9. |
(a.) |
List the respondent, and, if other than a natural person, its officers, directors, stockholders and other entities with attributable interests, non-insulated partners and/or members. If a corporation or partnership holds an attributable interest in the respondent, list separately its officers, directors, stockholders and other entities with attributable interests, non-insulated partners and/or members. Create a separate row for each individual or entity. Attach supplemental pages, if necessary.
[Enter Owner Information]
Owner Information
List the respondent, and, if other than a natural person, its officers, directors, stockholders and other entities with attributable interests, non-insulated partners and/or members. If a corporation or partnership holds an attributable interest in the respondent, list separately its officers, directors, stockholders and other entities with attributable interests, non-insulated partners and/or members. Create a separate row for each individual or entity. Attach supplemental pages, if necessary.
(Read carefully - The numbered items below refer to line numbers in the following table.) |
1. Name and address of respondent and each party to the respondent holding an attributable interest (if other than individual also show name, address and citizenship of natural person authorized to vote the stock or holding the attributable interest). List the respondent first, officers next, then directors and, thereafter, remaining stockholders and other entities with attributable interests, and partners.
2. Gender (male or female).
3. Ethnicity (check one).
4. Race (select one or more).
5. Citizenship. 6. Positional interest: Officer, director, general partner, limited partner, LLC member, investor/creditor attributable under the Commission's equity/debt plus standard, etc.
7. Percentage of votes.
8. Percentage of total assets (equity debt plus).
|
1. Name and Address |
ANDREW FRANKLIN, 230 SW RIVERDALE ROAD, PORTLAND, OR 97219 |
2. Gender (male or female) |
|
3. Ethnicity (check one) |
Hispanic or Latino
Not Hispanic or Latino |
4. Race (select one or more) |
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
|
5. Citizenship |
US |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
LIBBY SCHWARTZ, 6312 SW CAPITOL HWY, #175, PORTLAND, OR 97239 |
2. Gender (male or female) |
|
3. Ethnicity (check one) |
Hispanic or Latino
Not Hispanic or Latino |
4. Race (select one or more) |
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
|
5. Citizenship |
US |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
JIM HUSTON, BLUEPRINT VENTURES, 21125 SW RAMBLIN RECK RD., SHERWOOD, OR 97140 |
2. Gender (male or female) |
|
3. Ethnicity (check one) |
Hispanic or Latino
Not Hispanic or Latino |
4. Race (select one or more) |
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
|
5. Citizenship |
US |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
JULIE STRASSER DIXON, 432 JOSEPH CREEK ROAD, ASOTIN, WA 99402 |
2. Gender (male or female) |
|
3. Ethnicity (check one) |
Hispanic or Latino
Not Hispanic or Latino |
4. Race (select one or more) |
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
|
5. Citizenship |
US |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
LEDA I. GARSIDE, RN, BSN, 13611 BLAZER TRAIL, LAKE OSWEGO, OR 97035 |
2. Gender (male or female) |
|
3. Ethnicity (check one) |
Hispanic or Latino
Not Hispanic or Latino |
4. Race (select one or more) |
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
|
5. Citizenship |
US |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
AVEL GORDLY, PORTLAND STATE UNIVERSITY, PO BOX 751, PORTLAND, OR 97207 |
2. Gender (male or female) |
|
3. Ethnicity (check one) |
Hispanic or Latino
Not Hispanic or Latino |
4. Race (select one or more) |
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
|
5. Citizenship |
US |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
TINKER HATFIELD, NIKE, INC. 1 SW BOWERMAN DRIVE, BEAVERTON, OR 97005 |
2. Gender (male or female) |
|
3. Ethnicity (check one) |
Hispanic or Latino
Not Hispanic or Latino |
4. Race (select one or more) |
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
|
5. Citizenship |
US |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
DIAN HILLIARD, 2315 NW ASPEN AVENUE, PORTLAND, OR 97210 |
2. Gender (male or female) |
|
3. Ethnicity (check one) |
Hispanic or Latino
Not Hispanic or Latino |
4. Race (select one or more) |
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
|
5. Citizenship |
US |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
JODIE HUESKE, LES SCHWAB TIRE CENTERS, 20900 COOLEY ROAD, BEND, OR 97701 |
2. Gender (male or female) |
|
3. Ethnicity (check one) |
Hispanic or Latino
Not Hispanic or Latino |
4. Race (select one or more) |
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
|
5. Citizenship |
US |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
JEFF IWASAKI, SMITHCFI, 620 NE 19TH AVENUE, PORTLAND, OR 97232 |
2. Gender (male or female) |
|
3. Ethnicity (check one) |
Hispanic or Latino
Not Hispanic or Latino |
4. Race (select one or more) |
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
|
5. Citizenship |
US |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
PAMELA JONES, JONES PARTNERS, PO BOX 449, VANCOUVER, WA 98666 |
2. Gender (male or female) |
|
3. Ethnicity (check one) |
Hispanic or Latino
Not Hispanic or Latino |
4. Race (select one or more) |
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
|
5. Citizenship |
US |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
SYDNEY JOYNER, THE JOYNER GROUP, LTD, 19215 SE 34TH, STE 106 #307, CAMAS, WA 98607 |
2. Gender (male or female) |
|
3. Ethnicity (check one) |
Hispanic or Latino
Not Hispanic or Latino |
4. Race (select one or more) |
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
|
5. Citizenship |
US |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
GARY MAFFEI, MERLO CORPORATION, 1001 SE SANDY BLVD., PORTLAND, OR 97214 |
2. Gender (male or female) |
|
3. Ethnicity (check one) |
Hispanic or Latino
Not Hispanic or Latino |
4. Race (select one or more) |
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
|
5. Citizenship |
US |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
SHERYL MANNING, 864 NW ALBEMARLE TERRACE, PORTLAND, OR 97210 |
2. Gender (male or female) |
|
3. Ethnicity (check one) |
Hispanic or Latino
Not Hispanic or Latino |
4. Race (select one or more) |
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
|
5. Citizenship |
US |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
KEITH MOBLEY, PO BOX 537, DUFUR, OR 97021 |
2. Gender (male or female) |
|
3. Ethnicity (check one) |
Hispanic or Latino
Not Hispanic or Latino |
4. Race (select one or more) |
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
|
5. Citizenship |
US |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
MITCHELL MOORE, CLEAR CREEK TELEPHONE & TELEVISION, 18238 S. FISCHERS MILL RD., OREGON CITY, OR 97045-9696 |
2. Gender (male or female) |
|
3. Ethnicity (check one) |
Hispanic or Latino
Not Hispanic or Latino |
4. Race (select one or more) |
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
|
5. Citizenship |
US |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
ROMY MORTENSEN, BROOKS RESOURCES CORPORATION, 409 NW FRANKLIN AVE., BEND, OR 97701 |
2. Gender (male or female) |
|
3. Ethnicity (check one) |
Hispanic or Latino
Not Hispanic or Latino |
4. Race (select one or more) |
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
|
5. Citizenship |
US |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
RON SAXTON, JELD-WEN, 200 SW MARKET ST., STE. 550, PORTLAND, OR 97201 |
2. Gender (male or female) |
|
3. Ethnicity (check one) |
Hispanic or Latino
Not Hispanic or Latino |
4. Race (select one or more) |
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
|
5. Citizenship |
US |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
HOWARD SHAPIRO, 224 NW 13TH, PORTLAND, OR 97209 |
2. Gender (male or female) |
|
3. Ethnicity (check one) |
Hispanic or Latino
Not Hispanic or Latino |
4. Race (select one or more) |
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
|
5. Citizenship |
US |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
JOHN 'SKI' SYGIELSKI, MT. HOOD COMMUNITY COLLEGE, 26000 SE STARK ST., GRESHAM, OR 97030 |
2. Gender (male or female) |
|
3. Ethnicity (check one) |
Hispanic or Latino
Not Hispanic or Latino |
4. Race (select one or more) |
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
|
5. Citizenship |
US |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
JENNY ULUM, 2114 UNIVERSITY STREET, EUGENE, OR 97403 |
2. Gender (male or female) |
|
3. Ethnicity (check one) |
Hispanic or Latino
Not Hispanic or Latino |
4. Race (select one or more) |
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
|
5. Citizenship |
US |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
AL VERMEULEN, 1849 NW ESTAVIEW DR., CORVALLIS, OR 97330 |
2. Gender (male or female) |
|
3. Ethnicity (check one) |
Hispanic or Latino
Not Hispanic or Latino |
4. Race (select one or more) |
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
|
5. Citizenship |
US |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
FRED ZIARI, EZWIRELESS, 2800 NW 29TH AVENUE, PORTLAND, OR 97210 |
2. Gender (male or female) |
|
3. Ethnicity (check one) |
Hispanic or Latino
Not Hispanic or Latino |
4. Race (select one or more) |
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
|
5. Citizenship |
US |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
STEVEN M. BASS, OPB PRESIDENT & CEO, 7140 SW MACADAM AVENUE, PORTLAND, OR 97219-3099 |
2. Gender (male or female) |
|
3. Ethnicity (check one) |
Hispanic or Latino
Not Hispanic or Latino |
4. Race (select one or more) |
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
|
5. Citizenship |
US |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
1. Name and Address |
JACK MCGOWAN, CAB CHAIR, INDIAN FORD ROAD, SISTERS, OR 97759 |
2. Gender (male or female) |
|
3. Ethnicity (check one) |
Hispanic or Latino
Not Hispanic or Latino |
4. Race (select one or more) |
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
|
5. Citizenship |
US |
6. Positional Interest |
|
7. Percentage of votes |
|
8. Percentage of total assets (equity debt plus) |
|
|
(b) |
Respondent certifies that equity and financial interests not set forth in response to Question 9(a) are non-attributable. |
Yes No
N/A
See Explanation in
[Exhibit 2]
|
(c) |
Is the respondent or any party holding an attributable interest in the respondent also the holder of an attributable interest in any other broadcast station or in any cable or newspaper entities in the same market or with overlapping signals in the same broadcast service, as described in 47 C.F.R. Sections 73.3555 and 76.501? |
Yes No |
If "Yes", submit an Exhibit identifying the holder of that other attributable interest, listing the call signs, locations and facilities identifiers of such other broadcast stations, and describing the nature and size of the ownership interest and the positions held in the other broadcast, cable or newspaper entities. |
[Exhibit 3] |
(d) |
Are any of the individuals listed in response to Question 9(a) related as parent-child, husband-wife, brothers and sisters?
|
Yes No
|
|
If "Yes", submit an Exhibit setting forth full information as to the family relationship
|
[Exhibit 4]
|
(e) |
Is respondent seeking an attribution exemption for any officer or director with duties unrelated to the licensee or permittee?
If "Yes", submit an Exhibit identifying that individual by name and title, fully describing that individual's duties and responsibilities, and explaining why that individual should not be attributed an interest.
|
Yes No
[Exhibit 5]
|
|