House Study Bill 163 - Introduced


An Act 1relating to the code of ethics of the
2House of Representatives for the Eighty-ninth
3General Assembly.
   4BE IT RESOLVED BY THE HOUSE OF REPRESENTATIVES, That
5the House Code of Ethics shall be as follows:

6HOUSE CODE OF ETHICS
   7PREAMBLE. Every legislator and legislative employee
8has a duty to uphold the integrity and honor of the
9general assembly, to encourage respect for the law
10and for the general assembly, and to observe the house
11code of ethics. The members and employees of the house
12have a responsibility to conduct themselves so as to
13reflect credit on the general assembly, and to inspire
14the confidence, respect, and trust of the public. The
15following rules are adopted pursuant to chapter 68B of
16the Code, to assist the members and employees in the
17conduct of their activities:
   181. DEFINITIONS. The definitions of terms provided
19in chapter 68B of the Code apply to the use of those
20terms in these rules.
   212. ECONOMIC INTEREST OF MEMBER OR EMPLOYEE OF
22HOUSE.
   23a. Economic or investment opportunity. A member
24or employee of the house shall not solicit or accept
25economic or investment opportunity under circumstances
26where the member or employee knows, or should know,
27that the opportunity is being afforded with the intent
-1-1to influence the member’s or employee’s conduct in
2the performance of official duties. If a member
3or employee of the house learns that an economic
4or investment opportunity previously accepted was
5offered with the intent of influencing the member’s or
6employee’s conduct in the performance of the official
7duties, the member or employee shall take steps to
8divest that member or employee of that investment or
9economic opportunity, and shall report the matter
10in writing to the chairperson of the house ethics
11committee.
   12b. Excessive charges for services, goods, or
13property interests.
A member or employee of the
14house shall not charge to or accept from a person
15known to have a legislative interest, a price, fee,
16compensation, or other consideration for the sale or
17lease of any property or the furnishing of services
18which is in excess of that which the member or employee
19would ordinarily charge another person.
   20c. Use of confidential information. A member or
21employee of the house, in order to further the member’s
22or employee’s own economic interests, or those of any
23other person, shall not disclose or use confidential
24information acquired in the course of the member’s or
25employee’s official duties. For the purpose of this
26rule, information disclosed in open session at a public
27meeting and information that is a public record is not
28confidential information.
   29d. Employment. A member or employee of the house
30shall not accept employment, either directly or
-2-1indirectly, from a political action committee. A
2member of the house shall not act as a paid lobbyist
3for any organization. However, this paragraph shall
4not prohibit a member or employee of the house from
5working for a candidate’s committee, a political
6party’s action committee, or a political action
7committee which does not expressly advocate the
8nomination, election, or defeat of a candidate for
9public office in this state or expressly advocate the
10passage or defeat of a ballot issue in this state and
11which is not interested in issues before the general
12assembly.
   13For the purpose of this rule, a political action
14committee means a committee, but not a candidate’s
15committee, which accepts contributions, makes
16expenditures, or incurs indebtedness in the aggregate
17of more than one thousand dollars in any one calendar
18year to expressly advocate the nomination, election, or
19defeat of a candidate for public office or to expressly
20advocate the passage or defeat of a ballot issue or for
21the purpose of influencing legislative action.
   22e. Solicitation of employment as lobbyist. A member
23or employee of the house shall not solicit employment
24on behalf of the member or employee, or on behalf of
25another legislator or employee, as a lobbyist while the
26general assembly is in session.
   27f. Certain goods or services. A member or employee
28of the house shall not solicit or obtain goods or
29services from another person under circumstances where
30the member or employee knows or should know that the
-3-1goods or services are being offered or sold with the
2intent to influence the member’s or employee’s conduct
3in the performance of official duties. If a member
4or employee of the house is afforded goods or services
5by another person at a price that is not available to
6other members or classes of members of the general
7public or is afforded goods or services that are not
8available to other members or classes of members
9of the general public by another person where the
10member or employee knows or should know that the other
11person intends to influence the member’s or employee’s
12official conduct, the member or employee shall not take
13or purchase the goods or services.
   143. APPEARANCE BEFORE STATE AGENCY. A member or
15employee of the house may appear before a state agency
16in any representation case but shall not act as a
17lobbyist with respect to the passage, defeat, approval,
18veto, or modification of any legislation, rule, or
19executive order. Whenever a member or employee of
20the house appears before a state agency, the member
21or employee shall carefully avoid all conduct which
22might in any way lead members of the general public
23to conclude that the member or employee is using the
24member’s or employee’s official position to further the
25member’s or employee’s professional success or personal
26financial interest.
   274. CONFLICTS OF INTEREST. In order for the general
28assembly to function effectively, members of the house
29may be required to vote on bills and participate in
30committee work which will affect their employment and
-4-1other areas in which they may have a monetary interest.
2Action on bills and committee work which furthers a
3member’s specific employment, specific investment, or
4other specific interest, as opposed to the interests of
5the public in general or the interests of a profession,
6trade, business, or other class of persons, shall be
7avoided. In making a decision relative to a member’s
8activity on particular bills or in committee work, the
9following factors should be considered:
   10a. Whether a substantial threat to the member’s
11independence of judgment has been created by the
12conflict situation.
   13b. The effect of the member’s participation on
14public confidence in the integrity of the general
15assembly.
   16c. Whether the member’s participation is likely to
17have any significant effect on the disposition of the
18matter.
   19d. The need for the member’s particular
20contribution, such as special knowledge of the subject
21matter, to the effective functioning of the general
22assembly.
   23If a member decides not to participate in committee
24work or to abstain from voting because of a possible
25conflict of interest, the member should disclose
26this fact to the legislative body. The member shall
27not vote on any question in which the member has an
28economic interest that is distinguishable from the
29interests of the general public or a substantial class
30of persons.
-5-
   15. STATUTORY REQUIREMENTS. Members and employees
2of the house shall comply with the requirements
3contained in chapters 68B (Government Ethics and
4Lobbying), 721 (Official Misconduct), and 722 (Bribery
5and Corruption), and sections 2.18 (Contempt) and 711.4
6(Extortion) of the Code.
   76. CHARGE ACCOUNTS. Members and employees of the
8house shall not charge any amount or item to a charge
9account to be paid for by a lobbyist or any client of a
10lobbyist.
   117. TRAVEL EXPENSES. A member or employee of the
12house shall not charge to the state of Iowa amounts
13for travel and expenses unless the member or employee
14actually has incurred those mileage and expense costs.
15Members or employees shall not file the vouchers for
16weekly mileage reimbursement required by section 2.10,
17subsection 1 of the Code, unless the travel expense was
18actually incurred.
   19A member or employee of the house shall not file
20a claim for per diem compensation for a meeting of
21an interim study committee or a visitation committee
22unless the member or employee attended the meeting.
23However, the speaker may waive this provision and allow
24a claim to be filed if the member or employee attempted
25to attend the meeting but was unable to do so because
26of circumstances beyond the member’s or employee’s
27control.
   288. GIFTS ACCEPTED OR RECEIVED. Members and
29employees of the house shall comply with the
30restrictions relating to the receipt or acceptance
-6-1of gifts contained in section 68B.22 of the Code.
2The sponsor of a function under section 68B.22,
3subsection 4, paragraph “s”, shall electronically
4file a registration with the chief clerk of the house
5five days prior to the function disclosing the name of
6the sponsor, and the date, time, and location of the
7function. The sponsor shall also electronically file a
8report of expenditures as required pursuant to section
968B.22, subsection 4, paragraph “s”.
   109. HONORARIA RESTRICTIONS. Members and employees
11of the house shall comply with the restrictions
12relating to the receipt of honoraria contained in
13section 68B.23 of the Code.
   1410. DISCLOSURE REQUIRED. Each member of the
15house and the chief clerk of the house shall file the
16personal financial disclosure statements required under
17section 68B.35 of the Code by February 15 of each year
18for the prior calendar year.
   1911. HARASSMENT — SEXUAL HARASSMENT — RETALIATION.
20 Members and employees of the house shall not engage in
21conduct which constitutes harassment, including sexual
22harassment as defined in section 19B.12 of the Code, or
23retaliation, or conduct that is prohibited pursuant to
24any harassment policy adopted by the house committee
25on administration and rules. Harassment is a form of
26discrimination based on any protected basis, including
27race, color, national origin, religion, sex, pregnancy,
28physical or mental disability, age, marital status,
29veteran status, gender identity, sexual orientation,
30or any other characteristic protected by law, including
-7-1the federal Civil Rights Act of 1964, the federal Age
2Discrimination in Employment Act of 1967, the federal
3Americans with Disabilities Act of 1990, and chapter
4216 of the Code. Harassment of an individual based
5on any protected basis is unlawful if submission to
6or rejection of such conduct by an individual is made
7the basis for an employment decision affecting the
8individual or if such conduct is sufficiently severe
9or pervasive to create a hostile work environment.
10Members and employees of the house shall not engage
11in conduct which constitutes unlawful harassment
12or discrimination based on any protected basis, or
13retaliation for reporting harassment or discrimination,
14threatening to report harassment or discrimination,
15or participating in a harassment or discrimination
16investigation.
   1712. COMPLAINTS.
   18a. Filing of complaint. Complaints may be filed by
19any person believing that a member or employee of the
20house, a lobbyist, or a client of a lobbyist is guilty
21of a violation of the house code of ethics, the joint
22rules governing lobbyists, or chapter 68B of the Code.
   23b. Complaints by committee. The ethics committee
24may initiate a complaint on its own motion. Committee
25complaints may be initiated by the committee as a
26result of a committee investigation or as a result of
27receipt of any complaint or other information that does
28not meet the requirements of these rules regarding the
29form of a complaint but that contains allegations that
30would form the basis for a valid complaint.
-8-
   1c. Form and contents of complaint. A complaint
2shall be in writing.
   3Complaint forms shall be available from the chief
4clerk of the house, but a complaint shall not be
5rejected for failure to use the approved form if it
6complies with the requirements of these rules. The
7complaint shall contain a certification made by the
8complainant, under penalty of perjury, that the facts
9stated in the complaint are true to the best of the
10complainant’s knowledge.
   11To be valid, a complaint shall allege all of the
12following:
   13(1) Facts, that if true, establish a violation of
14a provision of chapter 68B of the Code, the house code
15of ethics, or joint rules governing lobbyists for which
16penalties or other remedies are provided.
   17(2) That the conduct providing the basis for the
18complaint occurred within three years of the filing of
19the complaint.
   20(3) That the party charged with a violation is
21a party subject to the jurisdiction of the ethics
22committee.
   23d. Confidentiality of complaint. The identity of
24the parties and the contents of the complaint shall
25be confidential until the time that the committee
26chairperson and ranking member determine under
27paragraph “f” that the complaint is sufficient as
28to form, unless either the complainant or the party
29charged in the complaint makes the identity of the
30parties, or the information contained in the complaint,
-9-1public. The chief clerk of the house and the committee
2chairperson and ranking member may communicate
3confidentially with appropriate legislative staff
4during any stage of the complaint process.
   5e. Notice of complaint. Upon receipt of the
6complaint, the chief clerk of the house shall promptly
7notify the chairperson and ranking member of the
8ethics committee that a complaint has been filed and
9provide both the chairperson and the ranking member
10with copies of the complaint and any supporting
11information. Within two working days, the chief clerk
12shall send notice, either by personal delivery or by
13certified mail, return receipt requested, to the person
14or persons alleged to have committed the violation,
15along with a copy of the complaint and any supporting
16information. The notice to the accused person shall
17contain a request that the person submit a written
18response to the complaint within ten working days of
19the date that the notice was sent by the chief clerk.
20At the request of the accused person, the committee may
21extend the time for the response, not to exceed ten
22additional calendar days. A response to a complaint
23shall not be confidential.
   24f. Hearing regarding validity of complaint. The
25committee chairperson and the ranking member shall
26review the complaint and supporting information to
27determine whether the complaint meets the requirements
28as to form. If the complaint is deficient as to form,
29the complaint shall be returned to the complainant
30with instructions indicating the deficiency. If the
-10-1complaint is in writing, is sufficient as to form,
2and contains the appropriate certification, as soon
3as practicable, the chairperson shall call a meeting
4of the committee to review the complaint to determine
5whether the complaint meets the requirements for
6validity and whether the committee should take action
7on the complaint pursuant to paragraph “g” or whether
8the committee should request that the chief justice
9of the supreme court appoint an independent special
10counsel to conduct an investigation to determine
11whether probable cause exists to believe that a
12violation of the house code of ethics, joint rules
13governing lobbyists, or chapter 68B of the Code, has
14occurred. The sufficiency as to form determination
15and the valid complaint requirements determination
16shall be based solely upon the original complaint and
17the response to the complaint. Additional documents
18or responses shall not be filed by the parties or
19otherwise considered by the committee prior to a
20validity determination. The committee shall not
21receive or consider oral testimony in support of or
22against a validity determination.
   23If the committee finds that a complaint does not
24meet the content requirements for a valid complaint,
25the committee shall dismiss the complaint and notify
26both the complainant and the party alleged to have
27committed the violation of the dismissal and the
28reasons for dismissal. A dismissal for failure to meet
29the formal requirements for the filing of a complaint
30shall be without prejudice and the complainant may
-11-1refile the complaint at any time within three years
2of the date that the alleged violation took place. If
3the dismissal is based upon a failure to allege facts
4and circumstances necessary for a valid complaint, the
5dismissal shall be with prejudice and the party shall
6not be permitted to file a complaint based upon the
7same facts and circumstances.
   8g. Action on undisputed complaint.If the committee
9determines a complaint is valid and determines no
10dispute exists between the parties regarding the
11material facts that establish a violation, the
12committee may take action on the complaint under this
13paragraph without requesting the appointment of an
14independent special counsel.
   15The committee may do any of the following:
   16(1) Issue an admonishment to advise against the
17conduct that formed the basis for the complaint and to
18exercise care in the future.
   19(2) Issue an order to cease and desist the conduct
20that formed the basis for the complaint.
   21(3) Make a recommendation to the house that
22the person subject to the complaint be censured or
23reprimanded.
   24h. Request for appointment of independent special
25counsel.
If, after review of the complaint and any
26response made by the party alleged to have committed
27the violation, the committee determines that the
28complaint meets the requirements for form and content
29and the committee has not taken action under paragraph
30“g”, the committee shall request that the chief justice
-12-1of the supreme court appoint independent special
2counsel to investigate the matter and determine whether
3probable cause exists to believe that a violation of
4chapter 68B of the Code, the house code of ethics, or
5the joint rules governing lobbyists has occurred.
   6i. Receipt of report of independent special counsel.
7The report from the independent special counsel
8regarding probable cause to proceed on a complaint
9shall be filed with the chief clerk of the house.
10Upon receipt of the report of the independent special
11counsel, the chief clerk shall notify the chairperson
12of the filing of the report and shall send copies of
13the report to the members of the ethics committee. As
14soon as practicable after the filing of the report, the
15chairperson shall schedule a public meeting for review
16of the report. The purpose of the public meeting
17shall be to determine whether the complaint should be
18dismissed, whether a formal hearing should be held on
19the complaint, or whether other committee action is
20appropriate. The complainant and the person alleged to
21have committed the violation shall be given notice of
22the public meeting, shall have the right to be present
23at the public meeting, and may, at the discretion
24of the committee, present testimony in support of or
25against the recommendations contained in the report.
   26If the committee determines that the matter should
27be dismissed, the committee shall cause an order to
28be entered dismissing the matter and notice of the
29dismissal shall be given to the complainant and the
30party alleged to have committed the violation. If
-13-1the committee determines that the complaint should be
2scheduled for formal hearing, the committee shall issue
3a charging statement which contains the charges and
4supporting facts that are to be set for formal hearing
5and notice shall be sent to the complainant and the
6accused person.
   7The notice shall include a statement of the nature
8of the charge or charges, a statement of the time and
9place of hearing, a short and plain statement of the
10facts asserted, and a statement of the rights of the
11accused person at the hearing.
   12j. Formal hearing. Formal hearings shall be public
13and conducted in the manner provided in section 68B.31,
14subsection 8 of the Code. At a formal hearing the
15accused shall have the right to be present and to
16be heard in person and by counsel, to cross-examine
17witnesses, and to present evidence. Members of
18the committee shall also have the right to question
19witnesses.
   20The committee may require, by subpoena or otherwise,
21the attendance and testimony of witnesses and the
22production of such books, records, correspondence,
23memoranda, papers, documents, and any other things it
24deems necessary to the conduct of the inquiry.
   25Evidence at the formal hearing shall be received
26in accordance with rules and procedures applicable to
27contested cases under chapter 17A of the Code.
   28The committee chairperson, or the vice chairperson
29or ranking member in the absence of the chairperson,
30shall preside at the formal hearing and shall rule on
-14-1the admissibility of any evidence received. The ruling
2of the chairperson may be overturned by a majority
3vote of the committee. Independent special counsel
4shall present the evidence in support of the charge
5or charges. The burden shall be on the independent
6special counsel to prove the charge or charges by clear
7and convincing evidence. Upon completion of the formal
8hearing, the committee shall adopt written findings
9of fact and conclusions concerning the merits of the
10charges and make its report and recommendation to the
11house.
   12k. Disqualification of member. Members of the
13committee may disqualify themselves from participating
14in any investigation of the conduct of another person
15upon submission of a written statement that the member
16cannot render an impartial and unbiased decision
17in a case. A member may also be disqualified by a
18unanimous vote of the remaining eligible members of the
19committee.
   20A member of the committee is ineligible to
21participate in committee meetings, as a member of the
22committee, in any proceeding relating to the member’s
23own official conduct.
   24If a member of the committee is disqualified or
25ineligible to act, the majority or minority leader who
26appointed the member shall appoint a replacement member
27to serve as a member of the committee during the period
28of disqualification or ineligibility.
   29l. Recommendations by the committee. The committee
30shall recommend to the house that the complaint be
-15-1dismissed, or that one or more of the following be
2imposed:
   3(1) That the member or employee of the house
4or lobbyist or client of a lobbyist be censured or
5reprimanded, and the recommended appropriate form of
6censure or reprimand be used.
   7(2) That the member of the house be suspended or
8expelled from membership in the house and required
9to forfeit the member’s salary for that period, the
10employee of the house be suspended or dismissed from
11employment, or that the lobbyist’s or lobbyist’s
12client’s lobbying privileges be suspended.
   1313. COMMUNICATIONS WITH ETHICS COMMITTEE. After a
14complaint has been filed or an investigation has been
15initiated, a party to the complaint or investigation
16shall not communicate, or cause another to communicate,
17as to the merits of the complaint or investigation with
18a member of the committee, except under the following
19circumstances:
   20a. During the course of any meetings or other
21official proceedings of the committee regarding the
22complaint or investigation.
   23b. In writing, if a copy of the writing is
24delivered to the adverse party or the designated
25representative for the adverse party.
   26c. Orally, if adequate prior notice of the
27communication is given to the adverse party or the
28designated representative for the adverse party.
   29d. As otherwise authorized by statute, the house
30code of ethics, joint rules governing lobbyists, or
-16-1vote of the committee.
   214. PERMANENT RECORD. The chief clerk of the house
3shall maintain a permanent record of all complaints
4filed and any corresponding committee action. The
5permanent record shall be prepared by the ethics
6committee and shall contain the date the complaint
7was filed, name and address of the complainant, name
8and address of the accused person, a brief statement
9of the charges made, any evidence received by the
10committee, any transcripts or recordings of committee
11action, and ultimate disposition of the complaint. In
12recording the ultimate disposition of a complaint that
13is dismissed, the information shall include whether
14the complaint was dismissed due to formal insufficiency
15or due to a failure to meet the content requirements
16of a valid complaint. Except as provided in rule
1712, paragraph “d”, the chief clerk shall keep each
18complaint confidential until public disclosure is made
19by the ethics committee.
   2015. MEETING AUTHORIZATION. The house ethics
21committee is authorized to meet at the discretion of
22the committee chairperson in order to conduct hearings
23and other business that properly may come before it.
24If the committee submits a report seeking house action
25against a member or employee of the house or lobbyist
26after the second regular session of a general assembly
27has adjourned sine die, the report shall be submitted
28to and considered by the subsequent general assembly.
   2916. ADVISORY OPINIONS.
   30a. Requests for formal opinions. A request for a
-17-1formal advisory opinion may be filed by any person who
2is subject to the authority of the ethics committee.
3The ethics committee may also issue a formal advisory
4opinion on its own motion, without having previously
5received a formal request for an opinion, on any issue
6that is within the jurisdiction of the committee.
7Requests shall be filed with either the chief clerk of
8the house or the chairperson of the ethics committee.
   9b. Form and contents of requests. A request for
10a formal advisory opinion shall be in writing and
11may pertain to any subject matter that is related to
12application of the house code of ethics, the joint
13rules governing lobbyists, or chapter 68B of the
14Code to any person who is subject to the authority of
15the ethics committee. Requests shall contain one or
16more specific questions and shall relate either to
17future conduct or be stated in the hypothetical. A
18request for an advisory opinion shall not specifically
19name any individual or contain any other specific
20identifying information, unless the request relates
21to the requester’s own conduct. However, any request
22may contain information which identifies the kind
23of individual who may be affected by the subject
24matter of the request. Examples of this latter kind
25of identifying information may include references to
26conduct of a category of individuals, such as but not
27limited to conduct of legislators, legislative staff,
28or lobbyists.
   29c. Confidentiality of formal requests and opinions.
30Requests for formal opinions are not confidential and
-18-1any deliberations of the committee regarding a request
2for a formal opinion shall be public. Opinions issued
3in response to requests for formal opinions are not
4confidential, shall be in writing, and shall be placed
5on file in the office of the chief clerk of the house.
6Persons requesting formal opinions shall personally
7receive a copy of the written formal opinion that is
8issued in response to the request.
   917. PERSONAL FINANCIAL DISCLOSURE FORM. The
10following form shall be used for disclosure of economic
11interests under these rules and section 68B.35 of the
12Code:
13STATEMENT OF ECONOMIC INTERESTS
14Name:_________________________________________________
   15(Last)     (First)     (Middle Initial)
16Address:______________________________________________
    17(Street Address, Apt.#/P.O. Box)
    18______________________________________________
    19(City)(State)(Zip)
20Phone:(Home)_____/____-_____(Business)_____/____-_____
21******************************************************
   22This form is due each year on or before February 15.
23The reporting period is the most recently completed
24calendar year. An amended form shall be filed if a
25change in business, occupation, or profession reported
26in Division I of the form has occurred. The amended
27form shall include the date the change took effect and
28must be filed within thirty days of the first day of
29the change in employment or engagement necessitating
30the amended form. If the date of the change occurs
-19-1between January 1 and February 15, the change shall be
2included in the filing due February 15.
   3In completing Division III of this form, if your
4percentage of ownership of an asset is less than 100
5percent, multiply your percentage of ownership by the
6total revenue produced to determine if you have reached
7the $1,000 threshold.
   8Do not report income received by your spouse or
9other family members.
   10In completing this form, if insufficient space is
11provided for your answer, you may attach additional
12information/answers on full-size sheets of paper.
   13Division I. Business, Occupation, or Profession.
   14List each business, occupation, or profession in
15which you are engaged, the nature of the business if
16not evident, and your position or job title. No income
17threshold or time requirement applies.
   18Examples:
   19If you are employed by an individual, state the name
20of the individual employer, the nature of the business,
21and your position.
   22If you are self-employed and are not incorporated
23or are not doing business under a particular business
24name, state that you are self-employed, the nature of
25the business, and your position.
   26If you own your own corporation, are employed by a
27corporation, or are doing business under a particular
28business name, state the name and nature of the
29business or corporation and your position.
301_____________________________________________________
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12_____________________________________________________
23_____________________________________________________
34_____________________________________________________
45_____________________________________________________
56_____________________________________________________
   6Division II. Commissions from Sales of Goods or
7Services to Political Subdivisions.
   8This part is to be completed only by Legislators.
9If you received income in the form of a commission
10from the sale of goods or services to a political
11subdivision, state the name of the purchasing political
12subdivision. The amount of commission earned is not
13required to be listed.
141_____________________________________________________
152_____________________________________________________
163_____________________________________________________
174_____________________________________________________
185_____________________________________________________
196_____________________________________________________
   20Division III. Sources of Gross Income.
   21In each one of the following categories list each
22source which produces more than $1,000 in annual gross
23income, if the revenue produced by the source was
24subject to federal or state income taxes last year.
25List the nature or type of each company, business,
26financial institution, corporation, partnership, or
27other entity which produces more than $1,000 of annual
28gross income. Neither the amount of income produced
29nor value of the holding is required to be listed in
30any of the items.
-21-
   1A. Securities: State the nature of the business of
2any company in which you hold stock, bonds, or other
3pecuniary interests that generate more than $1,000
4in annual gross income. Income generated by multiple
5holdings in a single company are deemed received from a
6single source.
7______________________________________________________
8______________________________________________________
9______________________________________________________
10______________________________________________________
11______________________________________________________
12______________________________________________________
   13B. Instruments of Financial Institutions: State
14the types of institutions in which you hold financial
15instruments, such as certificates of deposit, savings
16accounts, etc., that produce annual gross income in
17excess of $1,000, e.g., banks, savings and loans, or
18credit unions.
19______________________________________________________
20______________________________________________________
21______________________________________________________
22______________________________________________________
23______________________________________________________
24______________________________________________________
   25C. Trusts: State the nature or type of any trust
26from which you receive more than $1,000 of gross income
27annually.
28______________________________________________________
29______________________________________________________
30______________________________________________________
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1______________________________________________________
2______________________________________________________
3______________________________________________________
   4D. Real Estate: State the general nature of real
5estate interests that generate more than $1,000 of
6gross income annually, e.g., residential leasehold
7interest or farm leasehold interest. The size or
8location of the property interest is not required to be
9listed.
10______________________________________________________
11______________________________________________________
12______________________________________________________
13______________________________________________________
14______________________________________________________
15______________________________________________________
   16E. Retirement Systems: State the name of each
17pension plan or other corporation or company that pays
18you more than $1,000 annually in retirement benefits.
19______________________________________________________
20______________________________________________________
21______________________________________________________
22______________________________________________________
23______________________________________________________
24______________________________________________________
   25F. Other Income Categories Specified in State and
26Federal Income Tax Regulations.
27______________________________________________________
28______________________________________________________
29______________________________________________________
30______________________________________________________
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1______________________________________________________
2_______________________________________  ___________
3(Signature of Filer)             (Date)
-24-
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