Text: HSB47            Text: HSB49


House Study Bill 48

PAG LIN 1 1 HOUSE RESOLUTION NO. 1 2 BY (PROPOSED COMMITTEE ON ETHICS RESOLUTION BY 1 3 CHAIRPERSON DAVITT) 1 4 A Resolution relating to the House code of ethics. 1 5 BE IT RESOLVED BY THE HOUSE OF REPRESENTATIVES, 1 6 That the House Code of Ethics shall be as follows: 1 7 HOUSE CODE OF ETHICS 1 8 PREAMBLE. Every legislator and legislative 1 9 employee has a duty to uphold the integrity and honor 1 10 of the general assembly, to encourage respect for the 1 11 law and for the general assembly, and to observe the 1 12 house code of ethics. The members and employees of 1 13 the house have a responsibility to conduct themselves 1 14 so as to reflect credit on the general assembly, and 1 15 to inspire the confidence, respect, and trust of the 1 16 public. The following rules are adopted pursuant to 1 17 chapter 68B of the Code, to assist the members and 1 18 employees in the conduct of their activities: 1 19 1. DEFINITIONS. The definitions of terms provided 1 20 in chapter 68B of the Code apply to the use of those 1 21 terms in these rules. 1 22 2. ECONOMIC INTEREST OF MEMBER OR EMPLOYEE OF 1 23 HOUSE. 1 24 a. Economic or investment opportunity. A member 1 25 or employee of the house shall not solicit or accept 1 26 economic or investment opportunity under circumstances 1 27 where the member or employee knows, or should know, 1 28 that the opportunity is being afforded with the intent 1 29 to influence the member's or employee's conduct in the 1 30 performance of official duties. If a member or 2 1 employee of the house learns that an economic or 2 2 investment opportunity previously accepted was offered 2 3 with the intent of influencing the member's or 2 4 employee's conduct in the performance of the official 2 5 duties, the member or employee shall take steps to 2 6 divest that member or employee of that investment or 2 7 economic opportunity, and shall report the matter in 2 8 writing to the chairperson of the house ethics 2 9 committee. 2 10 b. Excessive charges for services, goods, or 2 11 property interests. A member or employee of the house 2 12 shall not charge to or accept from a person known to 2 13 have a legislative interest, a price, fee, 2 14 compensation, or other consideration for the sale or 2 15 lease of any property or the furnishing of services 2 16 which is in excess of that which the member or 2 17 employee would ordinarily charge another person. 2 18 c. Use of confidential information. A member or 2 19 employee of the house, in order to further the 2 20 member's or employee's own economic interests, or 2 21 those of any other person, shall not disclose or use 2 22 confidential information acquired in the course of the 2 23 member's or employee's official duties. For the 2 24 purpose of this rule, information disclosed in open 2 25 session at a public meeting under chapter 21 of the 2 26 Code and information that is a public record under 2 27 chapter 22 of the Code is not confidential 2 28 information. 2 29 d. Employment. A member or employee of the house 2 30 shall not accept employment, either directly or 3 1 indirectly, from a political action committee. A 3 2 member of the house shall not act as a paid lobbyist 3 3 for any organization. However, this paragraph shall 3 4 not prohibit a member or employee of the house from 3 5 working for a candidate's committee, a political 3 6 party's action committee, or a political action 3 7 committee which does not expressly advocate the 3 8 nomination, election, or defeat of a candidate for 3 9 public office in this state or expressly advocate the 3 10 passage or defeat of a ballot issue in this state and 3 11 which is not interested in issues before the general 3 12 assembly. 3 13 For the purpose of this rule, a political action 3 14 committee means a committee, but not a candidate's 3 15 committee, which accepts contributions, makes 3 16 expenditures, or incurs indebtedness in the aggregate 3 17 of more than seven hundred fifty dollars in any one 3 18 calendar year to expressly advocate the nomination, 3 19 election, or defeat of a candidate for public office 3 20 or to expressly advocate the passage or defeat of a 3 21 ballot issue or for the purpose of influencing 3 22 legislative action. 3 23 e. A member or employee of the house shall not 3 24 solicit employment on behalf of the member or 3 25 employee, or on behalf of another legislator or 3 26 employee, as a lobbyist while the general assembly is 3 27 in session. 3 28 f. Certain goods or services. A member or 3 29 employee of the house shall not solicit or obtain 3 30 goods or services from another person under 4 1 circumstances where the member or employee knows or 4 2 should know that the goods or services are being 4 3 offered or sold with the intent to influence the 4 4 member's or employee's conduct in the performance of 4 5 official duties. If a member or employee of the house 4 6 is afforded goods or services by another person at a 4 7 price that is not available to other members or 4 8 classes of members of the general public or is 4 9 afforded goods or services that are not available to 4 10 other members or classes of members of the general 4 11 public by another person where the member or employee 4 12 knows or should know that the other person intends to 4 13 influence the member's or employee's official conduct, 4 14 the member or employee shall not take or purchase the 4 15 goods or services. 4 16 3. APPEARANCE BEFORE STATE AGENCY. A member or 4 17 employee of the house may appear before a state agency 4 18 in any representation case but shall not act as a 4 19 lobbyist with respect to the passage, defeat, 4 20 approval, veto, or modification of any legislation, 4 21 rule, or executive order. Whenever a member or 4 22 employee of the house appears before a state agency, 4 23 the member or employee shall carefully avoid all 4 24 conduct which might in any way lead members of the 4 25 general public to conclude that the member or employee 4 26 is using the member's or employee's official position 4 27 to further the member's or employee's professional 4 28 success or personal financial interest. 4 29 4. CONFLICTS OF INTEREST. In order for the 4 30 general assembly to function effectively, members of 5 1 the house may be required to vote on bills and 5 2 participate in committee work which will affect their 5 3 employment and other areas in which they may have a 5 4 monetary interest. Action on bills and committee work 5 5 which furthers a member's specific employment, 5 6 specific investment, or other specific interest, as 5 7 opposed to the interests of the public in general or 5 8 the interests of a profession, trade, business, or 5 9 other class of persons, shall be avoided. In making a 5 10 decision relative to a member's activity on particular 5 11 bills or in committee work, the following factors 5 12 should be considered: 5 13 a. Whether a substantial threat to the member's 5 14 independence of judgment has been created by the 5 15 conflict situation. 5 16 b. The effect of the member's participation on 5 17 public confidence in the integrity of the general 5 18 assembly. 5 19 c. Whether the member's participation is likely to 5 20 have any significant effect on the disposition of the 5 21 matter. 5 22 d. The need for the member's particular 5 23 contribution, such as special knowledge of the subject 5 24 matter, to the effective functioning of the general 5 25 assembly. 5 26 If a member decides not to participate in committee 5 27 work or to abstain from voting because of a possible 5 28 conflict of interest, the member should disclose this 5 29 fact to the legislative body. The member shall not 5 30 vote on any question in which the member has an 6 1 economic interest that is distinguishable from the 6 2 interests of the general public or a substantial class 6 3 of persons. 6 4 5. STATUTORY REQUIREMENTS. Members and employees 6 5 of the house shall comply with the requirements 6 6 contained in chapters 68B (Conflicts of Interest of 6 7 Public Officers and Employees), 721 (Official 6 8 Misconduct), and 722 (Bribery and Corruption), and 6 9 sections 2.18 (Contempt) and 711.4 (Extortion) of the 6 10 Code. 6 11 6. CHARGE ACCOUNTS. Members and employees of the 6 12 house shall not charge any amount or item to a charge 6 13 account to be paid for by a lobbyist or any client of 6 14 a lobbyist. 6 15 7. TRAVEL EXPENSES. A member or employee of the 6 16 house shall not charge to the state of Iowa amounts 6 17 for travel and expenses unless the member or employee 6 18 actually has incurred those mileage and expense costs. 6 19 Members or employees shall not file the vouchers for 6 20 weekly mileage reimbursement required by section 2.10, 6 21 subsection 1 of the Code, unless the travel expense 6 22 was actually incurred. 6 23 A member or employee of the house shall not file a 6 24 claim for per diem compensation for a meeting of an 6 25 interim study committee or a visitation committee 6 26 unless the member or employee attended the meeting. 6 27 However, the speaker may waive this provision and 6 28 allow a claim to be filed if the member or employee 6 29 attempted to attend the meeting but was unable to do 6 30 so because of circumstances beyond the member's or 7 1 employee's control. 7 2 8. GIFTS ACCEPTED OR RECEIVED. Members and 7 3 employees of the house shall comply with the 7 4 restrictions relating to the receipt or acceptance of 7 5 gifts contained in section 68B.22 of the Code. 7 6 9. HONORARIA RESTRICTIONS. Members and employees 7 7 of the house shall comply with the restrictions 7 8 relating to the receipt of honoraria contained in 7 9 section 68B.23 of the Code. 7 10 10. DISCLOSURE REQUIRED. Each member of the house 7 11 and the chief clerk of the house shall file the 7 12 personal financial disclosure statements required 7 13 under section 68B.35 of the Code by February 15 of 7 14 each year for the prior calendar year. 7 15 11. SEXUAL HARASSMENT. Members and employees of 7 16 the house shall not engage in conduct which 7 17 constitutes sexual harassment as defined in section 7 18 19B.12 of the Code or pursuant to the sexual 7 19 harassment policy adopted by the house committee on 7 20 administration and rules. 7 21 12. COMPLAINTS. 7 22 a. Filing of complaint. Complaints may be filed 7 23 by any person believing that a member or employee of 7 24 the house, a lobbyist, or a client of a lobbyist is 7 25 guilty of a violation of the house code of ethics, the 7 26 house rules governing lobbyists, or chapter 68B of the 7 27 Code. 7 28 b. Complaints by committee. The ethics committee 7 29 may initiate a complaint on its own motion. Committee 7 30 complaints may be initiated by the committee as a 8 1 result of a committee investigation or as a result of 8 2 receipt of any complaint or other information that 8 3 does not meet the requirements of these rules 8 4 regarding the form of a complaint but that contains 8 5 allegations that would form the basis for a valid 8 6 complaint. 8 7 c. Form and contents of complaint. A complaint 8 8 shall be in writing. 8 9 Complaint forms shall be available from the chief 8 10 clerk of the house, but a complaint shall not be 8 11 rejected for failure to use the approved form if it 8 12 complies with the requirements of these rules. The 8 13 complaint shall contain a certification made by the 8 14 complainant, under penalty of perjury, that the facts 8 15 stated in the complaint are true to the best of the 8 16 complainant's knowledge. 8 17 To be valid, a complaint shall allege all of the 8 18 following: 8 19 (1) Facts, that if true, establish a violation of 8 20 a provision of chapter 68B of the Code, the house code 8 21 of ethics, or house rules governing lobbyists for 8 22 which penalties or other remedies are provided. 8 23 (2) That the conduct providing the basis for the 8 24 complaint occurred within three years of the filing of 8 25 the complaint. 8 26 (3) That the party charged with a violation is a 8 27 party subject to the jurisdiction of the ethics 8 28 committee. 8 29 d. Confidentiality of complaint. The filing of 8 30 the complaint and the contents of the complaint shall 9 1 be confidential until the time that the committee 9 2 meets to determine whether the complaint is valid, 9 3 unless either the complainant or the party charged in 9 4 the complaint makes the existence of, or the 9 5 information contained in, the complaint public. 9 6 However, if either the complainant or party alleged to 9 7 have committed the violation requests that the meeting 9 8 to determine whether the complaint is valid be a 9 9 closed meeting and the filing of the complaint or the 9 10 contents of the complaint have not been disclosed, the 9 11 meeting shall be closed. 9 12 e. Notice of complaint. Upon receipt of the 9 13 complaint, the chief clerk of the house shall promptly 9 14 notify the chairperson and ranking member of the 9 15 ethics committee that a complaint has been filed and 9 16 provide both the chairperson and the ranking member 9 17 with copies of the complaint and any supporting 9 18 information. Within two working days, the chief clerk 9 19 shall send notice, either by personal delivery or by 9 20 certified mail, return receipt requested, to the 9 21 person or persons alleged to have committed the 9 22 violation, along with a copy of the complaint and any 9 23 supporting information. The notice to the accused 9 24 person shall contain a request that the person submit 9 25 a written response to the complaint within ten working 9 26 days of the date that the notice was sent by the chief 9 27 clerk. At the request of the accused person, the 9 28 committee may extend the time for the response, not to 9 29 exceed ten additional calendar days. 9 30 f. Hearing regarding validity of complaint. The 10 1 committee chairperson and the ranking member shall 10 2 review the complaint and supporting information to 10 3 determine whether the complaint meets the requirements 10 4 as to form. If the complaint is deficient as to form, 10 5 the complaint shall be returned to the complainant 10 6 with instructions indicating the deficiency unless the 10 7 committee decides to proceed on its own motion. If 10 8 the complaint is in writing and contains the 10 9 appropriate certification, as soon as practicable, the 10 10 chairperson shall call a meeting of the committee to 10 11 review the complaint to determine whether the 10 12 complaint meets the requirements for validity and 10 13 whether the committee should request that the chief 10 14 justice of the supreme court appoint an independent 10 15 special counsel to conduct an investigation to 10 16 determine whether probable cause exists to believe 10 17 that a violation of the house code of ethics, house 10 18 rules governing lobbyists, or chapter 68B of the Code, 10 19 has occurred. 10 20 If the committee finds that a complaint does not 10 21 meet the content requirements for a valid complaint, 10 22 the committee shall dismiss the complaint and notify 10 23 both the complainant and the party alleged to have 10 24 committed the violation of the dismissal and the 10 25 reasons for dismissal. A dismissal for failure to 10 26 meet the formal requirements for the filing of a 10 27 complaint shall be without prejudice and the 10 28 complainant may refile the complaint at any time 10 29 within three years of the date that the alleged 10 30 violation took place. If the dismissal is based upon 11 1 a failure to allege facts and circumstances necessary 11 2 for a valid complaint, the dismissal shall be with 11 3 prejudice and the party shall not be permitted to file 11 4 a complaint based upon the same facts and 11 5 circumstances. 11 6 g. Request for appointment of independent special 11 7 counsel. If, after review of the complaint and any 11 8 response made by the party alleged to have committed 11 9 the violation, the committee determines that the 11 10 complaint meets the requirements for form and content, 11 11 the committee shall request that the chief justice of 11 12 the supreme court appoint independent special counsel 11 13 to investigate the matter and determine whether 11 14 probable cause exists to believe that a violation of 11 15 chapter 68B of the Code, the house code of ethics, or 11 16 the house rules governing lobbyists has occurred. 11 17 h. Receipt of report of independent special 11 18 counsel. The report from the independent special 11 19 counsel regarding probable cause to proceed on a 11 20 complaint shall be filed with the chief clerk of the 11 21 house. Upon receipt of the report of the independent 11 22 special counsel, the chief clerk shall notify the 11 23 chairperson of the filing of the report and shall send 11 24 copies of the report to the members of the ethics 11 25 committee. As soon as practicable after the filing of 11 26 the report, the chairperson shall schedule a public 11 27 meeting for review of the report. The purpose of the 11 28 public meeting shall be to determine whether the 11 29 complaint should be dismissed, whether a formal 11 30 hearing should be held on the complaint, or whether 12 1 other committee action is appropriate. The 12 2 complainant and the person alleged to have committed 12 3 the violation shall be given notice of the public 12 4 meeting, shall have the right to be present at the 12 5 public meeting, and may, at the discretion of the 12 6 committee, present testimony in support of or against 12 7 the recommendations contained in the report. 12 8 If the committee determines that the matter should 12 9 be dismissed, the committee shall cause an order to be 12 10 entered dismissing the matter and notice of the 12 11 dismissal shall be given to the complainant and the 12 12 party alleged to have committed the violation. If the 12 13 committee determines that the complaint should be 12 14 scheduled for formal hearing, the committee shall 12 15 issue a charging statement which contains the charges 12 16 and supporting facts that are to be set for formal 12 17 hearing and notice shall be sent to the complainant 12 18 and the accused person. 12 19 The notice shall include a statement of the nature 12 20 of the charge or charges, a statement of the time and 12 21 place of hearing, a short and plain statement of the 12 22 facts asserted, and a statement of the rights of the 12 23 accused person at the hearing. 12 24 i. Formal hearing. Formal hearings shall be 12 25 public and conducted in the manner provided in section 12 26 68B.31, subsection 8 of the Code. At a formal hearing 12 27 the accused shall have the right to be present and to 12 28 be heard in person and by counsel, to cross=examine 12 29 witnesses, and to present evidence. Members of the 12 30 committee shall also have the right to question 13 1 witnesses. 13 2 Evidence at the formal hearing shall be received in 13 3 accordance with rules and procedures applicable to 13 4 contested cases under chapter 17A of the Code. 13 5 The committee chairperson, or the vice chairperson 13 6 or ranking member in the absence of the chairperson, 13 7 shall preside at the formal hearing and shall rule on 13 8 the admissibility of any evidence received. The 13 9 ruling of the chairperson may be overturned by a 13 10 majority vote of the committee. Independent special 13 11 counsel shall present the evidence in support of the 13 12 charge or charges. The burden shall be on the 13 13 independent special counsel to prove the charge or 13 14 charges by a preponderance of clear and convincing 13 15 evidence. Upon completion of the formal hearing, the 13 16 committee shall adopt written findings of fact and 13 17 conclusions concerning the merits of the charges and 13 18 make its report and recommendation to the house. 13 19 j. Recommendations by the committee. The 13 20 committee shall recommend to the house that the 13 21 complaint be dismissed, or that one or more of the 13 22 following be imposed: 13 23 (1) That the member or employee of the house or 13 24 lobbyist or client of a lobbyist be censured or 13 25 reprimanded, and the recommended appropriate form of 13 26 censure or reprimand be used. 13 27 (2) That the member of the house be suspended or 13 28 expelled from membership in the house and required to 13 29 forfeit the member's salary for that period, the 13 30 employee of the house be suspended or dismissed from 14 1 employment, or that the lobbyist's or lobbyist's 14 2 client's lobbying privileges be suspended. 14 3 13. COMMUNICATIONS WITH ETHICS COMMITTEE. After a 14 4 complaint has been filed or an investigation has been 14 5 initiated, a party to the complaint or investigation 14 6 shall not communicate, or cause another to 14 7 communicate, as to the merits of the complaint or 14 8 investigation with a member of the committee, except 14 9 under the following circumstances: 14 10 a. During the course of any meetings or other 14 11 official proceedings of the committee regarding the 14 12 complaint or investigation. 14 13 b. In writing, if a copy of the writing is 14 14 delivered to the adverse party or the designated 14 15 representative for the adverse party. 14 16 c. Orally, if adequate prior notice of the 14 17 communication is given to the adverse party or the 14 18 designated representative for the adverse party. 14 19 d. As otherwise authorized by statute, the house 14 20 code of ethics, house rules governing lobbyists, or 14 21 vote of the committee. 14 22 14. PERMANENT RECORD. The chief clerk of the 14 23 house shall maintain a permanent record of all 14 24 complaints filed and any corresponding committee 14 25 action. The permanent record shall be prepared by the 14 26 ethics committee and shall contain the date the 14 27 complaint was filed, name and address of the 14 28 complainant, name and address of the accused person, a 14 29 brief statement of the charges made, any evidence 14 30 received by the committee, any transcripts or 15 1 recordings of committee action, and ultimate 15 2 disposition of the complaint. The chief clerk shall 15 3 keep each complaint confidential until public 15 4 disclosure is made by the ethics committee. 15 5 15. MEETING AUTHORIZATION. The house ethics 15 6 committee is authorized to meet at the discretion of 15 7 the committee chairperson in order to conduct hearings 15 8 and other business that properly may come before it. 15 9 If the committee submits a report seeking house action 15 10 against a member or employee of the house or lobbyist 15 11 after the second regular session of a general assembly 15 12 has adjourned sine die, the report shall be submitted 15 13 to and considered by the subsequent general assembly. 15 14 16. ADVISORY OPINIONS. 15 15 a. Requests for formal opinions. A request for a 15 16 formal advisory opinion may be filed by any person who 15 17 is subject to the authority of the ethics committee. 15 18 The ethics committee may also issue a formal advisory 15 19 opinion on its own motion, without having previously 15 20 received a formal request for an opinion, on any issue 15 21 that is within the jurisdiction of the committee. 15 22 Requests shall be filed with either the chief clerk of 15 23 the house or the chairperson of the ethics committee. 15 24 b. Form and contents of requests. A request for a 15 25 formal advisory opinion shall be in writing and may 15 26 pertain to any subject matter that is related to 15 27 application of the house code of ethics, the house 15 28 rules governing lobbyists, or chapter 68B of the Code 15 29 to any person who is subject to the authority of the 15 30 ethics committee. Requests shall contain one or more 16 1 specific questions and shall relate either to future 16 2 conduct or be stated in the hypothetical. A request 16 3 for an advisory opinion shall not specifically name 16 4 any individual or contain any other specific 16 5 identifying information, unless the request relates to 16 6 the requester's own conduct. However, any request may 16 7 contain information which identifies the kind of 16 8 individual who may be affected by the subject matter 16 9 of the request. Examples of this latter kind of 16 10 identifying information may include references to 16 11 conduct of a category of individuals, such as but not 16 12 limited to conduct of legislators, legislative staff, 16 13 or lobbyists. 16 14 c. Confidentiality of formal requests and 16 15 opinions. Requests for formal opinions are not 16 16 confidential and any deliberations of the committee 16 17 regarding a request for a formal opinion shall be 16 18 public. Opinions issued in response to requests for 16 19 formal opinions are not confidential, shall be in 16 20 writing, and shall be placed on file in the office of 16 21 the chief clerk of the house. Persons requesting 16 22 formal opinions shall personally receive a copy of the 16 23 written formal opinion that is issued in response to 16 24 the request. 16 25 17. PERSONAL FINANCIAL DISCLOSURE FORM. The 16 26 following form shall be used for disclosure of 16 27 economic interests under these rules and section 16 28 68B.35 of the Code: 16 29 STATEMENT OF ECONOMIC INTERESTS 16 30 Name:__________________________________________________ 17 1 (Last) (First) (Middle Initial) 17 2 Address:_______________________________________________ 17 3 (Street Address, Apt.#/P.O. Box) 17 4 _______________________________________________ 17 5 (City) (State) (Zip) 17 6 Phone:(Home)_____/___=_____(Business)_____/___=________ 17 7 ******************************************************* 17 8 This form is due each year on or before February 17 9 15. The reporting period is the most recently 17 10 completed calendar year. 17 11 In completing Division III of this form, if your 17 12 percentage of ownership of an asset is less than 100 17 13 percent, multiply your percentage of ownership by the 17 14 total revenue produced to determine if you have 17 15 reached the $1,000 threshold. 17 16 Do not report income received by your spouse or 17 17 other family members. 17 18 In completing this form, if insufficient space is 17 19 provided for your answer, you may attach additional 17 20 information/answers on full=size sheets of paper. 17 21 Division I. Business, Occupation, Profession. 17 22 List each business, occupation, or profession in 17 23 which you are engaged, the nature of the business if 17 24 not evident, and your position or job title. No 17 25 income threshold or time requirement applies. 17 26 Examples: 17 27 If you are employed by an individual, state the 17 28 name of the individual employer, the nature of the 17 29 business, and your position. 17 30 If you are self=employed and are not incorporated 18 1 or are not doing business under a particular business 18 2 name, state that you are self=employed, the nature of 18 3 the business, and your position. 18 4 If you own your own corporation, are employed by a 18 5 corporation, or are doing business under a particular 18 6 business name, state the name and nature of the 18 7 business or corporation and your position. 18 8 1_____________________________________________________ 18 9 2_____________________________________________________ 18 10 3_____________________________________________________ 18 11 4_____________________________________________________ 18 12 5_____________________________________________________ 18 13 6_____________________________________________________ 18 14 Division II. Commissions from Sales of Goods or 18 15 Services to Political Subdivisions. 18 16 This part is to be completed only by Legislators. 18 17 If you received income in the form of a commission 18 18 from the sale of goods or services to a political 18 19 subdivision, state the name of the purchasing 18 20 political subdivision. The amount of commission 18 21 earned is not required to be listed. 18 22 1_____________________________________________________ 18 23 2_____________________________________________________ 18 24 3_____________________________________________________ 18 25 4_____________________________________________________ 18 26 5_____________________________________________________ 18 27 6_____________________________________________________ 18 28 Division III. Sources of Gross Income. 18 29 In each one of the following categories list each 18 30 source which produces more than $1,000 in annual gross 19 1 income, if the revenue produced by the source was 19 2 subject to federal or state income taxes last year. 19 3 List the nature or type of each company, business, 19 4 financial institution, corporation, partnership, or 19 5 other entity which produces more than $1,000 of annual 19 6 gross income. Neither the amount of income produced 19 7 nor value of the holding is required to be listed in 19 8 any of the items. 19 9 A. Securities: State the nature of the business of 19 10 any company in which you hold stock, bonds, or other 19 11 pecuniary interests that generate more than $1,000 in 19 12 annual gross income. Income generated by multiple 19 13 holdings in a single company are deemed received from 19 14 a single source. 19 15 ______________________________________________________ 19 16 ______________________________________________________ 19 17 ______________________________________________________ 19 18 ______________________________________________________ 19 19 ______________________________________________________ 19 20 ______________________________________________________ 19 21 B. Instruments of Financial Institutions: State the 19 22 types of institutions in which you hold financial 19 23 instruments, such as certificates of deposit, savings 19 24 accounts, etc., that produce annual gross income in 19 25 excess of $1,000, e.g., banks, savings and loans, or 19 26 credit unions. 19 27 ______________________________________________________ 19 28 ______________________________________________________ 19 29 ______________________________________________________ 19 30 ______________________________________________________ 20 1 ______________________________________________________ 20 2 ______________________________________________________ 20 3 C. Trusts: State the nature or type of any trust 20 4 from which you receive more than $1,000 of gross 20 5 income annually. 20 6 ______________________________________________________ 20 7 ______________________________________________________ 20 8 ______________________________________________________ 20 9 ______________________________________________________ 20 10 ______________________________________________________ 20 11 ______________________________________________________ 20 12 D. Real Estate: State the general nature of real 20 13 estate interests that generate more than $1,000 of 20 14 gross income annually, e.g., residential leasehold 20 15 interest or farm leasehold interest. The size or 20 16 location of the property interest is not required to 20 17 be listed. 20 18 ______________________________________________________ 20 19 ______________________________________________________ 20 20 ______________________________________________________ 20 21 ______________________________________________________ 20 22 ______________________________________________________ 20 23 ______________________________________________________ 20 24 E. Retirement Systems: State the name of each 20 25 pension plan or other corporation or company that pays 20 26 you more than $1,000 annually in retirement benefits. 20 27 ______________________________________________________ 20 28 ______________________________________________________ 20 29 ______________________________________________________ 20 30 ______________________________________________________ 21 1 ______________________________________________________ 21 2 ______________________________________________________ 21 3 F. Other Income Categories Specified in State and 21 4 Federal Income Tax Regulations. 21 5 ______________________________________________________ 21 6 ______________________________________________________ 21 7 ______________________________________________________ 21 8 ______________________________________________________ 21 9 ______________________________________________________ 21 10 ______________________________________________________ 21 11 ______________________________________ _____________ 21 12 (Signature of Filer) (Date) 21 13 LSB 1959HC 82 21 14 tm:rj/gg/14.1
Text: HSB47            Text: HSB49