Due By April 28, 2006 rs Khode Island Ethics Commission 2005 YEARLY FINANCIAL STATEMENT & r a = x ALAN T ADAMS i 59 CYPRESS STREET = TIVERTON RI 02878 2 L = Ss ALL QUESTIONS REFER TO THE CALENDAR YEAR JANUARY 1, 2005 THROUGH DECEMBER 31, 2005 UNLESS OTHERWISE SPECIFIED, Please answer all questions and where your answer is "none" or “not applicable" so state. ANSWERS SHOULD BE PRINTED OR TYPED, and additional sheets may be used if more space is needed. For clarification of any question, read instruction sheet. Note: If you are a state or municipal official or employee that is required to fle a Yearly Financial Statement, a failure to file the Statement is a violation of the law and may subject you to substantial penalties, including fines. If you received a 2005 Yearly Financial Statement in the mail but believe you did not hold a public position in 2008 or 2006 that requires such filing, you should contact the Ethics Commission (See Instruction Sheet for contact information), 1 A ans Aonwe am aoe aa —_— ana 2 SP Crpasss AWE MEI 62978 am oie eres Gea TALIS ADDRESS ae a Po ET 3. List Public Posi n(s) you hold and governmental unit: Ezek Cw1EF UT H. eats TEE ero: FRCP ASS, | was elected in Iwas appointed in 6200.3 was hired in (year) (year) (year) If you no fonger hold a public position, state year of termination or resignation 4, List elected office(s) for which you were/are a candidate in either calendar year 2005 or 2006 (Read instruction #4) ADE 6. List the following: NAME OF SPOUSE NAME(S) OF DEPENDENT CHILD OR CHILDREN Doown 70 Miirrite A.AVYY Nowisod ‘ssaNisna JO SSauCay GNY aNYN 2SASWAW ATI 40 WON uon|sod juaweBeueW e 10 ‘eajsny ‘sued ‘se0yjo ‘10}DeNIp e Se UoRISod e ey pilyo yuepusdep 40 ‘esnods sno ‘nos YoIYMA Ul Woud-UoU Jo youd ‘ssauisng Aue Jo sseuppe pue eweU aul IsI] “6 ‘s1assy SINOONI LSM ONIAIBOSS ‘SMIGWI ATINVS JO BNVN ‘SSSMOGY GNY 341SMHL 40 AYN SIPFOPY ‘48m. 30 avn a (sunowy 3817 J0N oq) ‘umoUy 1! jesse 781] “eWlODUI SS0B B10U! 40 000'LS Paniede: AifenpIaIpUl UespITYD 40 pilyD uapuadep J0 ‘esnods sno ‘nox yoy wow ‘sn Aue Jo eaisnsy eu JO sseippe pue ewWeU Ysnyj AUE Jo SEU LR IS] “@ avery Noianiosaa wo sszuaay {18351NI 40 Senn sav ys01o}U! je]OUeUY e peY pilyo JuepUedep 10 ‘esnods: JNOK ‘NOK yoy uy ‘eouepisas ledjouyd snok UeY) Je\jo ‘eVEIs@ Jel Aue Jo UoRdOSEp [269] 40 sseuppe sy IS “LZ ie Sono Hint dasouros aeyted retd/7D wv wre] pp) tyros - | Ja Z wae: om, ms AIUD) WL pretial) jo omes LY aware saoyas 40 Nouver596 uc Uanorei 30 akon uaenn SHIN any Save ‘SSauocy env Sr “ews 30 3 (‘sjunowly 3817 JN OG) 284 Parsi] 8q ysNUW 11 00'09Z$ J0 sseOxe Uy eurooU} sso16 Jo junoWe Ue IMMA NOK sepinoud “enoge ‘Et Ul Pays JUALUKO|AwIe 10 Uog!Sod aygnd ty 3} “PasepueL ‘Seomnles JO SIMeU PUE SIEP BUN 151) ‘00'0SZS J0 SSEX9 UI aUCOU! Jo JUNOWE Ue 10} AOUEBE jedjo|UNW 40 eIeIs ® 0 palepuai aiem seoinies pue pafojdule-ses 4! 40 “AouaBe Jedioiunus 40 ayes e Aq pakojdwie J| ‘Danisoes sem ‘euioouy $5016 e10WW Jo 990'LS YoIUM Woy UoednocO Aue jS1| ‘peAo|duIe-sFes 41 ‘g00z Jee sepuejeo Buunp aLooUL ‘ss016 10UN 40 00'1$ Panl9dai Pilyo yUepUadep Jo ‘esnods NO ‘Nok YOIYM Woy JeKojdwe Aue Jo soWeU ey IS] “g® © 10. List the name and address of any interested person, or business entity, that made total gifs or total contributions in ‘excess of $100 in cash or property during calendar year 2005 to you, your spouse, or dependent child. Certain aifts from relatives and certain campaign contributions are excluded, (See instruction #10) [NAME OF PERSON RECEIVING [NAME AND ADDRESS OF PERSON OR ENTITY ‘OFT OR CONTRIBUTION MAKING GIFT OR CONTRIBUTION AIOE 11, List the name and address of any business in which you, your spouse, or dependent child individually or collectively holds a 10% or greater ownership interest, or a $5,000 or greater ownership or investment interest. NAME OF FAMILY MEMBER, NAME AND ADDRESS OF BUSINESS MOLE 12. If any business listed in #11, above, did business in excess of a total of $250 in calendar year 2005 with a state or municipal agency, AND you are a member or employee of the agency or exercise direct or legislative control over the agency, list the following: NAME AND ADDRESS NAME OF AGENCY DATE AND NATURE OF BUSINESS (OF TRANSACTION w]A 18. If any business listed in #11, above, was @ business entity subject to direct regulation by a stale or municipal agency, and you are a member or employee of the agency or exercise direct or legislative control over the agency, list the following: NAME AND ADDRESS OF BUSINESS NAME OF REGULATING AGENCY wfA