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4
STATEMENT OF ECONOMIC INTE RESTS
GORDY HULTEN, CHAMPAIGN COUNTY CLERK
1776 E Washington. Urbana, lL 61802
124 S
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Name (Please Print)
Phone
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Pes derce Aooress
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Mailing Address
City end Zip Code
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Position o’r office to. rwhich. statement is beno Ceo
Unit of Government
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Additional Position (it applioable) for this Statement
Unit of Covernment
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Additional Position fit aoolioabie) for thi:s Starement
Filing for Calendar Year 20
Un:i,t o Government
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General Direc:tioos
Tee. interest
It ronstrunuveny corntroilec
b th
person
mr
.
statement.) n a
spouse
considered to be the sa oe as
‘nteres of tile neisO 1 °akirq me staamenr
Campe go
this statement, If additional space is needed, please attach supplemental listing.
or an
Complete both sides. Do not leave any ouestion blank. Put NGNE where you have n.othinn
List the name
no
:nc
rur1er.t
moonceom0
of ownersnir. in an.
entirE ooo
i dm00
wi).h a
nr. of
to
0001 00 V ernnl:ent
e
o
other namby. snail be
included in
mccc ms
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not
ne
dtsclos•e.
n reiotinn to :ni5ir:H the
rorse
052
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rom won mm C nds n wcess Si 2G2 jore re
rhe can o rca —state ocation
ed o r g the ooed’n aierc year
thereof shall be trEed by the street address, or if none, then by legal description.) No time or demand deposit in a financial institution,
nor any debt instrum.ent shall be listed.
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2. List the name, address and type of practice, of a’ny orofessicoal orga :l:ization in which, the person making the statement was an
officer, director, a.ssociate. partner or proprie or or sm’vec’ in any advisory sapaoit.y loom, which income in th.e excess. of Ii 220 wa.s
derived during the nrecednp calendar year.
6.
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(CCMPLETF BUT DC NOT DETAL.H)
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r::nnme: 05cc eric t(cttrJ 01015
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rlecreIVe:.rI ror professional
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4. List the identtto nnAo!rJlng the eddress er legal d-eecriptlon of reel estate) nr: coo canital asse.t from which a capital
gain of 55,000 cr wore wee reelized during the. prec.eding calender veer.
5. List the name ot any entity and the nature of the govrrrnmentai act.ion rerr nested by any endty which has applied to
a cult of iocal gove mect a rela’,on to v hch rue person mus fcc for any cors arcmse or oermit or annexatIon
zoning or rezon ing of real estate during the preceding calendar year if the ownership intere•st of the person filing is in
exce.ss of $,ggg fair market: valut: at the time of filing or if income or dividends in excess of $1 20 were received by
the pm. rson filing from the entity during the. creceding calendar year.
enotv doing husiness with a unit of local povemnrer::r it relation to which the person is reguired
6. List the name of
e etherthan fortne
p
c Lc of 51 250 was dea,ed
for
to
professional servlrres and tn title; c;r descript.ion of any position hel ;t In, that a ntltv, Sf c tinne or demand deposit in a
ftnarnalal Insbtntlon nor err debt instrenaent need he lin.hed.
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plc is) tI
ele;ncotr
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r
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OtO:1 than
:2:1r UOO
or units
rnmun In
1
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Th
Of
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tf264
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410 lb
rra.rrriOn: to nt/n..Ori
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5 recuireo
10
file.
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“I dec:l.a.re rhnt tilO; stctt- rnnt of economic Interests: (IncludIng any acrrrinirrnarn, s.r’h;:;i’ tsar onrl. st,atemeotst has bee n examined by
ge and hellef is a true-, correct and cnn nrrlcos stalon ient of icy economic lntr: rests as requIred by
1
me and to roe best : :5 scowro
the IllinoIs Gcvernmeotal Ethics Act understand that the pona•lfv for wr.lbSIr’ftlcp s; false or i’ccnmplet.e statement shall be a fine
01 to excee’ b
n
onmen
pamal cots on ctner nan e
sa exceed one ea or oomn fme and
-
lmphsonmentt’
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(signature. of person making statement)
(date)