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81	Jennifer L Mieth 2015	Statement of Financial Interests for 2015 Mieth Jennifer L (978) 567-3189 jennifer.mieth@state.ma.us You indicated that you did have a spouse residing in your household during 2015. You indicated that you had no dependent child(ren) residing in your household at any time during 2015. 1. You have indicated that you are a candidate for public office. Select the office for which you are a candidate. Page 1 of 15 2. Identify the position you hold or have held which requires you to file a Statement of Financial Interests and provide the required information for that position. If you held more than one public position which requires you to file, identify each position. Department of Fire Services (DFS) 1 State Rd, Stow, MA, 01775, US Public Information Officer 01/01/1995 $60,001 to 100,000 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 2015, whether compensated or not, and whether full- or part-time. Public Agency Public Agency Consultant / Contractor? Municipal Town of Groton 173 Main St, Groton, MA, 01450, US Board of Registrars Services Provided services, at any time during 2015, whether compensated or not, and whether full- or part-time. Public Agency Public Agency Name Consultant / Contractor? Municipal Town of Groton Commission on Accessibility 173 Main St, Groton, MA, 01450, US member Services Provided any time during 2015, 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 2015, 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 2015, whether compensated or not, and whether full- or part-time, and provide the required information for each. owned more than 1% of any class of the outstanding stock or similar ownership interest, at any time during 2015, and provide the required information for each. during 2015, and provide the required information for each. dependent child(ren) residing in your household during 2015, 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 2015, whether Page 3 of 15 an officer, director, or trustee, at any time during 2015, whether compensated or not, and whether full- or part-time, and provide the required information for each. 13. Identify all Real Estate in Massachusetts which you owned directly or through a Business as of December 31, 2015, and which had an assessed value greater than $1,000, and provide the required information for each Real and/or any dependent child(ren) residing in your household owned directly or through a Business as of December 31, 2015, and which had an assessed value greater than $1,000, and provide the required information for each Real Page 4 of 15 15. Identify any Trust of which you were a beneficiary and which owned Real Estate in Massachusetts as of December 31, 2015, and which had an assessed value greater than $1,000, and provide the required information for each such Trust and Real Estate holding. 16. Other than the Real Estate identified in Question 15, identify any Trust of which your spouse and/or any dependent child(ren) residing in your household was a beneficiary and which owned Real Estate in Massachusetts as of December 31, 2015, with an assessed value greater than $1,000, and provide the required information for each such Trust and Real Estate holding. 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 2015, and provide the required information for each Real Estate holding. Page 5 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 2015, and provide the required information for each piece of Real Estate transferred. 19. Identify any Real Estate in Massachusetts with an assessed value greater than $1,000, on which, as of December 31, 2015, you, or a Trust of which you were a beneficiary, had a lien, attachment, or mortgage receivable, and provide the required information for each. 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, 2015, 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, attachment, or mortgage receivable, and provide the required information for each. Page 6 of 15 agencies, and authorities, which you owned directly or through a Business, as of December 31, 2015, and which had a fair market value as of that date greater than $1,000, and provide the required information for each such investment. Name of Bond/ Other Security Description of Investment Income from Investment DWS Scudder MA Tax Free F, S/C Mutual Fund Less than $1,001 22. Other than the bonds or other securities identified in Question 21, identify every bond or other security issued by the Commonwealth of Massachusetts or its political subdivisions, agencies, and authorities, which your spouse and/or any dependent child(ren) residing in your household owned directly or through a Business, as of December 31, 2015, 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 7 of 15 agencies, and authorities, which was owned as of December 31, 2015, 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. agencies, and authorities, which was owned as of December 31, 2015, 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. Page 8 of 15 25. Identify every Financial Investment that you owned directly or through a Business as of December 31, 2015, 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 Vanguard Health Care Fund F, S/C Mutual Fund PA PO Box 2600, Valley Forge, PA, 19482 2600, Franklin Gold & Precious Metals Mutual Fund FL 100 Fountain Parkway, St Petersburg, FL, 33733 8030, US Hewlett Packard Inc Common Stock MN Po Box 64856, St. Paul, MN, 55164 0856, US Vanguard Index 500 Mutual Fund PA PO Box 2600, Valley Forge, PA, 19482 2600, Vanguard Small Cap Index Fund F, S/C Mutual Fund PA PO Box 2600, Valley Forge, PA, 19482 2600, Manulife Common Stock Canada PO Box 43078, Providence, RI, 02940 3078, US Page 9 of 15 26. Other than the Financial Investments identified in Question 25, identify every Financial Investment that your spouse and/or any dependent child(ren) residing in your household owned directly or through a Business as of December 31, 2015, 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 issuer's principal place of business or state of incorporation as well as its address. Name of Issuer Description of Investment Principal Place of Business or State of Incorporation MetLife, Inc. Common Stock(MET) 27. Identify every Financial Investment that was owned as of December 31, 2015, 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 issuer's principal place of business or state of incorporation as well as its address. 28. Other than the Financial Investments identified in Question 27, identify every Financial Investment that was owned as of December 31, 2015, 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 issuer's principal place of business or state of incorporation as well as its address. Page 10 of 15 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, 2015, 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 PO Box 182613, Colmbus, OH, 43218, US 30 years 4.387 2041 IC Federal Credit Union 300 Bemis Rd, Fitchburg, MA, 01420, US n/a 2.85 0000 Primary Residence, on which more than $1,000 was owed as of December 31, 2015, 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? 31. Identify all mortgages, including home equity and reverse mortgage loans, OTHER than any mortgage on your Primary Residence, on which more than $1,000 was owed as of December 31, 2015, 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 your spouse and/or dependent child(ren) residing in your household 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. Page 11 of 15 32. Identify all non-mortgage debts of more than $1,000 that you owed as of December 31, 2015, IF the person to whom you 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 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, 2015, 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 34. Identify non-mortgage debts of more than $1,000 which you owed and which were forgiven at any time during 2015, 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. residing in your household and were forgiven at any time during 2015, EXCLUDING debts forgiven by a person who is, by blood or marriage, your parent, grandparent, great grandparent, child, grandchild, great grandchild, aunt, uncle, Page 12 of 15 36. Identify any Reimbursements for expenses in excess of $100 provided to you at any time during 2015 by any legislative agent or executive agent (lobbyist) or any person having a direct interest in a matter before the governmental body by which you were or are employed. 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 2015 from any person having a direct interest in a matter before the 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 2015 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 2015 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 2015 by any person having a direct interest in a matter before a governmental body by which you were or are now employed, and provide the required information for each. Page 13 of 15 39. Identify any Gifts and/or Honoraria worth more than $100 provided to your spouse and/or any dependent child(ren) residing in your household at any time during 2015 by any person having a direct interest in a matter before the governmental body by which you were or are now employed, and provide the required information for each. 40. Did you, your spouse and/or any dependent child(ren) residing in your household during 2015, own anything that you have not reported on this Statement of Financial Interests because it was held in a Blind Trust during 2015? Page 14 of 15 I, Jennifer L Mieth, certify under the pains and penalties of perjury that: Submitted: 06/22/2016 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, [Filing Year], where the creditor (person who loaned you the money) is, NOT a Family Member. “Family Member” means: 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. In question 29A, our home equity line of credit has no expiration date as long we live in the home. Ethics Commission staff said to put in 0000 as the expiration date as the computer system requires some number in the field and to put this explanation here. Also I do not know why my position shows up three times on the form. I keep deleting the repeated lines and they keep reappearing. Can you fix that? If you were required to amend your Statement of Financial Interests last year, we encourage you to carefully review your 2015 Page 15 of 15