Bill Text: IA HR5 | 2015-2016 | 86th General Assembly | Introduced
Bill Title: A resolution relating to the code of ethics of the House of Representatives for the Eighty-sixth General Assembly. (Formerly HSB 3)
Spectrum: Committee Bill
Status: (Introduced - Dead) 2015-02-03 - Resolution adopted. H.J. 227. [HR5 Detail]
Download: Iowa-2015-HR5-Introduced.html
House Resolution 5 - Introduced PAG LIN HOUSE RESOLUTION NO. BY COMMITTEE ON ETHICS 1 1 A Resolution relating to the code of ethics of the 1 2 House of Representatives for the Eighty=sixth 1 3 General Assembly. 1 4 BE IT RESOLVED BY THE HOUSE OF REPRESENTATIVES, That 1 5 the House Code of Ethics shall be as follows: 1 6 HOUSE CODE OF ETHICS 1 7 PREAMBLE. Every legislator and legislative employee 1 8 has a duty to uphold the integrity and honor of the 1 9 general assembly, to encourage respect for the law 1 10 and for the general assembly, and to observe the house 1 11 code of ethics. The members and employees of the house 1 12 have a responsibility to conduct themselves so as to 1 13 reflect credit on the general assembly, and to inspire 1 14 the confidence, respect, and trust of the public. The 1 15 following rules are adopted pursuant to chapter 68B of 1 16 the Code, to assist the members and employees in the 1 17 conduct of their activities: 1 18 1. DEFINITIONS. The definitions of terms provided 1 19 in chapter 68B of the Code apply to the use of those 1 20 terms in these rules. 1 21 2. ECONOMIC INTEREST OF MEMBER OR EMPLOYEE OF 1 22 HOUSE. 1 23 a. Economic or investment opportunity. A member 1 24 or employee of the house shall not solicit or accept 1 25 economic or investment opportunity under circumstances 1 26 where the member or employee knows, or should know, 1 27 that the opportunity is being afforded with the intent 2 1 to influence the member's or employee's conduct in 2 2 the performance of official duties. If a member 2 3 or employee of the house learns that an economic 2 4 or investment opportunity previously accepted was 2 5 offered with the intent of influencing the member's or 2 6 employee's conduct in the performance of the official 2 7 duties, the member or employee shall take steps to 2 8 divest that member or employee of that investment or 2 9 economic opportunity, and shall report the matter 2 10 in writing to the chairperson of the house ethics 2 11 committee. 2 12 b. Excessive charges for services, goods, or 2 13 property interests. A member or employee of the 2 14 house shall not charge to or accept from a person 2 15 known to have a legislative interest, a price, fee, 2 16 compensation, or other consideration for the sale or 2 17 lease of any property or the furnishing of services 2 18 which is in excess of that which the member or employee 2 19 would ordinarily charge another person. 2 20 c. Use of confidential information. A member or 2 21 employee of the house, in order to further the member's 2 22 or employee's own economic interests, or those of any 2 23 other person, shall not disclose or use confidential 2 24 information acquired in the course of the member's or 2 25 employee's official duties. For the purpose of this 2 26 rule, information disclosed in open session at a public 2 27 meeting and information that is a public record is not 2 28 confidential information. 2 29 d. Employment. A member or employee of the house 2 30 shall not accept employment, either directly or 3 1 indirectly, from a political action committee. A 3 2 member of the house shall not act as a paid lobbyist 3 3 for any organization. However, this paragraph shall 3 4 not prohibit a member or employee of the house from 3 5 working for a candidate's committee, a political 3 6 party's action committee, or a political action 3 7 committee which does not expressly advocate the 3 8 nomination, election, or defeat of a candidate for 3 9 public office in this state or expressly advocate the 3 10 passage or defeat of a ballot issue in this state and 3 11 which is not interested in issues before the general 3 12 assembly. 3 13 For the purpose of this rule, a political action 3 14 committee means a committee, but not a candidate's 3 15 committee, which accepts contributions, makes 3 16 expenditures, or incurs indebtedness in the aggregate 3 17 of more than seven hundred fifty dollars in any one 3 18 calendar year to expressly advocate the nomination, 3 19 election, or defeat of a candidate for public office or 3 20 to expressly advocate the passage or defeat of a ballot 3 21 issue or for the purpose of influencing legislative 3 22 action. 3 23 e. Solicitation of employment as lobbyist. A member 3 24 or employee of the house shall not solicit employment 3 25 on behalf of the member or employee, or on behalf of 3 26 another legislator or employee, as a lobbyist while the 3 27 general assembly is in session. 3 28 f. Certain goods or services. A member or employee 3 29 of the house shall not solicit or obtain goods or 3 30 services from another person under circumstances where 4 1 the member or employee knows or should know that the 4 2 goods or services are being offered or sold with the 4 3 intent to influence the member's or employee's conduct 4 4 in the performance of official duties. If a member 4 5 or employee of the house is afforded goods or services 4 6 by another person at a price that is not available to 4 7 other members or classes of members of the general 4 8 public or is afforded goods or services that are not 4 9 available to other members or classes of members 4 10 of the general public by another person where the 4 11 member or employee knows or should know that the other 4 12 person intends to influence the member's or employee's 4 13 official conduct, the member or employee shall not take 4 14 or purchase the goods or services. 4 15 3. APPEARANCE BEFORE STATE AGENCY. A member or 4 16 employee of the house may appear before a state agency 4 17 in any representation case but shall not act as a 4 18 lobbyist with respect to the passage, defeat, approval, 4 19 veto, or modification of any legislation, rule, or 4 20 executive order. Whenever a member or employee of 4 21 the house appears before a state agency, the member 4 22 or employee shall carefully avoid all conduct which 4 23 might in any way lead members of the general public 4 24 to conclude that the member or employee is using the 4 25 member's or employee's official position to further the 4 26 member's or employee's professional success or personal 4 27 financial interest. 4 28 4. CONFLICTS OF INTEREST. In order for the general 4 29 assembly to function effectively, members of the house 4 30 may be required to vote on bills and participate in 5 1 committee work which will affect their employment and 5 2 other areas in which they may have a monetary interest. 5 3 Action on bills and committee work which furthers a 5 4 member's specific employment, specific investment, or 5 5 other specific interest, as opposed to the interests of 5 6 the public in general or the interests of a profession, 5 7 trade, business, or other class of persons, shall be 5 8 avoided. In making a decision relative to a member's 5 9 activity on particular bills or in committee work, the 5 10 following factors should be considered: 5 11 a. Whether a substantial threat to the member's 5 12 independence of judgment has been created by the 5 13 conflict situation. 5 14 b. The effect of the member's participation on 5 15 public confidence in the integrity of the general 5 16 assembly. 5 17 c. Whether the member's participation is likely to 5 18 have any significant effect on the disposition of the 5 19 matter. 5 20 d. The need for the member's particular 5 21 contribution, such as special knowledge of the subject 5 22 matter, to the effective functioning of the general 5 23 assembly. 5 24 If a member decides not to participate in committee 5 25 work or to abstain from voting because of a possible 5 26 conflict of interest, the member should disclose 5 27 this fact to the legislative body. The member shall 5 28 not vote on any question in which the member has an 5 29 economic interest that is distinguishable from the 5 30 interests of the general public or a substantial class 6 1 of persons. 6 2 5. STATUTORY REQUIREMENTS. Members and employees 6 3 of the house shall comply with the requirements 6 4 contained in chapters 68B (Government Ethics and 6 5 Lobbying), 721 (Official Misconduct), and 722 (Bribery 6 6 and Corruption), and sections 2.18 (Contempt) and 711.4 6 7 (Extortion) of the Code. 6 8 6. CHARGE ACCOUNTS. Members and employees of the 6 9 house shall not charge any amount or item to a charge 6 10 account to be paid for by a lobbyist or any client of a 6 11 lobbyist. 6 12 7. TRAVEL EXPENSES. A member or employee of the 6 13 house shall not charge to the state of Iowa amounts 6 14 for travel and expenses unless the member or employee 6 15 actually has incurred those mileage and expense costs. 6 16 Members or employees shall not file the vouchers for 6 17 weekly mileage reimbursement required by section 2.10, 6 18 subsection 1 of the Code, unless the travel expense was 6 19 actually incurred. 6 20 A member or employee of the house shall not file 6 21 a claim for per diem compensation for a meeting of 6 22 an interim study committee or a visitation committee 6 23 unless the member or employee attended the meeting. 6 24 However, the speaker may waive this provision and allow 6 25 a claim to be filed if the member or employee attempted 6 26 to attend the meeting but was unable to do so because 6 27 of circumstances beyond the member's or employee's 6 28 control. 6 29 8. GIFTS ACCEPTED OR RECEIVED. Members and 6 30 employees of the house shall comply with the 7 1 restrictions relating to the receipt or acceptance 7 2 of gifts contained in section 68B.22 of the Code. 7 3 The sponsor of a function under section 68B.22, 7 4 subsection 4, paragraph "s", shall electronically 7 5 file a registration with the chief clerk of the house 7 6 five days prior to the function disclosing the name of 7 7 the sponsor, and the date, time, and location of the 7 8 function. The sponsor shall also electronically file a 7 9 report of expenditures as required pursuant to section 7 10 68B.22, subsection 4, paragraph "s". 7 11 9. HONORARIA RESTRICTIONS. Members and employees 7 12 of the house shall comply with the restrictions 7 13 relating to the receipt of honoraria contained in 7 14 section 68B.23 of the Code. 7 15 10. DISCLOSURE REQUIRED. Each member of the 7 16 house and the chief clerk of the house shall file the 7 17 personal financial disclosure statements required under 7 18 section 68B.35 of the Code by February 15 of each year 7 19 for the prior calendar year. 7 20 11. SEXUAL HARASSMENT. Members and employees of 7 21 the house shall not engage in conduct which constitutes 7 22 sexual harassment as defined in section 19B.12 of 7 23 the Code or pursuant to the sexual harassment policy 7 24 adopted by the house committee on administration and 7 25 rules. 7 26 12. COMPLAINTS. 7 27 a. Filing of complaint. Complaints may be filed by 7 28 any person believing that a member or employee of the 7 29 house, a lobbyist, or a client of a lobbyist is guilty 7 30 of a violation of the house code of ethics, the joint 8 1 rules governing lobbyists, or chapter 68B of the Code. 8 2 b. Complaints by committee. The ethics committee 8 3 may initiate a complaint on its own motion. Committee 8 4 complaints may be initiated by the committee as a 8 5 result of a committee investigation or as a result of 8 6 receipt of any complaint or other information that does 8 7 not meet the requirements of these rules regarding the 8 8 form of a complaint but that contains allegations that 8 9 would form the basis for a valid complaint. 8 10 c. Form and contents of complaint. A complaint 8 11 shall be in writing. 8 12 Complaint forms shall be available from the chief 8 13 clerk of the house, but a complaint shall not be 8 14 rejected for failure to use the approved form if it 8 15 complies with the requirements of these rules. The 8 16 complaint shall contain a certification made by the 8 17 complainant, under penalty of perjury, that the facts 8 18 stated in the complaint are true to the best of the 8 19 complainant's knowledge. 8 20 To be valid, a complaint shall allege all of the 8 21 following: 8 22 (1) Facts, that if true, establish a violation of 8 23 a provision of chapter 68B of the Code, the house code 8 24 of ethics, or joint rules governing lobbyists for which 8 25 penalties or other remedies are provided. 8 26 (2) That the conduct providing the basis for the 8 27 complaint occurred within three years of the filing of 8 28 the complaint. 8 29 (3) That the party charged with a violation is 8 30 a party subject to the jurisdiction of the ethics 9 1 committee. 9 2 d. Confidentiality of complaint. The identity of 9 3 the parties and the contents of the complaint shall 9 4 be confidential until the time that the committee 9 5 chairperson and ranking member determine under 9 6 paragraph "f" that the complaint is sufficient as 9 7 to form, unless either the complainant or the party 9 8 charged in the complaint makes the identity of the 9 9 parties, or the information contained in the complaint, 9 10 public. The chief clerk of the house and the committee 9 11 chairperson and ranking member may communicate 9 12 confidentially with appropriate legislative staff 9 13 during any stage of the complaint process. 9 14 e. Notice of complaint. Upon receipt of the 9 15 complaint, the chief clerk of the house shall promptly 9 16 notify the chairperson and ranking member of the 9 17 ethics committee that a complaint has been filed and 9 18 provide both the chairperson and the ranking member 9 19 with copies of the complaint and any supporting 9 20 information. Within two working days, the chief clerk 9 21 shall send notice, either by personal delivery or by 9 22 certified mail, return receipt requested, to the person 9 23 or persons alleged to have committed the violation, 9 24 along with a copy of the complaint and any supporting 9 25 information. The notice to the accused person shall 9 26 contain a request that the person submit a written 9 27 response to the complaint within ten working days of 9 28 the date that the notice was sent by the chief clerk. 9 29 At the request of the accused person, the committee may 9 30 extend the time for the response, not to exceed ten 10 1 additional calendar days. A response to a complaint 10 2 shall not be confidential. 10 3 f. Hearing regarding validity of complaint. The 10 4 committee chairperson and the ranking member shall 10 5 review the complaint and supporting information to 10 6 determine whether the complaint meets the requirements 10 7 as to form. If the complaint is deficient as to form, 10 8 the complaint shall be returned to the complainant 10 9 with instructions indicating the deficiency. If the 10 10 complaint is in writing, is sufficient as to form, 10 11 and contains the appropriate certification, as soon 10 12 as practicable, the chairperson shall call a meeting 10 13 of the committee to review the complaint to determine 10 14 whether the complaint meets the requirements for 10 15 validity and whether the committee should take action 10 16 on the complaint pursuant to paragraph "g" or whether 10 17 the committee should request that the chief justice 10 18 of the supreme court appoint an independent special 10 19 counsel to conduct an investigation to determine 10 20 whether probable cause exists to believe that a 10 21 violation of the house code of ethics, joint rules 10 22 governing lobbyists, or chapter 68B of the Code, has 10 23 occurred. The sufficiency as to form determination 10 24 and the valid complaint requirements determination 10 25 shall be based solely upon the original complaint and 10 26 the response to the complaint. Additional documents 10 27 or responses shall not be filed by the parties or 10 28 otherwise considered by the committee prior to a 10 29 validity determination. The committee shall not 10 30 receive or consider oral testimony in support of or 11 1 against a validity determination. 11 2 If the committee finds that a complaint does not 11 3 meet the content requirements for a valid complaint, 11 4 the committee shall dismiss the complaint and notify 11 5 both the complainant and the party alleged to have 11 6 committed the violation of the dismissal and the 11 7 reasons for dismissal. A dismissal for failure to meet 11 8 the formal requirements for the filing of a complaint 11 9 shall be without prejudice and the complainant may 11 10 refile the complaint at any time within three years 11 11 of the date that the alleged violation took place. If 11 12 the dismissal is based upon a failure to allege facts 11 13 and circumstances necessary for a valid complaint, the 11 14 dismissal shall be with prejudice and the party shall 11 15 not be permitted to file a complaint based upon the 11 16 same facts and circumstances. 11 17 g. Action on undisputed complaint. If the committee 11 18 determines a complaint is valid and determines no 11 19 dispute exists between the parties regarding the 11 20 material facts that establish a violation, the 11 21 committee may take action on the complaint under this 11 22 paragraph without requesting the appointment of an 11 23 independent special counsel. 11 24 The committee may do any of the following: 11 25 (1) Issue an admonishment to advise against the 11 26 conduct that formed the basis for the complaint and to 11 27 exercise care in the future. 11 28 (2) Issue an order to cease and desist the conduct 11 29 that formed the basis for the complaint. 11 30 (3) Make a recommendation to the house that 12 1 the person subject to the complaint be censured or 12 2 reprimanded. 12 3 h. Request for appointment of independent special 12 4 counsel. If, after review of the complaint and any 12 5 response made by the party alleged to have committed 12 6 the violation, the committee determines that the 12 7 complaint meets the requirements for form and content 12 8 and the committee has not taken action under paragraph 12 9 "g", the committee shall request that the chief justice 12 10 of the supreme court appoint independent special 12 11 counsel to investigate the matter and determine whether 12 12 probable cause exists to believe that a violation of 12 13 chapter 68B of the Code, the house code of ethics, or 12 14 the joint rules governing lobbyists has occurred. 12 15 i. Receipt of report of independent special counsel. 12 16 The report from the independent special counsel 12 17 regarding probable cause to proceed on a complaint 12 18 shall be filed with the chief clerk of the house. 12 19 Upon receipt of the report of the independent special 12 20 counsel, the chief clerk shall notify the chairperson 12 21 of the filing of the report and shall send copies of 12 22 the report to the members of the ethics committee. As 12 23 soon as practicable after the filing of the report, the 12 24 chairperson shall schedule a public meeting for review 12 25 of the report. The purpose of the public meeting 12 26 shall be to determine whether the complaint should be 12 27 dismissed, whether a formal hearing should be held on 12 28 the complaint, or whether other committee action is 12 29 appropriate. The complainant and the person alleged to 12 30 have committed the violation shall be given notice of 13 1 the public meeting, shall have the right to be present 13 2 at the public meeting, and may, at the discretion 13 3 of the committee, present testimony in support of or 13 4 against the recommendations contained in the report. 13 5 If the committee determines that the matter should 13 6 be dismissed, the committee shall cause an order to 13 7 be entered dismissing the matter and notice of the 13 8 dismissal shall be given to the complainant and the 13 9 party alleged to have committed the violation. If 13 10 the committee determines that the complaint should be 13 11 scheduled for formal hearing, the committee shall issue 13 12 a charging statement which contains the charges and 13 13 supporting facts that are to be set for formal hearing 13 14 and notice shall be sent to the complainant and the 13 15 accused person. 13 16 The notice shall include a statement of the nature 13 17 of the charge or charges, a statement of the time and 13 18 place of hearing, a short and plain statement of the 13 19 facts asserted, and a statement of the rights of the 13 20 accused person at the hearing. 13 21 j. Formal hearing. Formal hearings shall be public 13 22 and conducted in the manner provided in section 68B.31, 13 23 subsection 8 of the Code. At a formal hearing the 13 24 accused shall have the right to be present and to 13 25 be heard in person and by counsel, to cross=examine 13 26 witnesses, and to present evidence. Members of 13 27 the committee shall also have the right to question 13 28 witnesses. 13 29 The committee may require, by subpoena or otherwise, 13 30 the attendance and testimony of witnesses and the 14 1 production of such books, records, correspondence, 14 2 memoranda, papers, documents, and any other things it 14 3 deems necessary to the conduct of the inquiry. 14 4 Evidence at the formal hearing shall be received 14 5 in accordance with rules and procedures applicable to 14 6 contested cases under chapter 17A of the Code. 14 7 The committee chairperson, or the vice chairperson 14 8 or ranking member in the absence of the chairperson, 14 9 shall preside at the formal hearing and shall rule on 14 10 the admissibility of any evidence received. The ruling 14 11 of the chairperson may be overturned by a majority 14 12 vote of the committee. Independent special counsel 14 13 shall present the evidence in support of the charge 14 14 or charges. The burden shall be on the independent 14 15 special counsel to prove the charge or charges by 14 16 a preponderance of clear and convincing evidence. 14 17 Upon completion of the formal hearing, the committee 14 18 shall adopt written findings of fact and conclusions 14 19 concerning the merits of the charges and make its 14 20 report and recommendation to the house. 14 21 k. Disqualification of member. Members of the 14 22 committee may disqualify themselves from participating 14 23 in any investigation of the conduct of another person 14 24 upon submission of a written statement that the member 14 25 cannot render an impartial and unbiased decision 14 26 in a case. A member may also be disqualified by a 14 27 unanimous vote of the remaining eligible members of the 14 28 committee. 14 29 A member of the committee is ineligible to 14 30 participate in committee meetings, as a member of the 15 1 committee, in any proceeding relating to the member's 15 2 own official conduct. 15 3 If a member of the committee is disqualified or 15 4 ineligible to act, the majority or minority leader who 15 5 appointed the member shall appoint a replacement member 15 6 to serve as a member of the committee during the period 15 7 of disqualification or ineligibility. 15 8 l. Recommendations by the committee. The committee 15 9 shall recommend to the house that the complaint be 15 10 dismissed, or that one or more of the following be 15 11 imposed: 15 12 (1) That the member or employee of the house 15 13 or lobbyist or client of a lobbyist be censured or 15 14 reprimanded, and the recommended appropriate form of 15 15 censure or reprimand be used. 15 16 (2) That the member of the house be suspended or 15 17 expelled from membership in the house and required 15 18 to forfeit the member's salary for that period, the 15 19 employee of the house be suspended or dismissed from 15 20 employment, or that the lobbyist's or lobbyist's 15 21 client's lobbying privileges be suspended. 15 22 13. COMMUNICATIONS WITH ETHICS COMMITTEE. After a 15 23 complaint has been filed or an investigation has been 15 24 initiated, a party to the complaint or investigation 15 25 shall not communicate, or cause another to communicate, 15 26 as to the merits of the complaint or investigation with 15 27 a member of the committee, except under the following 15 28 circumstances: 15 29 a. During the course of any meetings or other 15 30 official proceedings of the committee regarding the 16 1 complaint or investigation. 16 2 b. In writing, if a copy of the writing is 16 3 delivered to the adverse party or the designated 16 4 representative for the adverse party. 16 5 c. Orally, if adequate prior notice of the 16 6 communication is given to the adverse party or the 16 7 designated representative for the adverse party. 16 8 d. As otherwise authorized by statute, the house 16 9 code of ethics, joint rules governing lobbyists, or 16 10 vote of the committee. 16 11 14. PERMANENT RECORD. The chief clerk of the house 16 12 shall maintain a permanent record of all complaints 16 13 filed and any corresponding committee action. The 16 14 permanent record shall be prepared by the ethics 16 15 committee and shall contain the date the complaint was 16 16 filed, name and address of the complainant, name and 16 17 address of the accused person, a brief statement of the 16 18 charges made, any evidence received by the committee, 16 19 any transcripts or recordings of committee action, 16 20 and ultimate disposition of the complaint. Except as 16 21 provided in rule 12, paragraph "d", the chief clerk 16 22 shall keep each complaint confidential until public 16 23 disclosure is made by the ethics committee. 16 24 15. MEETING AUTHORIZATION. The house ethics 16 25 committee is authorized to meet at the discretion of 16 26 the committee chairperson in order to conduct hearings 16 27 and other business that properly may come before it. 16 28 If the committee submits a report seeking house action 16 29 against a member or employee of the house or lobbyist 16 30 after the second regular session of a general assembly 17 1 has adjourned sine die, the report shall be submitted 17 2 to and considered by the subsequent general assembly. 17 3 16. ADVISORY OPINIONS. 17 4 a. Requests for formal opinions. A request for a 17 5 formal advisory opinion may be filed by any person who 17 6 is subject to the authority of the ethics committee. 17 7 The ethics committee may also issue a formal advisory 17 8 opinion on its own motion, without having previously 17 9 received a formal request for an opinion, on any issue 17 10 that is within the jurisdiction of the committee. 17 11 Requests shall be filed with either the chief clerk of 17 12 the house or the chairperson of the ethics committee. 17 13 b. Form and contents of requests. A request for 17 14 a formal advisory opinion shall be in writing and 17 15 may pertain to any subject matter that is related to 17 16 application of the house code of ethics, the joint 17 17 rules governing lobbyists, or chapter 68B of the 17 18 Code to any person who is subject to the authority of 17 19 the ethics committee. Requests shall contain one or 17 20 more specific questions and shall relate either to 17 21 future conduct or be stated in the hypothetical. A 17 22 request for an advisory opinion shall not specifically 17 23 name any individual or contain any other specific 17 24 identifying information, unless the request relates 17 25 to the requester's own conduct. However, any request 17 26 may contain information which identifies the kind 17 27 of individual who may be affected by the subject 17 28 matter of the request. Examples of this latter kind 17 29 of identifying information may include references to 17 30 conduct of a category of individuals, such as but not 18 1 limited to conduct of legislators, legislative staff, 18 2 or lobbyists. 18 3 c. Confidentiality of formal requests and opinions. 18 4 Requests for formal opinions are not confidential and 18 5 any deliberations of the committee regarding a request 18 6 for a formal opinion shall be public. Opinions issued 18 7 in response to requests for formal opinions are not 18 8 confidential, shall be in writing, and shall be placed 18 9 on file in the office of the chief clerk of the house. 18 10 Persons requesting formal opinions shall personally 18 11 receive a copy of the written formal opinion that is 18 12 issued in response to the request. 18 13 17. PERSONAL FINANCIAL DISCLOSURE FORM. The 18 14 following form shall be used for disclosure of economic 18 15 interests under these rules and section 68B.35 of the 18 16 Code: 18 17 STATEMENT OF ECONOMIC INTERESTS 18 18 Name:_________________________________________________ 18 19 (Last) (First) (Middle Initial) 18 20 Address:______________________________________________ 18 21 (Street Address, Apt.#/P.O. Box) 18 22 ______________________________________________ 18 23 (City)(State)(Zip) 18 24 Phone:(Home)_____/____=_____(Business)_____/____=_____ 18 25 ****************************************************** 18 26 This form is due each year on or before February 15. 18 27 The reporting period is the most recently completed 18 28 calendar year. An amended form shall be filed if a 18 29 change in business, occupation, or profession reported 18 30 in Division I of the form has occurred. The amended 19 1 form shall include the date the change took effect and 19 2 must be filed within thirty days of the first day of 19 3 the change in employment or engagement necessitating 19 4 the amended form. If the date of the change occurs 19 5 between January 1 and February 15, the change shall be 19 6 included in the filing due February 15. 19 7 In completing Division III of this form, if your 19 8 percentage of ownership of an asset is less than 100 19 9 percent, multiply your percentage of ownership by the 19 10 total revenue produced to determine if you have reached 19 11 the $1,000 threshold. 19 12 Do not report income received by your spouse or 19 13 other family members. 19 14 In completing this form, if insufficient space is 19 15 provided for your answer, you may attach additional 19 16 information/answers on full=size sheets of paper. 19 17 Division I. Business, Occupation, or Profession. 19 18 List each business, occupation, or profession in 19 19 which you are engaged, the nature of the business if 19 20 not evident, and your position or job title. No income 19 21 threshold or time requirement applies. 19 22 Examples: 19 23 If you are employed by an individual, state the name 19 24 of the individual employer, the nature of the business, 19 25 and your position. 19 26 If you are self=employed and are not incorporated 19 27 or are not doing business under a particular business 19 28 name, state that you are self=employed, the nature of 19 29 the business, and your position. 19 30 If you own your own corporation, are employed by a 20 1 corporation, or are doing business under a particular 20 2 business name, state the name and nature of the 20 3 business or corporation and your position. 20 4 1_____________________________________________________ 20 5 2_____________________________________________________ 20 6 3_____________________________________________________ 20 7 4_____________________________________________________ 20 8 5_____________________________________________________ 20 9 6_____________________________________________________ 20 10 Division II. Commissions from Sales of Goods or 20 11 Services to Political Subdivisions. 20 12 This part is to be completed only by Legislators. 20 13 If you received income in the form of a commission 20 14 from the sale of goods or services to a political 20 15 subdivision, state the name of the purchasing political 20 16 subdivision. The amount of commission earned is not 20 17 required to be listed. 20 18 1_____________________________________________________ 20 19 2_____________________________________________________ 20 20 3_____________________________________________________ 20 21 4_____________________________________________________ 20 22 5_____________________________________________________ 20 23 6_____________________________________________________ 20 24 Division III. Sources of Gross Income. 20 25 In each one of the following categories list each 20 26 source which produces more than $1,000 in annual gross 20 27 income, if the revenue produced by the source was 20 28 subject to federal or state income taxes last year. 20 29 List the nature or type of each company, business, 20 30 financial institution, corporation, partnership, or 21 1 other entity which produces more than $1,000 of annual 21 2 gross income. Neither the amount of income produced 21 3 nor value of the holding is required to be listed in 21 4 any of the items. 21 5 A. Securities: State the nature of the business of 21 6 any company in which you hold stock, bonds, or other 21 7 pecuniary interests that generate more than $1,000 21 8 in annual gross income. Income generated by multiple 21 9 holdings in a single company are deemed received from a 21 10 single source. 21 11 ______________________________________________________ 21 12 ______________________________________________________ 21 13 ______________________________________________________ 21 14 ______________________________________________________ 21 15 ______________________________________________________ 21 16 ______________________________________________________ 21 17 B. Instruments of Financial Institutions: State 21 18 the types of institutions in which you hold financial 21 19 instruments, such as certificates of deposit, savings 21 20 accounts, etc., that produce annual gross income in 21 21 excess of $1,000, e.g., banks, savings and loans, or 21 22 credit unions. 21 23 ______________________________________________________ 21 24 ______________________________________________________ 21 25 ______________________________________________________ 21 26 ______________________________________________________ 21 27 ______________________________________________________ 21 28 ______________________________________________________ 21 29 C. Trusts: State the nature or type of any trust 21 30 from which you receive more than $1,000 of gross income 22 1 annually. 22 2 ______________________________________________________ 22 3 ______________________________________________________ 22 4 ______________________________________________________ 22 5 ______________________________________________________ 22 6 ______________________________________________________ 22 7 ______________________________________________________ 22 8 D. Real Estate: State the general nature of real 22 9 estate interests that generate more than $1,000 of 22 10 gross income annually, e.g., residential leasehold 22 11 interest or farm leasehold interest. The size or 22 12 location of the property interest is not required to be 22 13 listed. 22 14 ______________________________________________________ 22 15 ______________________________________________________ 22 16 ______________________________________________________ 22 17 ______________________________________________________ 22 18 ______________________________________________________ 22 19 ______________________________________________________ 22 20 E. Retirement Systems: State the name of each 22 21 pension plan or other corporation or company that pays 22 22 you more than $1,000 annually in retirement benefits. 22 23 ______________________________________________________ 22 24 ______________________________________________________ 22 25 ______________________________________________________ 22 26 ______________________________________________________ 22 27 ______________________________________________________ 22 28 ______________________________________________________ 22 29 F. Other Income Categories Specified in State and 22 30 Federal Income Tax Regulations. 23 1 ______________________________________________________ 23 2 ______________________________________________________ 23 3 ______________________________________________________ 23 4 ______________________________________________________ 23 5 ______________________________________________________ 23 6 _______________________________________ ___________ 23 7 (Signature of Filer) (Date) LSB 1415HV (1) 86 tm/rj
