STATEMENT OF ECONOMIC INTERESTS 
For  xxxx  CALENDAR YEAR -  TO BE FILED NO LATER THAN , EXCEPT FOR CANDIDATES, who must file simultaneously with their qualifying forms as required by Section 36-25-15, Code of Alabama 1975
PLEASE READ INSTRUCTIONS BEFORE ATTEMPTING TO COMPLETE FORM.

If sections of this form do not apply to you personally, indicate this by marking or checking “N.A.” and proceed to the next section. Once you start working on this form, try to finish it in one sitting. You cannot save an incomplete form to finish at a later time. Your current session will expire at 5/17/2025 6:20 PM (Central Time) . If this happens, you must start over.
Page:
Filing Year:          

 Are you CANDIDATE?     
 
  YEAR OF CANDIDATE:
  FOR OFFICE IN  CITY       COUNTY     STATE 
 ( If you are a candidate, complete this section and see last page of instructions.)
I am a candidate for the ()  () or ()   FOR OFFICE OF     


 Are you in LAW ENFORCEMENT?     
 
Judge - Any Level    
District Attorney/Asst or Deputy DA/DA Investigator    
Attorney General/AG Attorney, Special Agent/Investigator    
Post Certified Law Enforcement Officers    
 
 
01.   Full Name, Home Address, and Telephone Number(s) of Filing Person:
  First Name:   P.O. Box:
  Middle Name:  City:
Last Name:     Suffix:    Zip Code:
  Nickname: County:
  Street:  
  Route: Business Phone:
(ex: 999-999-9999)
 
 
PLEASE FILL IN THE BLANKS OR CHECK ON THE CORRECT WORD(S) OR NUMBER(S) AS APPROPRIATE
02. Last year, I was an ()  ()  ()  with the
()  () () and the name and address of my
()  ()  ()  ()  ()  () ()  () was
Name:    
Address:
02.1 As an / / last year, my job title/position was
02.2 Last year, the name(s) of the ()  ()  ()   
 , , ,  ,  , of which I was a Member was(were) 
02.3 Last year in the above public position(s) in 02. thru 02.2 I earned: