02. |
Last year, I was an () ()
() with the |
|
()
() () and the name and address of my
()
() () () ()
() () () was
Name:
Limestone County Commission
Address:
101 Elm Street, Athens, Alabama
|
|
|
02.1 |
As an
/
/
last year, my job title/position was
Limestone County Sheriff |
|
|
02.2 |
Last year, the name(s) of the () () ()
|
|
,
,
, ,
,
of which I was a Member was(were)
NA |
|
|
02.3 |
Last year in the above public position(s) in 02. thru 02.2 I earned:
(More than $10,000) |
|
|
03. |
Other than any public position(s) listed in 02. thru 02.2, list any occupation, employment
or business
|
|
(including self-employment) where you or your spouse spent at least 1/3
of your or your spouse's working time:
Not Applicable |
|
|
03.1 |
The name and address of my employer, listed in 03. above,
was |
|
Name:
Not Applicable
Address:
Not Applicable |
|
|
03.2 |
I was SELF-EMPLOYED last year and the NAME and ADDRESS of my business was |
|
Name:
NA
Address:
NA |
03.3 |
From the occupations or businesses listed in
03., I, My Spouse and/or Dependents earned last year an aggregate of: |
|
Not Applicable
|
03.4 |
Last year, ( ()
() owned 5% or more of the stock in the firm(s) listed in (03.1 and/or 03.2)
|
|
Not Applicable
|
03.5
|
Last year, ( ()
()
was a consultant and earned more than $1,000 from each firm listed in (03.1 and/or 03.2)
|
|
Not Applicable
|
03.6 |
Last year, ( ()
()
served as an () () () of the firm(s) listed in (03.1
|
|
and/or 03.2) |
|
Not Applicable
|
|
|
04. |
Information on Family Members: |
|
Spouse Information:
Spouse Name |
Business or Employer |
Debbie Blakely
|
Retired
|
Names Only of LIVING ADULT CHILDREN:
|
Michael A. Blakely II |
|
|
Names Only of LIVING PARENTS:
(No Maiden Names)
|
NA |
|
|
Names Only of LIVING SISTERS/BROTHERS:
(No Maiden Names)
|
Brenda Owens Cliff Blakely |
|
|
Names Only of LIVING PARENTS OF SPOUSE:
(No Maiden Names)
|
Margret McElyea |
|
05. |
OTHER INCOME INFORMATION ON YOU, YOUR SPOUSE AND DEPENDENT CHILDREN
|
|
List total combined household income, in addition to what is listed in 02.3 thru
03.5, the names of each business income is derived from, and the income from each
business.
Applicable
OTHER HOUSEHOLD INCOME: not reported in 03.-03.6. Provide the name(s) of each SOURCE(s) of income | TYPE OF INCOME RECEIVED: Salary, Fees, Dividends, Profits, Commissions, Bank Interest, Other Compensation | Select Appropriate Income Amount |
TN Lottery and gaming establishments | Other | More than $250,000 |
|
05.1 |
Last year did you earn more than $5,000 as an: (Select the applicable
one)
|
|
Not Applicable
|
05.2 |
Last year did you earn more than $1,000 but less than $5,000 as an: |
|
(Select the applicable one)
|
|
Not Applicable
|
05.3 |
Last year, did YOU, YOUR SPOUSE or DEPENDENTS serve as: |
|
(Select the applicable one)
|
|
Not Applicable
|
05.4 |
Name any business or subsidiary thereof in which YOU, YOUR SPOUSE, or DEPENDENTS,
jointly or severally, owned 5% or
|
|
more of the stock or in which YOU, YOUR SPOUSE or DEPENDENTS served as an OFFICER,
DIRECTOR, TRUSTEE, or CONSULTANT where the service provides income of at least $1,000
and less than $5,000; or at least $5,000 or more for the reporting period. |
|
Not Applicable
|