Conyers, Georgia Baseball Program for Disable Children Southern Retirement Services, LLC 9 Lakeshore Dr Avondale Estates, GA Senior Living Services President & CEO President & CEO President & CEO Sr. Vice President Health Information System Fund, LLC 1555 Reagan Circle Conyers, Georgia Angel Fund Investmenting Allied Utility Network, LLC 1506 Klondike Road Conyers, Georgia Utility Consulting Firm ALLIED Energy Services, LLC 1506 Klondike Road Conyers, Georgia Energy Development Cobb Energy Managment Corporation 1000 EMC Parkway - P.O. Box 369 Marietta, Ga Utility Service Company Form FD - F CLARENCE DEAN ALFORD Page 2 of 6

17 SECTION III DIRECT OWNERSHIP INTERESTS IN BUSINESS ENTITY Direct ownership interest is the holding or possession of good legal or rightful title of property or the holding or enjoyment of real or beneficial use of the property by any person and includes any interest owned or held by a spouse of the person if such interest is held jointly or as tenants in common between the person and spouse. Identify the name, address and principal activity of any business entity and the office held by and the duties of the candidate for public office or public officer within a business entity any time during the covered year in which a direct ownership interest: (A) Is more than 5 percent of the total interest in the business; or (B) Has a net fair market value of more than $10, Name, address, and principal activity of business entity Alumni Properties, LLC 3832 Wesley Chapel Road Marietta, Ga Real Estate Buster & Brown, LLC 3832 Wesley Chapel Road Marietta, Ga Real Estate Health Information Systems Fund, LLC 1555 Reagan Circle Conyers, Georgia Angel Fund United Community Bank 391 Brackett's Way Blairsville, GA Banking Office held by candidate or public officer Duties of the candidate or public officer Managing Partner Financial Oversight Partner Financial Oversight President & CEO Chief Executive Responsiblities Advisory Board Member Board Duties Ownership Interests Ownership interest is more than 5% and has a net fair market valus of more than $10, Ownership interest is more than 5% and has a net fair market valus of more than $10, Ownership interest is more than 5% and has a net fair market valus of more than $10, Ownership interest has a net fair market valus of more than $10, Form FD - F CLARENCE DEAN ALFORD Page 3 of 6

18 SECTION IV DIRECT OWNERSHIP INTERESTS IN REAL PROPERTY Direct ownership interest is the holding or possession of good legal or rightful title of property or the holding or enjoyment of real or beneficial use of the property by any person and includes any interest owned or held by a spouse of the person if such interest is held jointly or as tenants in common between the person and spouse. Identify each tract of real property in which the candidate for public office or public officer has a direct ownership interest as of December 31 of the covered year when that interest has a fair market value in excess of $10, Fair market value means the appraised value of the property for ad valorem tax purposes. Check one box to show the applicable valuation range for each tract. County and State where property is located Bay County, FL Butts, GA Fulton, GA Fulton, GA Fulton, GA Jasper, GA Rockdale, GA General description of property (give street address or location, size of tract, and nature or use of property) Condo Front Beach Road Unit 3407 Panama City Beach, FA 1 Acre Ward Road Jackson, Georgia Condo th Street Atlanta, GA 1 Acre Tract Myrtle Street College Park, GA House 1518 Cambridge Ave. College, Georgia House 2601 Turtle Cove Trailway Monticello, GA Residence 1555 Reagan Cicle Conyers, Georgai Value of tract More than $200,000 Between $100, and $200,000 More than $200,000 Between $10,000 and $100,000 More than $200,000 More than $200,000 More than $200,000 SECTION V SPOUSE'S DIRECT OWNERSHIP INTERESTS IN REAL PROPERTY Identify each tract of real property in which the filer s spouse has a direct ownership interest as of December 31 of the covered year when that interest has a fair market value in excess of $10, Check one box to show the applicable valuation range for each tract. County and State where property is located General description of property (give street address or location, size of tract, and nature or use of property) Value of tract No ownership interests with a fair market value in excess of $10, Form FD - F CLARENCE DEAN ALFORD Page 4 of 6

19 SECTION VI EMPLOYMENT AND FAMILY MEMBERS Filer's Occupation: Filer's Employer: Employer's Address: Employer's Principal Activity: Filer's Spouse's Name: Spouse's Occupation: Spouse's Employer: Spouse's Employer's Address: Spouse's Employer Principal Activity: Names of Filer's Dependent Children: Executive Cobb Energy Management Corporation 1506 Klondike Road Suite 105 Conyers, GA Utility Service Company Terre S. Alford Housewife NA NA NA Chandler Dean Alford, Jacque Olivia Alford SECTION VII INVESTMENT INTERESTS List the name of any business or subsidiary thereof or investment in which the filer (either individually or with any other legal or natural person or entity) owns a direct ownership interest that: (1) is more than 5 percent of the total interests in such business or investment, or (2) has a net fair market value of more than $10, (Do not list individual stocks and bonds that are held by mutual funds.) Business or Investment Entity Name Alumni Properties, LLC Buster & Brown, LLC Health Information System Fund, LLC United Community Bank SECTION VIII KNOWN BUSINESS OR INVESTMENT INTERESTS OF SPOUSE AND DEPENDENT CHILDREN Identify any business or investment known to the filer in which the filer s spouse or dependent children have a direct ownership interest (either individually or with any other legal or natural person or entity) which interest: (1) is more than 5 percent of the total interest in the business or investment, (2) has a net fair market value exceeding $10,000.00, or (3) is one in an entity for which the filer s spouse or a dependent child serves as an officer, director, equitable partner, or trustee. (Do not list individual stocks and bonds that are held by mutual funds.) a. Name of Business or Investment Entity, b. Ownership (spouse/dependent children), c. Indicate if officer, director, equitable partner, or trustee (where applicable) Health Information Systems, LLC Wife Partner Form FD - F CLARENCE DEAN ALFORD Page 5 of 6

20 SECTION IX ANNUAL PAYMENTS RECEIVED FROM THE STATE OF GEORGIA (This section to be completed by Public Officers only) Identify all annual payments in excess of $20, received by the public officer, or by any business entity identified in Section III above, from the State or any agency, department, commission or authority created by the State, and authorized and exempted from disclosure under O.C.G.A Name, address of state entity making payment, and general nature of the consideration for the payment Amount of annual payment No annual payments in excess of $20, from any State entity. Form FD - F CLARENCE DEAN ALFORD Page 6 of 6