House Study Bill 77 - Introduced HOUSE RESOLUTION NO. _____ BY (PROPOSED COMMITTEE ON ETHICS RESOLUTION BY CHAIRPERSON OSMUNDSON) A Resolution relating to the code of ethics of the 1 House of Representatives for the Ninetieth General 2 Assembly. 3 BE IT RESOLVED BY THE HOUSE OF REPRESENTATIVES, That 4 the House Code of Ethics shall be as follows: 5 HOUSE CODE OF ETHICS 6 PREAMBLE. Every legislator and legislative employee 7 has a duty to uphold the integrity and honor of the 8 general assembly, to encourage respect for the law 9 and for the general assembly, and to observe the house 10 code of ethics. The members and employees of the house 11 have a responsibility to conduct themselves so as to 12 reflect credit on the general assembly, and to inspire 13 the confidence, respect, and trust of the public. The 14 following rules are adopted pursuant to chapter 68B of 15 the Code, to assist the members and employees in the 16 conduct of their activities: 17 1. DEFINITIONS. The definitions of terms provided 18 in chapter 68B of the Code apply to the use of those 19 terms in these rules. 20 2. ECONOMIC INTEREST OF MEMBER OR EMPLOYEE OF 21 HOUSE. 22 a. Economic or investment opportunity. A member 23 or employee of the house shall not solicit or accept 24 economic or investment opportunity under circumstances 25 where the member or employee knows, or should know, 26 that the opportunity is being afforded with the intent 27 -1- LSB 1579YC (1) 90 th/jh 1/ 24

H.R. _____ to influence the member’s or employee’s conduct in 1 the performance of official duties. If a member 2 or employee of the house learns that an economic 3 or investment opportunity previously accepted was 4 offered with the intent of influencing the member’s or 5 employee’s conduct in the performance of the official 6 duties, the member or employee shall take steps to 7 divest that member or employee of that investment or 8 economic opportunity, and shall report the matter 9 in writing to the chairperson of the house ethics 10 committee. 11 b. Excessive charges for services, goods, or 12 property interests. A member or employee of the 13 house shall not charge to or accept from a person 14 known to have a legislative interest, a price, fee, 15 compensation, or other consideration for the sale or 16 lease of any property or the furnishing of services 17 which is in excess of that which the member or employee 18 would ordinarily charge another person. 19 c. Use of confidential information. A member or 20 employee of the house, in order to further the member’s 21 or employee’s own economic interests, or those of any 22 other person, shall not disclose or use confidential 23 information acquired in the course of the member’s or 24 employee’s official duties. For the purpose of this 25 rule, information disclosed in open session at a public 26 meeting and information that is a public record is not 27 confidential information. 28 d. Employment. A member or employee of the house 29 shall not accept employment, either directly or 30 -2- LSB 1579YC (1) 90 th/jh 2/ 24

H.R. _____ indirectly, from a political action committee. A 1 member of the house shall not act as a paid lobbyist 2 for any organization. However, this paragraph shall 3 not prohibit a member or employee of the house from 4 working for a candidate’s committee, a political 5 party’s action committee, or a political action 6 committee which does not expressly advocate the 7 nomination, election, or defeat of a candidate for 8 public office in this state or expressly advocate the 9 passage or defeat of a ballot issue in this state and 10 which is not interested in issues before the general 11 assembly. 12 For the purpose of this rule, a political action 13 committee means a committee, but not a candidate’s 14 committee, which accepts contributions, makes 15 expenditures, or incurs indebtedness in the aggregate 16 of more than one thousand dollars in any one calendar 17 year to expressly advocate the nomination, election, or 18 defeat of a candidate for public office or to expressly 19 advocate the passage or defeat of a ballot issue or for 20 the purpose of influencing legislative action. 21 e. Solicitation of employment as lobbyist. A member 22 or employee of the house shall not solicit employment 23 on behalf of the member or employee, or on behalf of 24 another legislator or employee, as a lobbyist while the 25 general assembly is in session. 26 f. Certain goods or services. A member or employee 27 of the house shall not solicit or obtain goods or 28 services from another person under circumstances where 29 the member or employee knows or should know that the 30 -3- LSB 1579YC (1) 90 th/jh 3/ 24

H.R. _____ goods or services are being offered or sold with the 1 intent to influence the member’s or employee’s conduct 2 in the performance of official duties. If a member 3 or employee of the house is afforded goods or services 4 by another person at a price that is not available to 5 other members or classes of members of the general 6 public or is afforded goods or services that are not 7 available to other members or classes of members 8 of the general public by another person where the 9 member or employee knows or should know that the other 10 person intends to influence the member’s or employee’s 11 official conduct, the member or employee shall not take 12 or purchase the goods or services. 13 3. APPEARANCE BEFORE STATE AGENCY. A member or 14 employee of the house may appear before a state agency 15 in any representation case but shall not act as a 16 lobbyist with respect to the passage, defeat, approval, 17 veto, or modification of any legislation, rule, or 18 executive order. Whenever a member or employee of 19 the house appears before a state agency, the member 20 or employee shall carefully avoid all conduct which 21 might in any way lead members of the general public 22 to conclude that the member or employee is using the 23 member’s or employee’s official position to further the 24 member’s or employee’s professional success or personal 25 financial interest. 26 4. CONFLICTS OF INTEREST. In order for the general 27 assembly to function effectively, members of the house 28 may be required to vote on bills and participate in 29 committee work which will affect their employment and 30 -4- LSB 1579YC (1) 90 th/jh 4/ 24

H.R. _____ other areas in which they may have a monetary interest. 1 Action on bills and committee work which furthers a 2 member’s specific employment, specific investment, or 3 other specific interest, as opposed to the interests of 4 the public in general or the interests of a profession, 5 trade, business, or other class of persons, shall be 6 avoided. In making a decision relative to a member’s 7 activity on particular bills or in committee work, the 8 following factors should be considered: 9 a. Whether a substantial threat to the member’s 10 independence of judgment has been created by the 11 conflict situation. 12 b. The effect of the member’s participation on 13 public confidence in the integrity of the general 14 assembly. 15 c. Whether the member’s participation is likely to 16 have any significant effect on the disposition of the 17 matter. 18 d. The need for the member’s particular 19 contribution, such as special knowledge of the subject 20 matter, to the effective functioning of the general 21 assembly. 22 If a member decides not to participate in committee 23 work or to abstain from voting because of a possible 24 conflict of interest, the member should disclose 25 this fact to the legislative body. The member shall 26 not vote on any question in which the member has an 27 economic interest that is distinguishable from the 28 interests of the general public or a substantial class 29 of persons. 30 -5- LSB 1579YC (1) 90 th/jh 5/ 24

H.R. _____ 5. STATUTORY REQUIREMENTS. Members and employees 1 of the house shall comply with the requirements 2 contained in chapters 68B (Government Ethics and 3 Lobbying), 721 (Official Misconduct), and 722 (Bribery 4 and Corruption), and sections 2.18 (Contempt) and 711.4 5 (Extortion) of the Code. 6 6. CHARGE ACCOUNTS. Members and employees of the 7 house shall not charge any amount or item to a charge 8 account to be paid for by a lobbyist or any client of a 9 lobbyist. 10 7. TRAVEL EXPENSES. A member or employee of the 11 house shall not charge to the state of Iowa amounts 12 for travel and expenses unless the member or employee 13 actually has incurred those mileage and expense costs. 14 Members or employees shall not file the vouchers for 15 weekly mileage reimbursement required by section 2.10, 16 subsection 1 of the Code, unless the travel expense was 17 actually incurred. 18 A member or employee of the house shall not file 19 a claim for per diem compensation for a meeting of 20 an interim study committee or a visitation committee 21 unless the member or employee attended the meeting. 22 However, the speaker may waive this provision and allow 23 a claim to be filed if the member or employee attempted 24 to attend the meeting but was unable to do so because 25 of circumstances beyond the member’s or employee’s 26 control. 27 8. GIFTS ACCEPTED OR RECEIVED. Members and 28 employees of the house shall comply with the 29 restrictions relating to the receipt or acceptance 30 -6- LSB 1579YC (1) 90 th/jh 6/ 24

H.R. _____ of gifts contained in section 68B.22 of the Code. 1 The sponsor of a function under section 68B.22, 2 subsection 4, paragraph “s”, shall electronically 3 file a registration with the chief clerk of the house 4 five days prior to the function disclosing the name of 5 the sponsor, and the date, time, and location of the 6 function. The sponsor shall also electronically file a 7 report of expenditures as required pursuant to section 8 68B.22, subsection 4, paragraph “s”. 9 9. HONORARIA RESTRICTIONS. Members and employees 10 of the house shall comply with the restrictions 11 relating to the receipt of honoraria contained in 12 section 68B.23 of the Code. 13 10. DISCLOSURE REQUIRED. Each member of the 14 house and the chief clerk of the house shall file the 15 personal financial disclosure statements required under 16 section 68B.35 of the Code by February 15 of each year 17 for the prior calendar year. 18 11. HARASSMENT —— SEXUAL HARASSMENT —— RETALIATION. 19 Members and employees of the house shall not engage in 20 conduct which constitutes harassment, including sexual 21 harassment as defined in section 19B.12 of the Code, or 22 retaliation, or conduct that is prohibited pursuant to 23 any harassment policy adopted by the house committee 24 on administration and rules. Harassment is a form of 25 discrimination based on any protected basis, including 26 race, color, national origin, religion, sex, pregnancy, 27 physical or mental disability, age, marital status, 28 veteran status, gender identity, sexual orientation, 29 or any other characteristic protected by law, including 30 -7- LSB 1579YC (1) 90 th/jh 7/ 24

H.R. _____ the federal Civil Rights Act of 1964, the federal Age 1 Discrimination in Employment Act of 1967, the federal 2 Americans with Disabilities Act of 1990, and chapter 3 216 of the Code. Harassment of an individual based 4 on any protected basis is unlawful if submission to 5 or rejection of such conduct by an individual is made 6 the basis for an employment decision affecting the 7 individual or if such conduct is sufficiently severe 8 or pervasive to create a hostile work environment. 9 Members and employees of the house shall not engage 10 in conduct which constitutes unlawful harassment 11 or discrimination based on any protected basis, or 12 retaliation for reporting harassment or discrimination, 13 threatening to report harassment or discrimination, 14 or participating in a harassment or discrimination 15 investigation. 16 12. COMPLAINTS. 17 a. Filing of complaint. Complaints may be filed by 18 any person believing that a member or employee of the 19 house, a lobbyist, or a client of a lobbyist is guilty 20 of a violation of the house code of ethics, the joint 21 rules governing lobbyists, or chapter 68B of the Code. 22 b. Complaints by committee. The ethics committee 23 may initiate a complaint on its own motion. Committee 24 complaints may be initiated by the committee as a 25 result of a committee investigation or as a result of 26 receipt of any complaint or other information that does 27 not meet the requirements of these rules regarding the 28 form of a complaint but that contains allegations that 29 would form the basis for a valid complaint. 30 -8- LSB 1579YC (1) 90 th/jh 8/ 24

H.R. _____ c. Form and contents of complaint. A complaint 1 shall be in writing. 2 Complaint forms shall be available from the chief 3 clerk of the house, but a complaint shall not be 4 rejected for failure to use the approved form if it 5 complies with the requirements of these rules. The 6 complaint shall contain a certification made by the 7 complainant, under penalty of perjury, that the facts 8 stated in the complaint are true to the best of the 9 complainant’s knowledge. 10 To be valid, a complaint shall allege all of the 11 following: 12 (1) Facts, that if true, establish a violation of 13 a provision of chapter 68B of the Code, the house code 14 of ethics, or joint rules governing lobbyists for which 15 penalties or other remedies are provided. 16 (2) That the conduct providing the basis for the 17 complaint occurred within three years of the filing of 18 the complaint. 19 (3) That the party charged with a violation is 20 a party subject to the jurisdiction of the ethics 21 committee. 22 d. Confidentiality of complaint. The identity of 23 the parties and the contents of the complaint shall 24 be confidential until the time that the committee 25 chairperson and ranking member determine under 26 paragraph “f” that the complaint is sufficient as 27 to form, unless either the complainant or the party 28 charged in the complaint makes the identity of the 29 parties, or the information contained in the complaint, 30 -9- LSB 1579YC (1) 90 th/jh 9/ 24

H.R. _____ public. The chief clerk of the house and the committee 1 chairperson and ranking member may communicate 2 confidentially with appropriate legislative staff 3 during any stage of the complaint process. 4 e. Notice of complaint. Upon receipt of the 5 complaint, the chief clerk of the house shall promptly 6 notify the chairperson and ranking member of the 7 ethics committee that a complaint has been filed and 8 provide both the chairperson and the ranking member 9 with copies of the complaint and any supporting 10 information. Within two working days, the chief clerk 11 shall send notice, either by personal delivery or by 12 certified mail, return receipt requested, to the person 13 or persons alleged to have committed the violation, 14 along with a copy of the complaint and any supporting 15 information. The notice to the accused person shall 16 contain a request that the person submit a written 17 response to the complaint within ten working days of 18 the date that the notice was sent by the chief clerk. 19 At the request of the accused person, the committee may 20 extend the time for the response, not to exceed ten 21 additional calendar days. A response to a complaint 22 shall not be confidential. 23 f. Hearing regarding validity of complaint. The 24 committee chairperson and the ranking member shall 25 review the complaint and supporting information to 26 determine whether the complaint meets the requirements 27 as to form. If the complaint is deficient as to form, 28 the complaint shall be returned to the complainant 29 with instructions indicating the deficiency. If the 30 -10- LSB 1579YC (1) 90 th/jh 10/ 24

H.R. _____ complaint is in writing, is sufficient as to form, 1 and contains the appropriate certification, as soon 2 as practicable, the chairperson shall call a meeting 3 of the committee to review the complaint to determine 4 whether the complaint meets the requirements for 5 validity and whether the committee should take action 6 on the complaint pursuant to paragraph “g” or whether 7 the committee should request that the chief justice 8 of the supreme court appoint an independent special 9 counsel to conduct an investigation to determine 10 whether probable cause exists to believe that a 11 violation of the house code of ethics, joint rules 12 governing lobbyists, or chapter 68B of the Code, has 13 occurred. The sufficiency as to form determination 14 and the valid complaint requirements determination 15 shall be based solely upon the original complaint and 16 the response to the complaint. Additional documents 17 or responses shall not be filed by the parties or 18 otherwise considered by the committee prior to a 19 validity determination. The committee shall not 20 receive or consider oral testimony in support of or 21 against a validity determination. 22 If the committee finds that a complaint does not 23 meet the content requirements for a valid complaint, 24 the committee shall dismiss the complaint and notify 25 both the complainant and the party alleged to have 26 committed the violation of the dismissal and the 27 reasons for dismissal. A dismissal for failure to meet 28 the formal requirements for the filing of a complaint 29 shall be without prejudice and the complainant may 30 -11- LSB 1579YC (1) 90 th/jh 11/ 24

H.R. _____ refile the complaint at any time within three years 1 of the date that the alleged violation took place. If 2 the dismissal is based upon a failure to allege facts 3 and circumstances necessary for a valid complaint, the 4 dismissal shall be with prejudice and the party shall 5 not be permitted to file a complaint based upon the 6 same facts and circumstances. 7 g. Action on undisputed complaint. If the committee 8 determines a complaint is valid and determines no 9 dispute exists between the parties regarding the 10 material facts that establish a violation, the 11 committee may take action on the complaint under this 12 paragraph without requesting the appointment of an 13 independent special counsel. 14 The committee may do any of the following: 15 (1) Issue an admonishment to advise against the 16 conduct that formed the basis for the complaint and to 17 exercise care in the future. 18 (2) Issue an order to cease and desist the conduct 19 that formed the basis for the complaint. 20 (3) Make a recommendation to the house that 21 the person subject to the complaint be censured or 22 reprimanded. 23 h. Request for appointment of independent special 24 counsel. If, after review of the complaint and any 25 response made by the party alleged to have committed 26 the violation, the committee determines that the 27 complaint meets the requirements for form and content 28 and the committee has not taken action under paragraph 29 “g”, the committee shall request that the chief justice 30 -12- LSB 1579YC (1) 90 th/jh 12/ 24

H.R. _____ of the supreme court appoint independent special 1 counsel to investigate the matter and determine whether 2 probable cause exists to believe that a violation of 3 chapter 68B of the Code, the house code of ethics, or 4 the joint rules governing lobbyists has occurred. 5 i. Receipt of report of independent special counsel. 6 The report from the independent special counsel 7 regarding probable cause to proceed on a complaint 8 shall be filed with the chief clerk of the house. 9 Upon receipt of the report of the independent special 10 counsel, the chief clerk shall notify the chairperson 11 of the filing of the report and shall send copies of 12 the report to the members of the ethics committee. As 13 soon as practicable after the filing of the report, the 14 chairperson shall schedule a public meeting for review 15 of the report. The purpose of the public meeting 16 shall be to determine whether the complaint should be 17 dismissed, whether a formal hearing should be held on 18 the complaint, or whether other committee action is 19 appropriate. The complainant and the person alleged to 20 have committed the violation shall be given notice of 21 the public meeting, shall have the right to be present 22 at the public meeting, and may, at the discretion 23 of the committee, present testimony in support of or 24 against the recommendations contained in the report. 25 If the committee determines that the matter should 26 be dismissed, the committee shall cause an order to 27 be entered dismissing the matter and notice of the 28 dismissal shall be given to the complainant and the 29 party alleged to have committed the violation. If 30 -13- LSB 1579YC (1) 90 th/jh 13/ 24

H.R. _____ the committee determines that the complaint should be 1 scheduled for formal hearing, the committee shall issue 2 a charging statement which contains the charges and 3 supporting facts that are to be set for formal hearing 4 and notice shall be sent to the complainant and the 5 accused person. 6 The notice shall include a statement of the nature 7 of the charge or charges, a statement of the time and 8 place of hearing, a short and plain statement of the 9 facts asserted, and a statement of the rights of the 10 accused person at the hearing. 11 j. Formal hearing. Formal hearings shall be public 12 and conducted in the manner provided in section 68B.31, 13 subsection 8 of the Code. At a formal hearing the 14 accused shall have the right to be present and to 15 be heard in person and by counsel, to cross-examine 16 witnesses, and to present evidence. Members of 17 the committee shall also have the right to question 18 witnesses. 19 The committee may require, by subpoena or otherwise, 20 the attendance and testimony of witnesses and the 21 production of such books, records, correspondence, 22 memoranda, papers, documents, and any other things it 23 deems necessary to the conduct of the inquiry. 24 Evidence at the formal hearing shall be received 25 in accordance with rules and procedures applicable to 26 contested cases under chapter 17A of the Code. 27 The committee chairperson, or the vice chairperson 28 or ranking member in the absence of the chairperson, 29 shall preside at the formal hearing and shall rule on 30 -14- LSB 1579YC (1) 90 th/jh 14/ 24

H.R. _____ the admissibility of any evidence received. The ruling 1 of the chairperson may be overturned by a majority 2 vote of the committee. Independent special counsel 3 shall present the evidence in support of the charge 4 or charges. The burden shall be on the independent 5 special counsel to prove the charge or charges by clear 6 and convincing evidence. Upon completion of the formal 7 hearing, the committee shall adopt written findings 8 of fact and conclusions concerning the merits of the 9 charges and make its report and recommendation to the 10 house. 11 k. Disqualification of member. Members of the 12 committee may disqualify themselves from participating 13 in any investigation of the conduct of another person 14 upon submission of a written statement that the member 15 cannot render an impartial and unbiased decision 16 in a case. A member may also be disqualified by a 17 unanimous vote of the remaining eligible members of the 18 committee. 19 A member of the committee is ineligible to 20 participate in committee meetings, as a member of the 21 committee, in any proceeding relating to the member’s 22 own official conduct. 23 If a member of the committee is disqualified or 24 ineligible to act, the majority or minority leader who 25 appointed the member shall appoint a replacement member 26 to serve as a member of the committee during the period 27 of disqualification or ineligibility. 28 l. Recommendations by the committee. The committee 29 shall recommend to the house that the complaint be 30 -15- LSB 1579YC (1) 90 th/jh 15/ 24

H.R. _____ dismissed, or that one or more of the following be 1 imposed: 2 (1) That the member or employee of the house 3 or lobbyist or client of a lobbyist be censured or 4 reprimanded, and the recommended appropriate form of 5 censure or reprimand be used. 6 (2) That the member of the house be suspended or 7 expelled from membership in the house and required 8 to forfeit the member’s salary for that period, the 9 employee of the house be suspended or dismissed from 10 employment, or that the lobbyist’s or lobbyist’s 11 client’s lobbying privileges be suspended. 12 13. COMMUNICATIONS WITH ETHICS COMMITTEE. After a 13 complaint has been filed or an investigation has been 14 initiated, a party to the complaint or investigation 15 shall not communicate, or cause another to communicate, 16 as to the merits of the complaint or investigation with 17 a member of the committee, except under the following 18 circumstances: 19 a. During the course of any meetings or other 20 official proceedings of the committee regarding the 21 complaint or investigation. 22 b. In writing, if a copy of the writing is 23 delivered to the adverse party or the designated 24 representative for the adverse party. 25 c. Orally, if adequate prior notice of the 26 communication is given to the adverse party or the 27 designated representative for the adverse party. 28 d. As otherwise authorized by statute, the house 29 code of ethics, joint rules governing lobbyists, or 30 -16- LSB 1579YC (1) 90 th/jh 16/ 24

H.R. _____ vote of the committee. 1 14. PERMANENT RECORD. The chief clerk of the house 2 shall maintain a permanent record of all complaints 3 filed and any corresponding committee action. The 4 permanent record shall be prepared by the ethics 5 committee and shall contain the date the complaint 6 was filed, name and address of the complainant, name 7 and address of the accused person, a brief statement 8 of the charges made, any evidence received by the 9 committee, any transcripts or recordings of committee 10 action, and ultimate disposition of the complaint. In 11 recording the ultimate disposition of a complaint that 12 is dismissed, the information shall include whether 13 the complaint was dismissed due to formal insufficiency 14 or due to a failure to meet the content requirements 15 of a valid complaint. Except as provided in rule 16 12, paragraph “d”, the chief clerk shall keep each 17 complaint confidential until public disclosure is made 18 by the ethics committee. 19 15. MEETING AUTHORIZATION. The house ethics 20 committee is authorized to meet at the discretion of 21 the committee chairperson in order to conduct hearings 22 and other business that properly may come before it. 23 If the committee submits a report seeking house action 24 against a member or employee of the house or lobbyist 25 after the second regular session of a general assembly 26 has adjourned sine die, the report shall be submitted 27 to and considered by the subsequent general assembly. 28 16. ADVISORY OPINIONS. 29 a. Requests for formal opinions. A request for a 30 -17- LSB 1579YC (1) 90 th/jh 17/ 24

H.R. _____ formal advisory opinion may be filed by any person who 1 is subject to the authority of the ethics committee. 2 The ethics committee may also issue a formal advisory 3 opinion on its own motion, without having previously 4 received a formal request for an opinion, on any issue 5 that is within the jurisdiction of the committee. 6 Requests shall be filed with either the chief clerk of 7 the house or the chairperson of the ethics committee. 8 b. Form and contents of requests. A request for 9 a formal advisory opinion shall be in writing and 10 may pertain to any subject matter that is related to 11 application of the house code of ethics, the joint 12 rules governing lobbyists, or chapter 68B of the 13 Code to any person who is subject to the authority of 14 the ethics committee. Requests shall contain one or 15 more specific questions and shall relate either to 16 future conduct or be stated in the hypothetical. A 17 request for an advisory opinion shall not specifically 18 name any individual or contain any other specific 19 identifying information, unless the request relates 20 to the requester’s own conduct. However, any request 21 may contain information which identifies the kind 22 of individual who may be affected by the subject 23 matter of the request. Examples of this latter kind 24 of identifying information may include references to 25 conduct of a category of individuals, such as but not 26 limited to conduct of legislators, legislative staff, 27 or lobbyists. 28 c. Confidentiality of formal requests and opinions. 29 Requests for formal opinions are not confidential and 30 -18- LSB 1579YC (1) 90 th/jh 18/ 24

H.R. _____ any deliberations of the committee regarding a request 1 for a formal opinion shall be public. Opinions issued 2 in response to requests for formal opinions are not 3 confidential, shall be in writing, and shall be placed 4 on file in the office of the chief clerk of the house. 5 Persons requesting formal opinions shall personally 6 receive a copy of the written formal opinion that is 7 issued in response to the request. 8 17. PERSONAL FINANCIAL DISCLOSURE FORM. The 9 following form shall be used for disclosure of economic 10 interests under these rules and section 68B.35 of the 11 Code: 12 STATEMENT OF ECONOMIC INTERESTS 13 Name:_________________________________________________ 14 (Last) (First) (Middle Initial) 15 Address:______________________________________________ 16 (Street Address, Apt.#/P.O. Box) 17 ______________________________________________ 18 (City)(State)(Zip) 19 Phone:(Home)_____/____-_____(Business)_____/____-_____ 20 ****************************************************** 21 This form is due each year on or before February 15. 22 The reporting period is the most recently completed 23 calendar year. An amended form shall be filed if a 24 change in business, occupation, or profession reported 25 in Division I of the form has occurred. The amended 26 form shall include the date the change took effect and 27 must be filed within thirty days of the first day of 28 the change in employment or engagement necessitating 29 the amended form. If the date of the change occurs 30 -19- LSB 1579YC (1) 90 th/jh 19/ 24

H.R. _____ between January 1 and February 15, the change shall be 1 included in the filing due February 15. 2 In completing Division III of this form, if your 3 percentage of ownership of an asset is less than 100 4 percent, multiply your percentage of ownership by the 5 total revenue produced to determine if you have reached 6 the $1,000 threshold. 7 Do not report income received by your spouse or 8 other family members. 9 In completing this form, if insufficient space is 10 provided for your answer, you may attach additional 11 information/answers on full-size sheets of paper. 12 Division I. Business, Occupation, or Profession. 13 List each business, occupation, or profession in 14 which you are engaged, the nature of the business if 15 not evident, and your position or job title. No income 16 threshold or time requirement applies. 17 Examples: 18 If you are employed by an individual, state the name 19 of the individual employer, the nature of the business, 20 and your position. 21 If you are self-employed and are not incorporated 22 or are not doing business under a particular business 23 name, state that you are self-employed, the nature of 24 the business, and your position. 25 If you own your own corporation, are employed by a 26 corporation, or are doing business under a particular 27 business name, state the name and nature of the 28 business or corporation and your position. 29 1_____________________________________________________ 30 -20- LSB 1579YC (1) 90 th/jh 20/ 24

H.R. _____ 2_____________________________________________________ 1 3_____________________________________________________ 2 4_____________________________________________________ 3 5_____________________________________________________ 4 6_____________________________________________________ 5 Division II. Commissions from Sales of Goods or 6 Services to Political Subdivisions. 7 This part is to be completed only by Legislators. 8 If you received income in the form of a commission 9 from the sale of goods or services to a political 10 subdivision, state the name of the purchasing political 11 subdivision. The amount of commission earned is not 12 required to be listed. 13 1_____________________________________________________ 14 2_____________________________________________________ 15 3_____________________________________________________ 16 4_____________________________________________________ 17 5_____________________________________________________ 18 6_____________________________________________________ 19 Division III. Sources of Gross Income. 20 In each one of the following categories list each 21 source which produces more than $1,000 in annual gross 22 income, if the revenue produced by the source was 23 subject to federal or state income taxes last year. 24 List the nature or type of each company, business, 25 financial institution, corporation, partnership, or 26 other entity which produces more than $1,000 of annual 27 gross income. Neither the amount of income produced 28 nor value of the holding is required to be listed in 29 any of the items. 30 -21- LSB 1579YC (1) 90 th/jh 21/ 24

H.R. _____ A. Securities: State the nature of the business of 1 any company in which you hold stock, bonds, or other 2 pecuniary interests that generate more than $1,000 3 in annual gross income. Income generated by multiple 4 holdings in a single company are deemed received from a 5 single source. 6 ______________________________________________________ 7 ______________________________________________________ 8 ______________________________________________________ 9 ______________________________________________________ 10 ______________________________________________________ 11 ______________________________________________________ 12 B. Instruments of Financial Institutions: State 13 the types of institutions in which you hold financial 14 instruments, such as certificates of deposit, savings 15 accounts, etc., that produce annual gross income in 16 excess of $1,000, e.g., banks, savings and loans, or 17 credit unions. 18 ______________________________________________________ 19 ______________________________________________________ 20 ______________________________________________________ 21 ______________________________________________________ 22 ______________________________________________________ 23 ______________________________________________________ 24 C. Trusts: State the nature or type of any trust 25 from which you receive more than $1,000 of gross income 26 annually. 27 ______________________________________________________ 28 ______________________________________________________ 29 ______________________________________________________ 30 -22- LSB 1579YC (1) 90 th/jh 22/ 24

H.R. _____ ______________________________________________________ 1 ______________________________________________________ 2 ______________________________________________________ 3 D. Real Estate: State the general nature of real 4 estate interests that generate more than $1,000 of 5 gross income annually, e.g., residential leasehold 6 interest or farm leasehold interest. The size or 7 location of the property interest is not required to be 8 listed. 9 ______________________________________________________ 10 ______________________________________________________ 11 ______________________________________________________ 12 ______________________________________________________ 13 ______________________________________________________ 14 ______________________________________________________ 15 E. Retirement Systems: State the name of each 16 pension plan or other corporation or company that pays 17 you more than $1,000 annually in retirement benefits. 18 ______________________________________________________ 19 ______________________________________________________ 20 ______________________________________________________ 21 ______________________________________________________ 22 ______________________________________________________ 23 ______________________________________________________ 24 F. Other Income Categories Specified in State and 25 Federal Income Tax Regulations. 26 ______________________________________________________ 27 ______________________________________________________ 28 ______________________________________________________ 29 ______________________________________________________ 30 -23- LSB 1579YC (1) 90 th/jh 23/ 24