2014 Virginia Code
Title 30 - General Assembly
§ 30-111. Disclosure form


VA Code § 30-111 (2014) What's This?

A. The disclosure form to be used for filings required by subsections A and B of § 30-110 shall be substantially as follows:

STATEMENT OF ECONOMIC INTERESTS.

Name...................................................................…

Office or position held or sought......................................…

Address................................................................…

Names of members of immediate family...................................…

DEFINITIONS AND EXPLANATORY MATERIAL.

"Business" means a corporation, partnership, sole proprietorship, firm,
enterprise, franchise, association, trust or foundation, or any other
individual or entity carrying on a business or profession, whether or not for
profit.

"Close financial association" means an association in which the filer
shares significant financial involvement with an individual and the filer
would reasonably be expected to be aware of the individual's business
activities and would have access to the necessary records either directly or
through the individual. "Close financial association" does not mean an
association based on (i) the receipt of retirement benefits or deferred
compensation from a business by which the legislator is no longer employed, or

(ii) the receipt of compensation for work performed by the legislator as an
independent contractor of a business that represents an entity before any
state governmental agency when the legislator has had no communications with
the state governmental agency.

"Contingent liability" means a liability that is not presently fixed or
determined, but may become fixed or determined in the future with the
occurrence of some certain event.

"Gift" means any gratuity, favor, discount, entertainment, hospitality,
loan, forbearance, or other item having monetary value. It includes services
as well as gifts of transportation, lodgings and meals, whether provided
in-kind, by purchase of a ticket, payment in advance or reimbursement after
the expense has been incurred. "Gift" does not include (i) any offer of a
ticket, coupon, or other admission or pass unless the ticket, coupon,
admission, or pass is used; (ii) honorary degrees; (iii) any athletic, merit,
or need-based scholarship or any other financial aid awarded by a public or
private school, institution of higher education, or other educational program
pursuant to such school, institution, or program's financial aid standards and
procedures applicable to the general public; (iv) a campaign contribution
properly received and reported pursuant to Chapter 9.3 (§ 24.2-945 et seq.) of
Title 24.2; (v) any gift related to the private profession or occupation of a
legislator or of a member of his immediate family; or (vi) gifts from
relatives or personal friends. "Relative" means the donee's spouse, child,
uncle, aunt, niece, or nephew; a person to whom the donee is engaged to be
married; the donee's or his spouse's parent, grandparent, grandchild, brother,
or sister; or the donee's brother's or sister's spouse. "Personal friend" does
not include any person that the filer knows or has reason to know is (a) a
lobbyist registered pursuant to Article 3 (§ 2.2-418 et seq.) of Chapter 4 of
Title 2.2; (b) a lobbyist's principal as defined in § 2.2-419; or (c) a
person, organization, or business who is a party to or is seeking to become a
party to a contract with the Commonwealth. "Person, organization, or business"
includes individuals who are officers, directors, or owners of or who have a
controlling ownership interest in such organization or business.

"Immediate family" means (i) a spouse and (ii) any child who resides in the
same household as the legislator and who is a dependent of the legislator.

"Lobbyist relationship" means (i) an engagement, agreement, or
representation that relates to legal services, consulting services, or public
relations services, whether gratuitous or for compensation, between a member
or member-elect and any person who is, or has been within the prior calendar
year, registered as a lobbyist with the Secretary of the Commonwealth or (ii)
a greater than three percent ownership interest by a member or member-elect in
a business that employs, or engages as an independent contractor, any person
who is, or has been within the prior calendar year, registered as a lobbyist
with the Secretary of the Commonwealth. The disclosure of a lobbyist
relationship shall not (a) constitute a waiver of any attorney-client or other
privilege, (b) require a waiver of any attorney-client or other privilege for
a third party, or (c) be required where a member or member-elect is employed
or engaged by a person and such person also employs or engages a person in a
lobbyist relationship so long as the member or member-elect has no financial
interest in the lobbyist relationship.

TRUST. If you or your immediate family, separately or together, are the
only beneficiaries of a trust, treat the trust's assets as if you own them
directly. If you or your immediate family has a proportional interest in a
trust, treat that proportion of the trust's assets as if you own them
directly. For example, if you and your immediate family have a one-third
interest in a trust, complete your Statement as if you own one-third of each
of the trust's assets. If you or a member of your immediate family created a
trust and can revoke it without the beneficiaries' consent, treat its assets
as if you own them directly.

REPORT TO THE BEST OF INFORMATION AND BELIEF. Information required on this
Statement must be provided on the basis of the best knowledge, information,
and belief of the individual filing the Statement as of the date of this
report unless otherwise stated.

COMPLETE ITEMS 1 THROUGH 11. REFER TO SCHEDULES ONLY IF DIRECTED.

You may attach additional explanatory information.

1. Offices and Directorships.

Are you or a member of your immediate family a paid officer or paid
director of a business?

EITHER check NO //OR check YES //and complete Schedule A.

2. Personal Liabilities.

Do you or a member of your immediate family owe more than $5,000 to any
one creditor including contingent liabilities? (Exclude debts to any
government and loans secured by recorded liens on property at least equal in
value to the loan.)

EITHER check NO //OR check YES //and complete Schedule B.

3. Securities.

Do you or a member of your immediate family, directly or indirectly,
separately or together, own securities valued in excess of $5,000 invested in
one business? Account for mutual funds, limited partnerships and trusts.

EITHER check NO //OR check YES //and complete Schedule C.

4. Payments for Talks, Meetings, and Publications.

During the past six months did you receive in your capacity as a
legislator lodging, transportation, money, or anything else of value with a
combined value exceeding $200 (i) for a single talk, meeting, or published
work or (ii) for a meeting, conference, or event where your attendance at the
meeting, conference, or event was designed to (a) educate you on issues
relevant to your duties as a legislator, including issues faced by your
constituents, or (b) enhance your knowledge and skills relative to your duties
as a legislator? Do not include payments and reimbursements from the
Commonwealth for meetings attended in your capacity as a legislator; see
Question 11 and Schedule D2 to report such meetings.

EITHER check NO //OR check YES //and complete Schedule D.

5. Gifts.

During the past six months did a business, government, or individual
other than a relative or personal friend (i) furnish you or a member of your
immediate family with any gift or entertainment at a single event, and the
value received exceeded $50 or (ii) furnish you or a member of your immediate
family with gifts or entertainment in any combination and the total value
received exceeded $100, and for which you or the member of your immediate
family neither paid nor rendered services in exchange? Account for
entertainment events only if the average value per person attending the event
exceeded $50. Account for all business entertainment (except if related to
the private profession or occupation of you or the member of your immediate
family who received such business entertainment) even if unrelated to your
official duties.

EITHER check NO //OR check YES //and complete Schedule E.

6. Salary and Wages.

List each employer that pays you or a member of your immediate family
salary or wages in excess of $5,000 annually. (Exclude any salary received as
a member of the General Assembly pursuant to § 30-19.11. )

If no reportable salary or wages, check here //.

7. Business Interests and Lobbyist Relationships.

7A. Do you or a member of your immediate family, separately or together,
operate your own business, or own or control an interest in excess of $5,000
in a business?

EITHER check NO //OR check YES //and complete Schedule F-1.

7B. Do you have a lobbyist relationship as that term is defined above?

EITHER check NO //OR check YES //and complete Schedule F-2.

8. Payments for Representation and Other Services.

8A. Did you represent any businesses before any state governmental
agencies, excluding courts or judges, for which you received total
compensation during the past six months in excess of $1,000, excluding
compensation for other services to such businesses and representation
consisting solely of the filing of mandatory papers and subsequent
representation regarding the mandatory papers?

EITHER check NO //OR check YES //and complete Schedule G-1.

8B. Subject to the same exceptions as in 8A, did persons with whom you
have a close financial association (partners, associates or others) represent
any businesses before any state governmental agency for which total
compensation was received during the past six months in excess of $1,000?

EITHER check NO //OR check YES //and complete Schedule G-2.

8C. Did you or persons with whom you have a close financial association
furnish services to businesses operating in Virginia, pursuant to an agreement
between you and such businesses, or between persons with whom you have a close
financial association and such businesses for which total compensation in
excess of $1,000 was received during the past six months? Services reported
under this provision shall not include services involving the representation
of businesses that are reported under question 8A or 8B above.

EITHER check NO //OR check YES //and complete Schedule G-3.

9. Real Estate.

Do you or a member of your immediate family hold an interest, including
a partnership interest, valued at more than $5,000 in real property (other
than your principal residence) for which you have not already listed the full
address on Schedule F? Account for real estate held in trust.

EITHER check NO //OR check YES //and complete Schedule H.

10. Real Estate Contracts with State Governmental Agencies.

Do you or a member of your immediate family hold an interest valued at
more than $5,000 in real estate, including a corporate, partnership, or trust
interest, option, easement, or land contract, which real estate is the subject
of a contract, whether pending or completed within the past six months, with a
state governmental agency?

If the real estate contract provides for the leasing of the property to
a state governmental agency, do you or a member of your immediate family hold
an interest in the real estate, including a corporate, partnership, or trust
interest, option, easement, or land contract valued at more than $1,000?
Account for all such contracts whether or not your interest is reported in
Schedule F or H. This requirement to disclose an interest in a lease does not
apply to an interest derived through an ownership interest in a business
unless the ownership interest exceeds three percent of the total equity of the
business.

EITHER check NO //OR check YES //and complete Schedule I.

11. Payments by the Commonwealth for Meetings.

During the past six months did you receive lodging, transportation,
money, or anything else of value with a combined value exceeding $200 from
the Commonwealth for a single meeting attended out-of-state in your capacity
as a legislator? Do not include reimbursements from the Commonwealth for
meetings attended in the Commonwealth.

EITHER check NO //OR check YES //and complete Schedule D-2.

For Statements filed in January 2016 and each two years thereafter,
complete the following statement indicating whether you completed the ethics
orientation sessions provided pursuant to law:

I certify that I completed ethics training as required by § 30-129.1.
YES //or NO//.

Statements of Economic Interests are open for public inspection.

AFFIRMATION.

In accordance with the rules of the house in which I serve, if I receive
a request that this disclosure statement be corrected, augmented, or revised
in any respect, I hereby pledge that I shall respond promptly to the request.
I understand that if a determination is made that the statement is
insufficient, I will satisfy such request or be subjected to disciplinary
action of my house.

I swear or affirm that the foregoing information is full, true and
correct to the best of my knowledge.

Signature (Such signature shall be deemed to constitute
a valid notarization and shall have the same effect as if performed by a
notary public.)

(Return only if needed to complete Statement.)

SCHEDULES
to
STATEMENT OF ECONOMIC INTERESTS.

NAME

SCHEDULE A -- OFFICES AND DIRECTORSHIPS. Identify each business of which you or a member of your immediate family is a paid officer or paid director.

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Name of BusinessAddress of BusinessPosition Held
and by Whom
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RETURN TO ITEM 2

SCHEDULE B -- PERSONAL LIABILITIES. Report personal liability by checking each category. Report only debts in excess of $5,000. Do not report debts to any government. Do not report loans secured by recorded liens on property at least equal in value to the loan.

Report contingent liabilities below and indicate which debts are contingent.

1. My personal debts are as follows:

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CheckCheck one
appropriate$5,001 toMore than
categories$50,000$50,000
Banks
Savings institutions
Other loan or finance companies
Insurance companies
Stock, commodity or other brokerage
companies
Other businesses:
(State principal business activity for each
creditor and its name.)


Individual creditors:
(State principal business or occupation of
each creditor and its name.)

2. The personal debts of the members of my immediate family are as follows:

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CheckCheck one
appropriate$5,001 toMore than
categories$50,000$50,000
Banks
Savings institutions
Other loan or finance companies
Insurance companies
Stock, commodity or other brokerage
companies
Other businesses:
(State principal business activity for each
creditor and its name.)


Individual creditors:
(State principal business or occupation of
each creditor and its name.)

RETURN TO ITEM 3

SCHEDULE C -- SECURITIES. "Securities" INCLUDES stocks, bonds, "Securities" EXCLUDES

mutual funds, limited partnerships, certificates of deposit,

and commodity futures contracts. money market funds, annuity

contracts, and insurance policies.

Identify each business or Virginia governmental entity in which you or a member of your immediate family, directly or indirectly, separately or together, own securities valued in excess of $5,000. Name each issuer and type of security individually.

Do not list U.S. Bonds or other government securities not issued by the Commonwealth of Virginia or its authorities, agencies, or local governments. Do not list organizations that do not do business in this Commonwealth, but most major businesses conduct business in Virginia. Account for securities held in trust.

If no reportable securities, check here / / .

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Check one
Type of Security$5,001$50,001More
(stocks, bonds, mutualtotothan
Name of Issuerfunds, etc.)$$250,000$
50,000250,000
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---
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---
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---
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RETURN TO ITEM 4

SCHEDULE D-1 -- PAYMENTS FOR TALKS, MEETINGS, AND PUBLICATIONS. List each source from which you received during the past six months in your capacity as a legislator lodging, transportation, money, or any other thing of value with a combined value exceeding $200 (i) for your presentation of a single talk, participation in one meeting, or publication of a work or (ii) for your attendance at a meeting, conference, or event where your attendance at the meeting, conference, or event was designed to (a) educate you on issues relevant to your duties as a legislator, including issues faced by your constituents, or (b) enhance your knowledge and skills relative to your duties as a legislator. Any lodging, transportation, money, or other thing of value received by a legislator that does not satisfy the criteria of clause (i), (ii)(a), or (ii)(b) shall be listed as a gift on Schedule E. Do not list payments or reimbursements by the Commonwealth. (See Schedule D-2 for such payments or reimbursements.) List a payment even if you donated it to charity. Do not list information about a payment if you returned it within 60 days or if you received it from an employer already listed under Item 6 or from a source of income listed on Schedule F.

If no payment must be listed, check here / /.

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Type of Payment
(e.g.Honoraria
Travel reimburse-
PayerApproximate ValueCircumstancesment, etc.)
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RETURN TO ITEM 5

SCHEDULE D-2 -- PAYMENTS BY THE COMMONWEALTH FOR MEETINGS. List each meeting for which the Commonwealth provided payments or reimbursements during the past six months to you for lodging, transportation, money, or any other thing of value with a combined value exceeding $200 for your participation in your capacity as a legislator. Do not list payments or reimbursements by the Commonwealth for meetings or travel within the Commonwealth.

If no payment must be listed, check here / /.

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Type of Payment
(e.g. Honoraria,
travel reimburse-
PayerApproximate ValueCircumstancesment, etc.)
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------------------------------------------------------------
------------------------------------------------------------
------------------------------------------------------------
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SCHEDULE E -- GIFTS. List each business, governmental entity, or individual that, during the past six months, (i) furnished you or a member of your immediate family with any gift or entertainment at a single event, and the value received exceeded $50 or (ii) furnished you or a member of your immediate family with gifts or entertainment in any combination and the total value received exceeded $100, and for which you or the member of your immediate family neither paid nor rendered services in exchange. List each such gift or event.

Do not list entertainment events unless the average value per person attending the event exceeded $50. Do not list business entertainment related to the private profession or occupation of you or the member of your immediate family who received such business entertainment. Do not list gifts or other things of value given by a relative or personal friend for reasons clearly unrelated to your public position. Do not list campaign contributions publicly reported as required by Chapter 9.3 (§ 24.2-945 et seq.) of Title 24.2 of the Code of Virginia.

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Name of Business,City orExact
Name ofOrganization, orCountyGift orApproximate
RecipientIndividualand StateEventValue

RETURN TO ITEM 6

SCHEDULE F-1 -- BUSINESS INTERESTS. Complete this Schedule for each self-owned or family-owned business (including rental property, a farm, or consulting work), partnership, or corporation in which you or a member of your immediate family, separately or together, own an interest having a value in excess of $5,000.

If the enterprise is owned or operated under a trade, partnership, or corporate name, list that name; otherwise, merely explain the nature of the enterprise. If rental property is owned or operated under a trade, partnership, or corporate name, list the name only; otherwise, give the address of each property. Account for business interests held in trust.

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Name ofGrossincome
BusinessNature of
CorporationEnterprise
Partnership,(farming,
Farm;law,
Address ofCity orrental$50,000$50,001More
RentalCountyproperty,or lesstothan
Propertyand State etc.)$250,000$250,000
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RETURN TO ITEM 8

SCHEDULE F-2 -- LOBBYIST RELATIONSHIPS AND PAYMENTS. Complete this Schedule for each lobbyist relationship with the following:

(i) any person who is, or has been within the prior calendar year, registered as a lobbyist with the Secretary of the Commonwealth, or

(ii) any business in which you have a greater than three percent ownership interest and that business employs, or engages as an independent contractor, any person who is, or has been within the prior calendar year, registered as a lobbyist with the Secretary of the Commonwealth.

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List of each personDescribe eachDates ofPayments to
or businessrelationshiprelationshipLobbyist
$More than
10,000
or less$10,000
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---
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---
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THE DISCLOSURE OF A LOBBYIST RELATIONSHIP SHALL NOT (I) CONSTITUTE A WAIVER OF ANY ATTORNEY-CLIENT OR OTHER PRIVILEGE, (II) REQUIRE A WAIVER OF ANY ATTORNEY-CLIENT OR OTHER PRIVILEGE FOR A THIRD PARTY, OR (III) BE REQUIRED WHERE A MEMBER OR MEMBER-ELECT IS EMPLOYED OR ENGAGED BY A PERSON AND SUCH PERSON ALSO EMPLOYS OR ENGAGES A PERSON IN A LOBBYIST RELATIONSHIP SO LONG AS THE MEMBER OR MEMBER-ELECT HAS NO FINANCIAL INTEREST IN THE LOBBYIST RELATIONSHIP.

SCHEDULE G-1 -- PAYMENTS FOR REPRESENTATION BY YOU. List the businesses you represented before any state governmental agency, excluding any court or judge, for which you received total compensation during the past six months in excess of $1,000, excluding compensation for other services to such businesses and representation consisting solely of the filing of mandatory papers and subsequent representation regarding the mandatory papers filed by you.

Identify each business, the nature of the representation and the amount received by dollar category from each such business. You may state the type, rather than name, of the business if you are required by law not to reveal the name of the business represented by you.

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Amount Received
NameTypePur-Name
ofofposeof
Busi- Busi- ofAgen-
nessnessRepre- cy
senta-
tion$1,001$10,001$50,001$100,001$250,001
totototoand
$10,000$50,000$100,000$250,000over
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----- ----- ------ ----------------------------------------------
----- ----- ------ ----------------------------------------------
----- ----- ------ ----------------------------------------------
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If you have received $250,001 or more from a single business within the
reporting period, indicate the amount received, rounded to the nearest $
10,000.Amount Received: .

SCHEDULE G-2 -- PAYMENTS FOR REPRESENTATION BY ASSOCIATES. List the businesses that have been represented before any state governmental agency, excluding any court or judge, by persons who are your partners, associates or others with whom you have a close financial association and who received total compensation in excess of $1,000 for such representation during the past six months, excluding representation consisting solely of the filing of mandatory papers and subsequent representation regarding the mandatory papers filed by your partners, associates or others with whom you have a close financial association.

Identify such businesses by type and also name the state governmental agencies before which such person appeared on behalf of such businesses.

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Type of BusinessName of State Governmental Agency
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SCHEDULE G-3 -- PAYMENTS FOR OTHER SERVICES GENERALLY. Indicate below types of businesses that operate in Virginia to which services were furnished by you or persons with whom you have a close financial association pursuant to an agreement between you and such businesses, or between persons with whom you have a close financial association and such businesses and for which total compensation in excess of $1,000 was received during the past six months. Services reported in this Schedule shall not include services involving the representation of businesses that are reported in Schedule G-1 or G-2 above.

Identify opposite each category of businesses listed below (i) the type of business, (ii) the type of service rendered and (iii) the value by dollar category of the compensation received for all businesses falling within each category.

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Value of Compensation
CheckType
ifof
ser-ser-
vicesvice
wereren-
ren-dered
dered$1,001 $10,001 $50,001$100,001$250,001
totototoand
$10,000$50,000$100,000$250,000over
Electric utilities
Gas utilities
Telephone utilities
Water utilities
Cable television
companies
Interstate
transportation
companies
Intrastate
transportation
companies
Oil or gas retail
companies
Banks
Savings institutions
Loan or finance
companies
Manufacturing
companies(state
type of product,
e.g., textile,
furniture, etc.)
Mining companies
Life insurance
companies
Casualty insurance
companies
Other insurance
companies
Retail companies
Beer, wine or liquor
companies or
distributors
Trade associations
Professional
associations
Associations of
public employees or
officials
Counties, cities or
towns
Labor organizations
Other

RETURN TO ITEM 9

SCHEDULE H -- REAL ESTATE. List real estate other than your principal residence in which you or a member of your immediate family holds an interest, including a partnership interest, option, easement, or land contract, valued at $5,000 or more. Each parcel shall be listed individually.

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List the locationDescribe the type of realIf the real estate is
(state, and countyestate you own in eachowned or recorded in
or city where youlocation (business,a name other than your
own real estaterecreational, apartment,own, list that name
commercial, open land,
etc.)
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RETURN TO ITEM 10

SCHEDULE I -- REAL ESTATE CONTRACTS WITH STATE GOVERNMENTAL AGENCIES. List all contracts, whether pending or completed within the past six months, with a state governmental agency for the sale or exchange of real estate in which you or a member of your immediate family holds an interest, including a corporate, partnership or trust interest, option, easement, or land contract, valued at more than $10,000. List all contracts with a state governmental agency for the lease of real estate in which you or a member of your immediate family holds such an interest valued at more than $1,000. This requirement to disclose an interest in a lease does not apply to an interest derived through an ownership interest in a business unless the ownership interest exceeds three percent of the total equity of the business.

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List your realList eachState the annual
estate interest andgovernmental agencyincome from the
the person or entity,which is a party tocontract, and the
including the type ofthe contract andamount, if any, of
entity, which isindicate the countyincome you or any
party to the contract.or city where theimmediate family
Describe anyreal estate ismember derives
management
role and thelocated.annually from
percentage
ownership interestthe contract.
you or your immediate
family member has in
the real estate
or entity.
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B. Any legislator who makes a knowing misstatement of a material fact on the Statement of Economic Interests shall be subject to disciplinary action for such violations by the house in which the legislator sits.

C. The Statement of Economic Interests of all members of each house shall be reviewed by the Council. If a legislator's Statement is found to be inadequate as filed, the legislator shall be notified in writing and directed to file an amended Statement correcting the indicated deficiencies, and a time shall be set within which such amendment shall be filed. If the Statement of Economic Interests, in either its original or amended form, is found to be adequate as filed, the legislator's filing shall be deemed in full compliance with this section as to the information disclosed thereon.

D. Ten percent of the membership of a house, on the basis of newly discovered facts, may in writing request the house in which those members sit, in accordance with the rules of that house, to review the Statement of Economic Interests of another member of that house in order to determine the adequacy of his filing. In accordance with the rules of each house, each Statement of Economic Interests shall be promptly reviewed, the adequacy of the filing determined, and notice given in writing to the legislator whose Statement is in issue. Should it be determined that the Statement requires correction, augmentation or revision, the legislator involved shall be directed to make the changes required within such time as shall be set under the rules of each house.

If a legislator, after having been notified in writing in accordance with the rules of the house in which he sits that his Statement is inadequate as filed, fails to amend his Statement so as to come into compliance within the time limit set, he shall be subject to disciplinary action by the house in which he sits. No legislator shall vote on any question relating to his own Statement.

1987, Sp. Sess., c. 1, § 2.1-639.41; 1988, c. 849; 1994, cc. 724, 733, 735, 777, 793; 1995, c. 763; 1996, c. 77; 1997, cc. 577, 844; 1998, c. 732; 2001, c. 844; 2003, c. 610; 2006, cc. 779, 787, 892; 2007, cc. 620, 627; 2010, cc. 418, 474, 670; 2014, cc. 792, 804.

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