STATEMENT OF ECONOMIC INTERESTS

STATEMENT OF ECONOMIC INTERESTS
Filing Year: 2019 Submit Date: 4/21/2020 4:09:06 PM

Candidate

CANDIDATE:

FOR OFFICE IN CITY COUNTY AL STATE

FOR OFFICE OF

Law Enforcement

Law Enforcement: Judge - Any Level: District Attorney/Assistant 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:	Samuel	Business Phone:	251-680-3030
	Middle Name:	L
	Last Name:	Jones Suffix:
	Nickname:	Sam

PLEASE FILL IN THE BLANKS OR CHECK ON THE CORRECT WORD(S) OR NUMBER(S) AS APPROPRIATE

Organization(s)


02.0	*Last year,* I was an (elected official) (appointed official) (employee) with the
	(Municipality) (County) (State) and the name and address of my (department) (office) (agency) (board) (college) (county) (municipality) (commission) was Name: Alabama House of Representatives Address: 11 S Union Street Montgomery, Alabama 36130

02.1	As an elected / appointed official / employee last year, my job title/position was Representative - House District 99

02.2	Last year in the above public position(s) in 02.0a thru 02.1a I earned: (More than $10,000)
	Add another organization

02.3	*Last year*, the name(s) of the ( State) ( County) ( Municipal)
	Board(s), Commission(s), Committee(s), Authority(ies), Council(s), Others of which I was a Member was(were) Mobile Area Water and Sewer

03.

Other than my public position(s) in 02. thru 02.2, list any occupation, employment or business

(including self-employment) where you or your spouse spent at least 1/3 of your or your spouse's working time:
Ball Healthcare

03.1

The name and address of my employer, listed in 03. above, was

Name: Ball Healthcare
Address: 1 Southern Way Mobile, Alabama 36695

03.2

I was SELF-EMPLOYED last year and the NAME and ADDRESS of my business was

Name: N/A
Address: N/A

03.3

From the occupations or businesses listed in 03., I, My Spouse and/or Dependents earned last year an aggregate of:

(More than $10,000)

03.4

Last year, (I ) (My Spouse) (Dependents) owned 5% or more of the stock in the firm(s) listed in (03.1 and/or 03.2)

Not Applicable

03.5

Last year, (I ) (My Spouse) (Dependents) was a CONSULTANT and earned more than $1,000 from each
firm listed in (03.1 and/or 03.2)

Not Applicable

03.6

Last year, (I ) (My Spouse) (Dependents) served as an (Officer) (Director) (Trustee) of the
firm(s) listed in (03.1 and/or 03.2)

Not Applicable

04.

Information on Family Members:

Spouse Information:

Spouse Name	Business or Employer
N.A.	N.A.

Names Only of LIVING ADULT CHILDREN:	N/A

Names Only of LIVING PARENTS: (No Maiden Names)	N/A

Names Only of LIVING SIBLINGS: (No Maiden Names)	William Smith, Rose Williams, Gloria Sterling, Francee Smith, Ken Smith

Names Only of LIVING PARENTS OF SPOUSE: (No Maiden Names)	N/A

05.	OTHER INCOME INFORMATION ON YOU, YOUR SPOUSE AND DEPENDENT CHILDREN
	List total combined household income, in addition to what is listed in 02.3 thru 03.5, the names of each business income is derived from, and the income from each business. Not Applicable
05.1	Last year did you earn more than $5,000 as an: (Select the applicable one)
	Not Applicable
05.2	Last year did you earn more than $1,000 but less than $5,000 as an:
	(Select the applicable one and explain, if necessary.)
	Not Applicable
05.3	Last year, did YOU, YOUR SPOUSE or DEPENDENTS serve as an:
	(Select the applicable one and explain, if necessary.)
	Not Applicable
05.4	Name any business or subsidiary thereof in which YOU, YOUR SPOUSE, or DEPENDENTS, jointly or severally, owned 5% or
	more of the stock or in which YOU, YOUR SPOUSE or DEPENDENTS served as an OFFICER, DIRECTOR, TRUSTEE, or CONSULTANT where the service provides income of at least $1,000 and less than $5,000; or at least $5,000 or more for the reporting period.
	Not Applicable

06.	REAL ESTATE HOLDINGS (Exclude your Homestead) (TO BE COMPLETED ONLY BY ELECTED OFFICIALS,
	APPOINTED OFFICIALS or CANDIDATES for State, County or Municipal Offices.) Are you an ELECTED OFFICIAL, APPOINTED OFFICIAL or a CANDIDATE for State, County or Municipal Offices ? Yes

06.1

Did YOU, YOUR SPOUSE or DEPENDENTS own real estate for investment or revenue production last year?

Yes

If yes, list each piece of real estate wherever situated separately below and provide the requested information.

City County State What is the fair market value? What is the annual gross rent or lease income?
Mobile Mobile AL $50,000 - $100,000 Less than $10,000
Mobile Mobile AL $50,000 - $100,000 Less than $10,000
Mobile Mobile AL $100,000 - $150,000 $10,000 but less than $50,000
Mobile Mobile AL Less than $50,000 Less than $10,000
Mobile Mobile AL Less than $50,000 Less than $10,000
Mobile Mobile AL Less than $50,000 Less than $10,000
Mobile Mobile AL Less than $50,000 Less than $10,000
Mobile Mobile AL Less than $50,000 Less than $10,000
Mobile Mobile AL Less than $50,000 Less than $10,000
Mobile Mobile AL Less than $50,000 Less than $10,000

06.2

Did YOU, YOUR SPOUSE OR DEPENDENTS or A BUSINESS WITH WHICH YOU ARE ASSOCIATED receive any rent or

lease income from any governmental agency in Alabama last year?
No

If yes, specific details of the lease or rent agreement shall be filed with the Ethics Commission.

07.

INDEBTEDNESS INFORMATION: Report debts owed to all businesses operating in Alabama**as of December 31, of the reporting year. Include debts for YOU, YOUR SPOUSE and DEPENDENT CHILDREN.

(**Doing business in Alabama, regardless of where their home office is located or where you mail your payment.) DO NOT INCLUDE indebtedness associated with HOMESTEAD - home in which you live.

Provide ACTUAL Number of Debts and Check Corresponding COMBINED Dollar Amount
DO NOT list Debtor's Names or Accounts Numbers.

TYPE	How many do you OWE?	How much do you OWE? (Select one that relates to the combined total in each category)
07.1 BANKS (include Credit Cards)	3	$100,000 - $150,000
07.2 CREDIT UNIONS and SAVINGS and LOAN ASSOCIATIONS (include Credit Cards)	1	Less than $25,000
07.3 INSURANCE COMPANIES	0	Not Applicable
07.4 MORTGAGE FIRMS	0	Not Applicable
07.5 STOCKBROKERS or BOND FIRMS	0	Not Applicable
07.6 INDIVIDUALS or OTHER BUSINESS(ES) (include store cards)	1	Less than $25,000
07.7 STUDENT LOANS	0	Not Applicable

08.

PROFESSIONAL OR CONSULTING SERVICES: Complete this Section ONLY if YOU or YOUR SPOUSE received income last year in return for professional or consulting activities.

State the NUMBER of CLIENTS and CHECK Corresponding Income and/or Retainer Income.)

Check if no income was received for Professional or Consulting Services for the categories of Clients shown below.

Categories of Clients	Annual Gross Income During Reporting Year	Anticipated Annual Retainer Income
08.1 UTILITIES	Not Applicable	Not Applicable
Electric	Not Applicable	Not Applicable
Gas	Not Applicable	Not Applicable
Telephone	Not Applicable	Not Applicable
Water	Not Applicable	Not Applicable
Cable Television	Not Applicable	Not Applicable
08.2 TRANSPORTATION	Not Applicable	Not Applicable
Intrastate Companies	Not Applicable	Not Applicable
Pipeline Companies	Not Applicable	Not Applicable
Oil Exploration	Not Applicable	Not Applicable
Gas Exploration	Not Applicable	Not Applicable
Oil and Gas Retailers	Not Applicable	Not Applicable
08.3 FINANCE and INSURANCE	Not Applicable	Not Applicable
Banks	Not Applicable	Not Applicable
Savings & Loan Associations	Not Applicable	Not Applicable
Loan and/or Finance Companies	Not Applicable	Not Applicable
Manufacturing Firms	Not Applicable	Not Applicable
Mining Companies	Not Applicable	Not Applicable
Life Insurance Companies	Not Applicable	Not Applicable
Casualty Insurance Companies	Not Applicable	Not Applicable
Other Insurance Companies	Not Applicable	Not Applicable
Retail Companies	Not Applicable	Not Applicable
Beer Companies	Not Applicable	Not Applicable
Wine Companies	Not Applicable	Not Applicable
Liquor Companies	Not Applicable	Not Applicable
Beverage Distributors	Not Applicable	Not Applicable
08.4 ASSOCIATIONS	Not Applicable	Not Applicable
Trade	Not Applicable	Not Applicable
Professional	Not Applicable	Not Applicable
Governmental	Not Applicable	Not Applicable
Public Employee	Not Applicable	Not Applicable
Public Official	Not Applicable	Not Applicable
08.5 GOVERNMENT	Not Applicable	Not Applicable
State	Not Applicable	Not Applicable
County	Not Applicable	Not Applicable
Municipal	Not Applicable	Not Applicable
Other Government Corp. Or Authorities	Not Applicable	Not Applicable
08.6 MISCELLANEOUS	Not Applicable	Not Applicable

09.	DECLARATION OF REPORTING PERSON
	I have read and completed this Statement of Economic Interests Form, and do swear (or affirm) that the information contained in said Statement of Economic Interests is true and correct. I fully understand that anyone who violates the disclosure provision of this Act shall be subject to a fine of $10.00 a day not to exceed $1,000 annually. I also understand that any attachments that I place with this form become a part of this public record.
	I agree with the above statement.
	PLEASE PRINT/TYPE NAME OF PERSON SIGNING FORM: Jones, Samuel

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