House Journal: Page 228: Tuesday, February 4, 2003
23 writing, and shall be placed on file in the office of
24 the chief clerk of the house. Persons requesting
25 formal opinions shall personally receive a copy of the
26 written formal opinion that is issued in response to
27 the request.
28 17. PERSONAL FINANCIAL DISCLOSURE FORM. The
29 following form shall be used for disclosure of
30 economic interests under these rules and section
Page 17
1 68B.35 of the Code:
2 STATEMENT OF ECONOMIC INTERESTS
3 Name:__________________________________________________
4 (Last) (First) (Middle Initial)
5 Address:_______________________________________________
6 (Street Address, Apt.#/P.O. Box)
7 _______________________________________________
8 (City) (State) (Zip)
9 Phone:(Home)_____/___-_____(Business)_____/___-________
10 *******************************************************
11 This form is due each year on or before February
12 15. The reporting period is the most recently
13 completed calendar year.
14 In completing Division III of this form, if your
15 percentage of ownership of an asset is less than 100
16 percent, multiply your percentage of ownership by the
17 total revenue produced to determine if you have
18 reached the $1,000 threshold.
19 Do not report income received by your spouse or
20 other family members.
21 In completing this form, if insufficient space is
22 provided for your answer, you may attach additional
23 information/answers on full-size sheets of paper.
24 Division I. Business, Occupation, Profession.
25 List each business, occupation, or profession in
26 which you are engaged, the nature of the business if
27 not evident, and your position or job title. No
28 income threshold or time requirement applies.
29 Examples:
30 If you are employed by an individual, state the
Page 18
1 name of the individual employer, the nature of the
2 business, and your position.
3 If you are self-employed and are not incorporated
4 or are not doing business under a particular business
5 name, state that you are self-employed, the nature of
6 the business, and your position.
7 If you own your own corporation, are employed by a
8 corporation, or are doing business under a particular
© 2003 Cornell College and
League of Women Voters of Iowa
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