Disclosure Statement Included Information

Disclosure of nature and extent of employment relationship (See relationship chart Appendix A)

Disclosure of gifts received by officer, employee (if required) and family members if the aggregate value of the gifts exceeds $250. This will include gifts that are received but not accepted. (See attached forms CIS (PDF) and CIQ (PDF))

An acknowledgment that the disclosure applies to each family member of the officer and the statement covers the 12 month period preceding the date the officer becomes aware of that a contract has been executed or the local governmental entity is considering doing business with the person.

Signature of the local government officer acknowledging that the statement is made under oath under penalty of perjury.