2006 Code of Virginia § 2.2-3118 - Disclosure form; certain citizen members

2.2-3118. Disclosure form; certain citizen members.

A. The financial disclosure form to be used for filings required pursuant tosubsection B of 2.2-3114 and subsection B of 2.2-3115 shall besubstantially as follows:

DEFINITIONS AND EXPLANATORY MATERIAL.

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

"Close financial association" means an association in which the personfiling shares significant financial involvement with an individual and thefiler would reasonably be expected to be aware of the individual's businessactivities and would have access to the necessary records either directly orthrough the individual. "Close financial association" does not mean anassociation based on (i) the receipt of retirement benefits or deferredcompensation from a business by which the person filing this statement is nolonger employed, or (ii) the receipt of compensation for work performed bythe person filing as an independent contractor of a business that representsan entity before any state governmental agency when the person filing has nocommunications with the state governmental agency.

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

"Immediate family" means (i) a spouse and (ii) any other person residing inthe same household as the filer, who is a dependent of the filer or of whomthe filer is a dependent.

"Dependent" means any person, whether or not related by blood or marriage,who receives from the filer, or provides to the filer, more than one-half ofhis financial support.

"Personal interest" means, for the purposes of this form only, a personaland financial benefit or liability accruing to a filer or a member of hisimmediate family. Such interest shall exist by reason of (i) ownership inreal or personal property, tangible or intangible; (ii) ownership in abusiness; (iii) income from a business; or (iv) personal liability on behalfof a business; however, unless the ownership interest in a business exceedsthree percent of the total equity of the business, or the liability on behalfof a business exceeds three percent of the total assets of the business, orthe annual income, and/or property or use of such property, from the businessexceeds $10,000 or may reasonably be anticipated to exceed $10,000, suchinterest shall not constitute a "personal interest."

Name.........................................................................
Officeorpositionheldortobeheld
..............................................................................
Address.....................................................................
I.FINANCIALINTERESTS
Mypersonalinterestsandthoseofmyimmediatefamilyareasfollows:
Includeallformsofpersonalinterestsheldatthetimeoffiling:real
estate,stocks,bonds,equityinterestsinproprietorshipsandpartnerships.
Youmayexclude:
1.Depositsandinterestbearingaccountsinbanks,savingsinstitutionsand
otherinstitutionsacceptingsuchdepositsoraccounts;
2.Interestsinanybusiness,otherthananewsmedium,representinglessthan
threepercentofthetotalequityvalueofthebusiness;
3.Liabilityonbehalfofanybusinessrepresentinglessthanthreepercentof
thetotalassetsofsuchbusiness;and
4.Income(otherthanfromsalary)lessthan$10,000annuallyfromany
business.Youneednotstatethevalueofanyinterest.Youmuststatethe
nameorprincipalbusinessactivityofeachbusinessinwhichyouhavea
personalinterest.
A.Mypersonalinterestsare:
1.Residence,address,or,ifnoaddress,location...........................
2.Otherrealestate,address,or,ifnoaddress,location...................
3.Nameorprincipalbusinessactivityofeachbusinessinwhichstock,bond
orequityinterestisheld...................................................
B.Thepersonalinterestsofmyimmediatefamilyare:
1.Realestate,addressor,ifnoaddress,location..........................
2.Nameorprincipalbusinessactivityofeachbusinessinwhichstock,bond
orequityinterestisheld..................................
II.OFFICES,DIRECTORSHIPSANDSALARIEDEMPLOYMENTS
Thepaidoffices,paiddirectorshipsandsalariedemploymentswhichIholdor
whichmembersofmyimmediatefamilyholdandthebusinessesfromwhichIor
membersofmyimmediatefamilyreceiveretirementbenefitsareasfollows:
(Youneednotstateanydollaramounts.)
A.Mypaidoffices,paiddirectorshipsandsalariedemploymentsare:

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PositionheldNameofbusiness
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B. The paid offices, paid directorships and salaried employments of membersof my immediate family are:

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PositionheldNameofbusiness
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III. BUSINESSES TO WHICH SERVICES WERE FURNISHED

A. The businesses I have represented, excluding activity defined as lobbyingin 2.2-419, before any state governmental agency, excluding any court orjudge, for which I have received total compensation in excess of $1,000during the preceding year, excluding compensation for other services to suchbusinesses and representation consisting solely of the filing of mandatorypapers, are as follows:

Identify businesses by name and name the state governmental agencies beforewhich you appeared on behalf of such businesses.

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NameofbusinessNameofgovernmentalagency
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B. The businesses that, to my knowledge, have been represented, excludingactivity defined as lobbying in 2.2-419, before any state governmentalagency, excluding any court or judge, by persons with whom I have a closefinancial association and who received total compensation in excess of $1,000during the preceding year, excluding compensation for other services to suchbusinesses and representation consisting solely of the filing of mandatorypapers, are as follows:

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

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TypeofbusinessNameofstategovernmentalagency
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C. All other businesses listed below that operate in Virginia to whichservices were furnished pursuant to an agreement between you and suchbusinesses and for which total compensation in excess of $1000 was receivedduring the preceding year:

Check each category of business to which services were furnished.

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Electricutilities
Gasutilities
Telephoneutilities
Waterutilities
Cabletelevisioncompanies
Intrastatetransportationcompanies
Interstatetransportationcompanies
Oilorgasretailcompanies
Banks
Savingsinstitutions
Loanorfinancecompanies
Manufacturingcompanies(statetypeofproduct,e.g.,
textile,furniture,etc.)
Miningcompanies
Lifeinsurancecompanies
Casualtyinsurancecompanies
Otherinsurancecompanies
Retailcompanies
Beer,wineorliquorcompaniesordistributors
Tradeassociations
Professionalassociations
Associationsofpublicemployeesorofficials
Counties,citiesortowns
Labororganizations

IV. COMPENSATION FOR EXPENSES

The persons, associations, or other sources other than my governmental agencyfrom which I or a member of my immediate family received remuneration inexcess of $200 during the preceding year, in cash or otherwise, ashonorariums or payment of expenses in connection with my attendance at anymeeting or other function to which I was invited in my official capacity areas follows:

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DescriptionAmountofremuneration
NameofSourceofoccasionforeachoccasion
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B. The provisions of Part III A and B of the disclosure form prescribed bythis section shall not be applicable to officers and employees of localgovernmental and local advisory agencies.

C. Except for real estate located within the county, city or town in whichthe officer or employee serves or a county, city or town contiguous to thecounty, city or town in which the officer or employee serves, officers andemployees of local governmental or advisory agencies shall not be required todisclose under Part I of the form any other interests in real estate.

(1988, c. 849, 2.1-639.15:1; 1996, c. 77; 2001, c. 844; 2006, c. 779.)