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(xiv) the first $2,000 of per capita shares received from judgments <br /> awarded by the Indian Claims Commission or the Court of Claims or <br /> from funds held in trust for an Indian tribe by the Secretary of Interior. <br /> 7. Net Family Assets. If any of the persons described in item 1 above (or any <br /> person whose income or contributions were included in item 6 above) has any <br /> savings, stocks, bonds, equity in real property or other form of capital investment <br /> (excluding interests in Indian trust lands), provide: <br /> (a) the total value of all such assets owned by all such persons: <br /> $ ; <br /> (b) the amount of income expected to be derived from such assets in the <br /> 12-month period commencing on the date hereof: <br /> $ ; <br /> (c) the amount of such income included in item 6: <br /> $ ; <br /> 8. Orono Connection <br /> (a) Are any of the persons listed in item 1 above residents of the City of <br /> Orono, former residents of the City of Orono, parents of residents of the City of <br /> Orono or former full-time employees of the City of Orono? <br /> Yes No <br /> (b) (Complete only if the answer to item 8(a) is "Yes") Describe the basis <br /> for the "Yes" response, including relevant names, addresses and time periods. <br /> • <br /> The above information is full, true and complete to the best of my knowledge. <br /> I have no objections to inquiries being made for the purpose of verifying the <br /> statements made herein. The undersigned acknowledge that the lease executed by the <br /> undersigned may be canceled upon notice as provided therein if the undersigned have <br /> misrepresented any of the information set forth above. <br /> Date: <br /> Signature <br />