SF2ig (Rev. 011000)

SF2ig (Rev. 011000) 5 CFRPart 2634 US Once of Government Ethics Date of Appointment. Candidacy. Election or Nomination (Month. Day. Year 1/20/09 Executive Branch Personnel PUBLIC FINANCIAL DISCLOSURE REPORT Form Approved OMB No. 3209.0001 Reporting Status Pea 4graP7ON bMeS) In K cumbent Calendar Year Covered by Report 2008 New Entrant, Nominee. Termination Ij or Candidate Filer lamination Date (If Avon- Coale )(Mona [Jay, tear) Reporting Individual's Name last Name Zichal First Name andSAiddle initial Heather R Position for Which Filing Title of Position Deputy Assistant to the President Address (Number. Street, Om State, and ZIP Code Department or Agency I if Applicable) Fee for Late Rine Any individual who is required to file this report and does so more than 30 days after the date the report is required to be filed, or. Jan extension is granted, more than 30 days after the last day of the filing extension period shall be subject to • $200 foe. Location of Present Office (or forwarding address) Position(s) Held with the Federal Government During the Preceding 12 Months (If Not Same as Above) tea) grosqlticulk Mt , Lek Aar,47 Title of Positionfs) and Dalt:all-kid Legislative Director, US Senator John Kerry 12/2007 - 772008 Telephone No /Include Area Code) tistrt Lei Presidential Nominees Subject to Senate Confirmation Name of Congressional Committee coniiderineNominatton Do You ffitend to Create a Qualified Diversified Trust'' ON° temptation I CERTIFY that the statements I have made on this form and all attached schedules are true, complete and correct to the best of my knowledge. Other Review (If desired by agency) ut ate in .mival W - 6 1617( nIak Signature ot Other KeneiWK //tact-6 Az Vale fmanm- LAN. I COT I zelzi t oc) Date (Month Year) Agency ethics Official's Opinion On the basis of information contained in this report, 1 conclude that the filer is in compliance with applicable laws and regulations (subject to any comments in the box below). Office of Government Ethics Use Only Signal' of Designated ARMICV Ethics OfficialfReviewing Official Ilignanne tomments of Reviewing Officials Of additional space Is required we the reverse side of this sheer/ Date (Month Day. Year) 3/11709 Date (Month Day Year (Check box flitting extension granted & indicate number of days p rude) Q (Check bar yf comments are continued on the reverse Reporting Periods Incumbents: The reporting period is the preceding calendar year except Pan II of Schedule C and Part I of Schedule D where you must also include the filing year up to the date you file. Part El of Schedule D is not applicable. Termination Filers: The reporting period begins at the end of the period covered by your previous filing and ends at the date of termination. Part II of Schedule D is not applicable. Nominees. New Entrants and Candidates for President and Vice President: Schedule A—The reporting period for income (BLOCK C) is the preceding calendar year and the current calendar yeas up to the date of filing. Value assets as of any date you choose that is within 31 days of the date of Mint Schedule B--Not applicable. Schedule C. Part I (Liabilities)— reporting period is the preceding calendar year and the current calendar year up to any date you choose that is within 31 days of the date of filing. Schedule C. Part II (Agreements or Arrangements)— Show any agreements arrangements as of the date of filing. Schedule 1)-The reporting period is the preceding two calendar years and the current calendar year up to the date of filing. Agency Use Only OGE Use Only Supersedes Prior Editions. Which Cannot Be Used. 278412 Form Designed Microsoft Excel 2000 NSN 7540-01-0704444 3 4 9 al/efr EFTA00624859 5 C F.R Pat 2634 U.S. Office of Gownimem Edu.., 'Locoing individual's Name Zichal • SCHEDULE A Page Number Assets and Income BLOC% A Va :ration of Assets at close of cporting period BLOCK 8 Income: type and amount. If "None (or less than $201)" is checked, no other entry is needed in Block C for that item. BLOCK C For you, your report each production value exceeding ing period in income during with such income. For yourself, amount of earned than from the report the source income of more actual &count your spouse). None❑ spouse, and dependent children, asset held for investment or the of income which had a fair market S1.000 at the close of the report- or which generated more than 5200 the mooning period together also report the source and &mud income occeedimt 5200 (oda, U.S. Govemmemt). For your spouse. but not the amount of tamed than SI ,000 (except moon the of any honoraria over $200 of None (or less than STOOD _I c E 44 i; zi4 E-8 4g- ri'ilA ct re,- 2 Z , iff rn• gEE c -- am? 'nI g cl - in ' — g 7) 6. ;I wi ' — .9, cn 4 / if, 7, • — f vi - 2 g ez - r. :Z. I4 y., g". ci; R§ vi rel . — S .4 4 A R `4,' - q .,, 4'4 § cc g 6 r. ti Excepted Investment Fund Excepted Trust 2-- .— 4 3 0' Type Amount Date ale.. Day. Yr.) Only if Honoraria 4 c :2 .e. CZ Rent and Royalties ...1— E- 1-' 4-„- — ' - — ,,, c„ & cpa - c C. ° ...., — . , ,.., c c ..! c Z ..„ .., — C) V, IN V) • g N VI fel k N 0 ,f . .‘ V) —§is —^ 149) § g VI l e cr r.; 01 g 4,4) A•' 4 ZOI gr. :a , E. g 7) •. : 0 C .7). 6 1 . v' ,y 0 °- g c.: ;74 Over 35,000,000 Other Income (Spoei6, Tyre Bc Actual Amount) Examples Central Airlines Common Doe Jones& Smith, Hometown, State Kengistar Etritioilluid _ _ _ IRA: Heartland 500 Index Fund _ _ x x , _ ..x . . x _ 1 x x x c i s.I.I. I...am i 2 Obama for America 7 .34i Pal, 9 (23-46 3 Obama-Biden Transition ,,4 4,, Liiiik.. 7030 .1 7 4 5 /Err 7 Cr2) 6-- k.-- , f• il,. 6 . mark aims category applies only it the a5ScUmethric is solely that ot'thc tile spouse or depend= children. lithe ay,. ., iconic i. ,. .•.. or the tiler or jointly held by the liter w the other higher categories of value, as ar propriate. th the spouse or (lepend in children. Poor Editions Cannot be Used EFTA00624860 SF 278 (Rt.. 03/2000) SCFRPan 2634 Do not Complete Schedule B if you are a new entrant, nominee, Vice Presidential or Presidential Candidate I.1 s Office orGovernment Ethics reporting Individuars Name SCHEDULE B Page Number Part Report or dependent property, securities siboo. I: Transactions env purchase, sale. or exchange by YOU, ow spouse, report a transaction involving property used solely as your children during the reporting period of any real personal residence, or a transaction solely between you. stocks. bonds, commodity future., and other your spouse. or dependent child Check the "Certificate of when the amount of the transaction exceeded divestiture" block to indicate sales made pursuant to a Include transactions that resulted in Do not certificate of divestiture from OGE. None Transaction (x) Date Dia . Day. Yr.) Amount of Transaction (x) i 1 Exchange a ll az1§§a»Illiagzaggrea§ . ,g i l e 1 i 8° E• gai t. § k g.. §. I.gO " -4 k . 8- g. § 48 I Identification of Assets Example: Central Airlines Common x 211/99 x 1 NOT REQUIRED FOR NOMINEES 2 lg. 3 4 5 • This by the category applies only if the underlying asset is solely that of the fda's spouse or dependent children. If the underlying asset is either held files or jointly held by the fda with the spouse or thaa.nduit children, use the other higher categories of value, as appropriate. Part For lion, food. (2) than as authority. dates. II: Gifts, Reimbursements, and Travel Expenses you, your spouse and dependent children. report the source, a brief descrio- the U.S. Govenunent given to your agency in connection with official travel: end the value of: (1) gifts (such as tangible items. transnortation. lodging. received from relatives: received by your mouse or dependent child totally or entertainment) received from one source totaling more than $260: and independent of their relationship to you: or provided as personal hospitality travel-related cash reimbursements received from one source totaling more the donor's residence. Also. for purposes of aggregating gifts to determine the $260. For conflicts analysis, it is helpful to indicate a basis for receipt, such total value from one source, exclude items worth $104 or less. See instructions personal friend, agency approval under S U.S.C. 4 4111 or other statutory for other exclusions. etc. For travel-related gifts and reimbursements. include travel itinerary. None and the nature of expenses provided. Exclude anything given to you by at mu Source Dame and Address) BriefDeseription Value Examples: Nit Assn. of Rock Colinas:its. NN. NY_ _ _ Flank Tones, Son Francisco, CA Ail Me ticket, bpi room & meals incident to among confsreoce6/15199 (fienonal vial anre_lated_to MIN_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ UliWtiiirefaamepao7aligaTer------ ----- — Ss® s 2 3 4 5 nor ENuons Cannot Be Used EFTA00624861 SF VS (Rev. 0312000) CRS Pert 6634 U.S. Office • Goventreace Ethics Wig individuals Name Zictial SCHEDULE C Part I: Liabilities Report liabilities over $10,000 owed to any one creditor at any time during the reporting period by you, vow spouse. or dependent children. Chock the highest amount owed during the repotting period. Exclude a mortgage on your personal residence unless it is rented out; loans secured by automobiles, household furniture or appliances; and liabilities owed to certain relatives listed in instnictions. See instructions for revolving charge accounts. Term if cable Category of Amoimi or Valve• Examples: Creditors (Name and Address) Firsi Distpet ItanSyashin.copac - - - John lones,12.1 1St. Washington, DC Type of Liability Morsagesventai topers,petante_ _ _ _ -11/40111iSSOly note Date Incurred 1991 1999 Interest Rate 10% 25>n_ on demand n 0 VI tra a f i a§ _x , x 0 RI §. U s r - - 2 3 • This category applies only if the liability is solely that oldie filers spouse Of dependent children. if the liability is that ofte filer or a joint liability of the filer with the spouse or dependent children, mark the other higher categories, as appropriate. Part II: Agreements or Arrangements Report your agreements or arrangements for continuing participation in an emDloYee benefit Plan (e4t. 401k. deferred compensation; (2) continuation Dement by a former employer (including severance payments); (3) leaves E ample: Status and Terms of any Agreement or AnageraCOI Puma= to partnership agreement, will receive limy awn payment of capital account & partnership share calculated on service performed throne)) /100. of absence; and (4) future employment. See instructions regarding the reporting of negotiations for any of these arrangements or benefits (wile pci Parties Doe Jones & Smith, Hometown, State Date 7/85 2 3 4 5 6 Prior Editions Cannot Be Used. EFTA00624862 SF 276 (Rev. 03,2000) C.F.R Pan 2634 U.5. Office of Cola:mama, Ethics Kooning Individual's Name Zichal - SCHEDULE D Page Number Part I: Positions Held Outs'de U.S. Government Report any positions held during the applicable reporting period, whether consultant of any corporation, firm, partnership, or other business enterprise or any compensated or not. Positions include but are not limited to those of an officer, organization or educational institution. Exclude positions with religious. director, trustee, general partner, proprietor, representative, employee, or social. fraternal, or political entities and those solely of an honorary nature. None NM Organization (Name and Address) Type of Organization Position Held From (Mo., Yr.) To (Mo., Yr ) Examples.!Earl Astn. of Rock Collectors, NY, NY . _ _ _ _ . _ _ _ _ _ _ Do; Jones & Smith, Honletovm, State . _blokplotit Educalion _ _ _ Law fine President _ _ _ . _ _ __ Partner . 6/92 _ 7/85 _ Present_ _ 1/00 I Obama for America Presidential Campaign Policy Director 7/08 11/08 2 African Wildlife Foundation Non-profit environmental Council member 10/08 12/08 3 0.7re''', k 4/ 0 /*:•,N -1/1. rt, 5 f 7 /5A/ - 11_, .6e i.-idifist, -1,44,, _ 0 t....r ,--;""trz- nu /64/ p,,,, - -7-7 r.ri -1.-Aa.4.> / ;,.- I r ' ' ./() 4 7- 5 6 Part H: Compensation In Excess Of $5,000 Paid by One Source Do not complete Report sources of more than $5,000 compensation received by you or your corporation, firm, partnership, or other business enterprise, or any other non-profit if you are an business affiliation for services provided directly by you during any one year of organization when you directly provided the services generating a fee or payment Termination the reporting period. This includes the names of clients and customers of any of more than $5,000. You need not report the U.S. Government as a source. Vice Presidential or Presidential Nonc this part Incumbent, Filer, or Candidate MN Source /Name and Address) Brief Description of Duties Examples:roe low & Smith.; Hometown State Metro University (client of Doe Jones & Smith), Moneylosim, State Lesal services _ _ Legal services in connection with university construction 1 0 / .1.2 t al .4,1 hi: /1/2-:(2.:-( Z(6 1 c, ... .,i4 f/17/ . /.. / '''' ltri /2 ni ecz 26 ( C, lit 4-4' (11O2-st- a9,41.) elii <1 ‘1% ..,?__ 2 - -- ' 0 //), YIA 1 - et) 6,p# 1 e .vi' i:// (( a (1/ i , , : /7 cf3)4 t, -- L I t. / i --'- / . #1 7' - rsy - Tied' r&L . rif Z 7 71 G -r 1 , 77= -4-77-7 Li 0 54?/ ,c! 3 4 5 6 nor Editions Cannot Be Used. 4 4 EFTA00624863