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11851 Debra S Rokosz 2018 Statement of Financial Interests for 2018 Rokosz Debra S (617) 626-2905 rokosz@dor.state.ma.us You indicated that you did have a spouse residing in your household during 2018. You indicated that you did have dependent child(ren) residing in your household during 2018. Page 1 of 15 provide the required information for that position. If you held more than one public position which requires you to file, identify each position. Massachusetts Department of Revenue (DOR) 100 Cambridge Street, Boston, MA, 02114, US Deputy Commissioner, Resolution 01/30/2017 3. Other than the position(s) identified in Question 2, identify every public position you held, and every public agency to which you provided services, at any time during 2018, whether compensated or not, and whether full- or part-time. services, at any time during 2018, whether compensated or not, and whether full- or part-time. any time during 2018, whether compensated or not, and whether full- or part-time, and provide the required 6. Identify any Business from which you were on a leave of absence at any time during 2018, and provide its address. Page 2 of 15 7. Identify every Business for which your spouse and/or any dependent child(ren) residing in your household worked as an employee, manager, consultant, or independent contractor at any time during 2018, whether compensated or not, and whether full- or part-time, and provide the required information for each. Buckingham Browne and Nichols Summer Camp 80 Gerry's Landing Road, Cambridge, MA, 02138, US Employee Boston Harbor Sailing Club 65 E. India Row, Boston, MA, 02110, US Employee MIT, Lincoln Laboratory 244 Wood Street, Lexington, MA, 02421, US Employee University of Vermont 81 Carrigan Drive, Burlington , VT, 05405, US Employee owned more than 1% of any class of the outstanding stock or similar ownership interest, at any time during 2018, and provide the required information for each. during 2018, and provide the required information for each. Adicep Technologies, Inc. 26 Sweeney Ridge Road, Bedford, MA, 01730 Page 3 of 15 dependent child(ren) residing in your household during 2018, and provide the required information for each. 11. Identify any Business in which you served as an officer, director, or trustee, at any time during 2018, whether an officer, director, or trustee, at any time during 2018, whether compensated or not, and whether full- or part-time, and provide the required information for each. Page 4 of 15 13. Identify all Real Estate in Massachusetts which you owned directly or through a Business as of December 31, 2018, and which had an assessed value greater than $1,000, and provide the required information for each Real Estate F, S/C 91 Wallace Street, Somerville, MA, 02144, US F, S/C and/or any dependent child(ren) residing in your household owned directly or through a Business as of December 31, 2018, and which had an assessed value greater than $1,000, and provide the required information for each Real Estate Page 5 of 15 15. Identify any Trust of which you were a beneficiary, and which owned Real Estate in Massachusetts as of December 31, 2018, with an assessed value greater than $1,000, and provide the required information for each such Trust and Real 31, 2018, with an assessed value greater than $1,000, and provide the required information for each such Trust and Real 17. Identify any Real Estate in Massachusetts with an assessed value greater than $1,000, that was transferred to another person or entity by you, or by a Trust of which you were a beneficiary, at any time during 2018, and provide the required information for each Real Estate holding. Page 6 of 15 18. Other than the Real Estate identified in Question 17, identify any Real Estate in Massachusetts with an assessed value greater than $1,000, that was transferred to another person or entity by your spouse and/or any dependent child(ren) residing in your household, or by a Trust of which your spouse and/or any dependent child(ren) residing in your household was a beneficiary, at any time during 2018, and provide the required information for each piece of Real Estate transferred. 2018, you, or a Trust of which you were a beneficiary, had a lien, attachment, or mortgage receivable, and provide the 20. Other than the Real Estate identified in Question 19, identify any Real Estate in Massachusetts with an assessed value greater than $1,000, on which, as of December 31, 2018, your spouse and/or any dependent child(ren) residing in your household, or a Trust of which your spouse and/or any dependent child(ren) residing in your household, had a lien, Page 7 of 15 agencies, and authorities, which you owned directly or through a Business, as of December 31, 2018, and which had a dependent child(ren) residing in your household owned directly or through a Business, as of December 31, 2018, and which had a fair market value as of that date greater than $1,000, and provide the required information for each such investment. agencies, and authorities, which was owned as of December 31, 2018, by a Trust of which you were a beneficiary, whether directly or through a Business, and which had a fair market value as of that date greater than $1,000, and provide the required information for each such investment. Page 8 of 15 agencies, and authorities, which was owned as of December 31, 2018, by a Trust of which your spouse and/or any dependent child(ren) residing in your household was a beneficiary, whether directly or through a Business, and which had a fair market value as of that date greater than $1,000, and provide the required information for each such investment. 25. Identify every Financial Investment that you owned directly or through a Business as of December 31, 2018, and which had a fair market value as of that date greater than $1,000, and provide the required information for each. Name of Issuer Description of Investment Principal Place of Business or State of Incorporation United States Treasury F, S/C Bond United States Unknown, Unknown, DC, 99999, US and/or any dependent child(ren) residing in your household owned directly or through a Business as of December 31, 2018, and which had a fair market value as of that date greater than $1,000, and provide the required information for Name of Issuer Description of Investment Principal Place of Business or State of Incorporation US Treasury Bonds U.S. Government US Treasury, District of Columbia, DC, 99999, US Page 9 of 15 27. Identify every Financial Investment that was owned as of December 31, 2018, by a Trust of which you were a beneficiary, and which had a fair market value as of that date greater than $1,000, and provide the required information for each. For any Financial Investment not included on the drop-down list of publicly traded stock, you must provide the 28. Other than the Financial Investments identified in Question 27, identify every Financial Investment that was owned as of December 31, 2018, by a Trust of which your spouse and/or any dependent child(ren) residing in your household was a beneficiary, and which had a fair market value as of that date greater than $1,000, and provide the required information for each. For any Financial Investment not included on the drop-down list of publicly traded stock, you must provide the 29. Identify all mortgages, including home equity and reverse mortgage loans, on your Primary Residence, on which more than $1,000 was owed as of December 31, 2018, where the creditor (person who loaned you the money) is not, by blood or marriage, your parent, grandparent, great grandparent, child, grandchild, great-grandchild, aunt, uncle, sister, brother, niece, nephew, or the spouse of any such relative, and provide the required information for each. Chase P.O. Box 78035, Phoenix, AZ, 85062, US 30 3.625 2043 Page 10 of 15 Primary Residence, on which more than $1,000 was owed as of December 31, 2018, which you were obligated to pay and where the creditor (person who loaned you the money) is NOT, by blood or marriage, your parent, grandparent, great grandparent, child, grandchild, great-grandchild, aunt, uncle, sister, brother, niece, nephew, or the spouse of any such relative? Obligor Amount Outstanding Amount Mortgage Term Interest Rate (%) Termination Year 91 Wallace Street, Somervil le, MA, 02144, F, S/C $100,001 or more $100,001 or more 15 3.625 2031 Creditor Round Point Mortgage Company Creditor 5016 Parkway Plaza Blvd, Charlott e, NC, 28217, 31, 2018, and which your spouse and/or any dependent child(ren) residing in your household were obligated to pay and where the creditor (person who loaned the money to your spouse and/or dependent child(ren) residing in your household) is not, by blood or marriage, your parent, grandparent, great grandparent, child, grandchild, great-grandchild, aunt, uncle, 32. Identify all non-mortgage debts of more than $1,000 that you owed as of December 31, 2018, IF the person to whom Page 11 of 15 33. Identify all non-mortgage debts of more than $1,000 that your spouse and/or any dependent child(ren) residing in your household owed as of December 31, 2018, if the person to whom your spouse and/or any dependent child(ren) residing in your household owed the debt is not, by blood or marriage, your parent, grandparent, great grandparent, child, grandchild, great-grandchild, aunt, uncle, sister, brother, niece, nephew, or the spouse of any such relative, and provide the required information for each. 34. Identify non-mortgage debts of more than $1,000 which you owed and which were forgiven at any time during 2018, grandchild, great-grandchild, aunt, uncle, sister, brother, niece, nephew, or the spouse of any such relative, and provide the required information for each. residing in your household and were forgiven at any time during 2018, excluding debts forgiven by a person who is, by blood or marriage, your parent, grandparent, great grandparent, child, grandchild, great-grandchild, aunt, uncle, sister, brother, niece, nephew, or the spouse of any such relative, and provide the required information for each. 36. Identify any Reimbursements for expenses in excess of $100 provided to you at any time during 2018 by any legislative agent or executive agent (lobbyist). Page 12 of 15 36.a Identify any Reimbursements for expenses in excess of $100, other than those identified in response to Question 36, you received at any time during 2018 from any person having a direct interest in a matter before the governmental body by which you were or are now employed. 37. Identify any Reimbursements for expenses in excess of $100 provided to your spouse and/or any dependent child(ren) residing in your household at any time during 2018 by any legislative agent or executive agent (lobbyist). 37.a Identify any Reimbursements for expenses in excess of $100, other than those identified in response to Question 36, provided to your spouse and/or dependent child(ren) residing in your household at any time during 2018 by any person having a direct interest in a matter before the governmental body by which you were or are now employed. 38. Identify any Gifts and/or Honoraria worth more than $100 provided to you at any time during 2018 by any person having a direct interest in a matter before a governmental body by which you were or are now employed. residing in your household at any time during 2018 by any person having a direct interest in a matter before the Page 13 of 15 40. Did you, your spouse and/or any dependent child(ren) residing in your household during 2018, own anything that you have not reported on this Statement of Financial Interests because it was held in a Blind Trust during 2018? Page 14 of 15 I, Debra S Rokosz, certify under the pains and penalties of perjury that: Submitted: 04/28/2019 If you were required to amend your Statement of Financial Interests last year, we encourage you to carefully review your 2018 Page 15 of 15
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