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<br />5. state the nature of any other income in excess of one thousand <br />dollars during the preceding 12 months, per source, besides <br />income from your employer. Each source of income must be <br />listed, regardless of its tax status. Sources also must be <br />listed specifically; that is, "stocks" would be insufficient; <br />you must state "stock in XYZ company." The nature of the <br />income can be stated generally: "capital gain," "dividend," <br />"rent," etc. You are not required to disclose the amount of <br />income from any source, but you may if you wish. <br /> <br />Source <br /> <br />Nature <br /> <br />6. State the name, location and nature of activity of any <br />business entities for profit, with holdings of real or <br />personal property or with business dealings in Boulder County, <br />in which you have any interest. For each, state the nature of <br />your interest or activity therewith, and state whether you <br />have controlling interest in the entity. "Business entity" <br />means any entity carried on for purposes of profit including <br />a business, sole proprietorship, firm, partnership, <br />association, venture, trust, or corporation. It is immaterial <br />whether the business is making money; if it was founded with <br />that intent, it must be listed. Also, note that the business <br />must be listed if it has any property, or anv business <br />dealings, in Boulder County, but that those holdings and <br />dealings do not have to be set forth (real estate holdings of <br />businesses in which you have a controlling interest must be <br />disclosed in the next question, however). The nature of your <br />involvement should be stated with a degree of specificity; <br />that is, state "corporate vice-president" rather than simply <br />"officer." The amount of financial involvement need not be <br />disclosed, but it may be if you wish. <br /> <br />Form date: July 13, 1992 <br /> <br />Page 2 of 4 <br />