House Journal: Page 229: Tuesday, February 4, 2003
9 business name, state the name and nature of the
10 business or corporation and your position.
11 1_____________________________________________________
12 2_____________________________________________________
13 3_____________________________________________________
14 4_____________________________________________________
15 5_____________________________________________________
16 6_____________________________________________________
17 Division II. Commissions from Sales of Goods or
18 Services to Political Subdivisions.
19 This part is to be completed only by Legislators.
20 If you received income in the form of a commission
21 from the sale of goods or services to a political
22 subdivision, state the name of the purchasing
23 political subdivision. The amount of commission
24 earned is not required to be listed.
25 1_____________________________________________________
26 2_____________________________________________________
27 3_____________________________________________________
28 4_____________________________________________________
29 5_____________________________________________________
30 6_____________________________________________________
Page 19
1 Division III. Sources of Gross Income.
2 In each one of the following categories list each
3 source which produces more than $1,000 in annual gross
4 income, if the revenue produced by the source was
5 subject to federal or state income taxes last year.
6 List the nature or type of each company, business,
7 financial institution, corporation, partnership, or
8 other entity which produces more than $1,000 of annual
9 gross income. Neither the amount of income produced
10 nor value of the holding is required to be listed in
11 any of the items.
12 A. Securities: State the nature of the business of
13 any company in which you hold stock, bonds, or other
14 pecuniary interests that generate more than $1,000 in
15 annual gross income. Income generated by multiple
16 holdings in a single company are deemed received from
17 a single source.
18 ______________________________________________________
19 ______________________________________________________
20 ______________________________________________________
21 ______________________________________________________
22 ______________________________________________________
23 ______________________________________________________
24 B. Instruments of Financial Institutions: State the
25 types of institutions in which you hold financial
26 instruments, such as certificates of deposit, savings
27 accounts, etc., that produce annual gross income in
© 2003 Cornell College and
League of Women Voters of Iowa
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