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House Journal: Page 325: Monday, February 17, 1997

Page  17

  1                  (Last)          (First)           (Middle
Initial)
  2  Address:_______________________________________________
  3                (Street Address, Apt.#/P.O. Box)
  4            _______________________________________________
  5                  (City)           (State)                 
(Zip)
  6  Phone:(Home)_____/___-_____(Business)_____/___-________
  7  *******************************************************
  8     This form is due each year on or before February
  9  15.  The reporting period is the most recently
10  completed calendar year.
11     In completing Division III of this form, if your
12  percentage of ownership of an asset is less than 100
13  percent, multiply your percentage of ownership by the
14  total revenue produced to determine if you have
15  reached the $1,000 threshold.
16     Do not report income received by your spouse or
17  other family members.
18     In completing this form, if insufficient space is
19  provided for your answer, you may attach additional
20  information/answers on full-size sheets of paper.
21  Division I.  Business, Occupation, Profession.
22     List each business, occupation, or profession in
23  which you are engaged, the nature of the business if
24  not evident, and your position or job title.  No
25  income threshold or time requirement applies.
26     Examples:
27     If you are employed by an individual, state the
28  name of the individual employer, the nature of the
29  business, and your position.
30     If you are self-employed and are not incorporated

Page  18

 1  or are not doing business under a particular business
 2  name, state that you are self-employed, the nature of
 3  the business, and your position.
 4     If you own your own corporation, are employed by a
 5  corporation, or are doing business under a particular
 6  business name, state the name and nature of the
 7  business or corporation and your position.
 8   1_____________________________________________________
 9   2_____________________________________________________
10  3_____________________________________________________
11  4_____________________________________________________
12  5_____________________________________________________
13  6_____________________________________________________
14  Division II.  Commissions from Sales of Goods or
15  Services to Political Subdivisions.
16     This part is to be completed only by Legislators.
17  If you received income in the form of a commission
18  from the sale of goods or services to a political

Iowa General Assembly

Index: House Journal (77th General Assembly: Session 1)

© 1997 Cornell College and League of Women Voters of Iowa

Comments? hjourn@legis.iowa.gov.

Last update: Tue Feb 18 13:40:03 CST 1997
URL: /DOCS/GA/77GA/Session.1/HJournal/00300/00325.html
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