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WILLIAM ic MADILL, Clerk House of Representatives Melissa Kucserik, State House First Assistant Clerk Montpelier, VT05633-5501 Rebecca Silbemagel, Tel: (802) 828-2247 Second Assistant Clerk e-mail: hcierkeleg.statemLus Jeremy Weiss, Journal Clerk Dlerdre Allen, Resolution Clerk VERMONT HOUSE OF REPRESENTATIVES Chris Ditmeyer, OFFICE OF THE CLERK Clerk Assistant House of Representatives Disclosure Form jic Name: Prt I serve on, or am a member of, the following Boards, Commissions, or Entities that are regulated by law or that receive funding from the State: Remuneration Board, Entity, or Commission Name, No Yes- Yes and Position (e.g. Board Member, Only Board Chair) Expenses e.g. mileage (J4 Of My Employer: Mon tx-- -(Salary disclosure not required) Signed this IL day of 30vv-i'r ,(cid:9) 2019 c k Printed Name, please sign on back

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