Form 700, Schedule A-1, Investments: Stocks, Bonds, and Other Interests (Ownership Interest is Less than 10 Percent)

Investments must be itemized. Do not attach brokerage or financial statements.

Filer's Name

Investment 1

Name of Business Entity General Description of this Business Activity

Fair Market Value $2,000 to $10,000 $10,001 to $100,000 $100,001 to $1,000,000 Over $1,000,000

Nature of Investment Stock Partnership Other, If other checked, describe other:

Income Received Income Received of $0 to $499
Income Received of $500 or More (Report on Schedule C)