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AWIG-31-1994 14:44 FROM To} UNIT TO @ WMFO -. against you or your political comnittee with the Federal Election Conmigsion or atate or Local Have you aver been disciplined or cited for a breach of ethics or unprofessional conduct by, oF been the subject of @ complaint to any court, administrative agency, professional association, disciplinary committee, or other professional group? If so, please give full detaile. 4 ft Complaints Filed while ducge or thier. JUG EA, all ¢ pont usec, - ” Have you ever run for political office, served on a political committee or been {dentified in a public way with a particular organization, candidate of issue? Nave any complaints been. lodged election authorities? If so, please deacr ibe. election commissfOn Check FEC . "are you currently, .or have you ever heen, a metber or office holder. in any club-of organizetion ~ that restricts ‘or restricted membership on the basis of sex, race, color, religion, natlonal _otigin, age or handicap? !f so, provide the name, address and dates of metbership for each. 4 Plesse: identity any adults (18 years of older) ‘currently Living with you who are not members of your inmnediate family. Provide the names of those individuals, dates and places of birth, and whether or fot they are United States citizens. ; Nome 4 is there anything in your personal life that could be used by someone to coerce or blackmail you? _ Is there anything in your life that could cause an embarrassment to you or te the President if wblicty known? If so, please provide fult details. . ; No AUG 31 1 understand that the information being provided on this supplement to the SF+86 is to be considered pert of the original SF-36 dated ond a false statement on this form i¢ punizhable by law. _ "S44 13:23 fea? S@4 1373 PAGE.GIE x (SV) check, Liino's siete |.