2006 Code of Virginia § 30-111 - Disclosure form

30-111. Disclosure form.

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


STATEMENTOFECONOMICINTERESTS.
Name.........................................................................
Officeorpositionheldorsought............................................
Homeaddress.................................................................
Namesofmembersofimmediatefamily........................................

DEFINITIONS AND EXPLANATORY MATERIAL.

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

"Dependent" means any person, whether or not related by blood or marriage,who receives from the legislator, or provides to the legislator, more thanone-half of his financial support.

"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 filershares significant financial involvement with an individual and the filerwould 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 legislator is no longer employed or(ii) the receipt of compensation for work performed by the legislator as anindependent contractor of a business that represents an entity before anystate governmental agency when the legislator has had no communications withthe state governmental agency.

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

"Gift" means any gratuity, favor, discount, entertainment, hospitality,loan, forbearance, or other item having monetary value. It includes servicesas well as gifts of transportation, local travel, lodgings and meals, whetherprovided in-kind, by purchase of a ticket, payment in advance orreimbursement after the expense has been incurred. "Gift" shall not includeany offer of a ticket or other admission or pass unless the ticket,admission, or pass is used. "Gift" shall not include honorary degrees andpresents from relatives. "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, orsister; or the donee's brother's or sister's spouse.

"Lobbyist relationship" means (i) an engagement, agreement, orrepresentation that relates to legal services, consulting services, or publicrelations services, whether gratuitous or for compensation, between a memberor member-elect and any person who is, or has been within the prior calendaryear, 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 asa lobbyist with the Secretary of the Commonwealth. The disclosure of alobbyist relationship shall not (i) constitute a waiver of anyattorney-client or other privilege, (ii) require a waiver of anyattorney-client or other privilege for a third party, or (iii) be requiredwhere a member or member-elect is employed or engaged by a person and suchperson also employs or engages a person in a lobbyist relationship so long asthe member or member-elect has no financial interest in the lobbyistrelationship.

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

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

COMPLETE ITEMS 1 THROUGH 10. 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 directorof 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 $10,000 to any onecreditor including contingent liabilities? (Exclude debts to any governmentand loans secured by recorded liens on property at least equal in value tothe 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 $10,000 investedin 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 12 months did you receive lodging, transportation, money, oranything else of value with a combined value exceeding $200 for a singletalk, meeting, or published work in your capacity as a legislator?

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

5. Gifts.

During the past 12 months did a business, government, or individual otherthan a relative or personal friend (i) furnish you with any gift orentertainment at a single event, and the value received by you exceeded $50in value or (ii) furnish you with gifts or entertainment in any combinationand the value received by you exceeded $100 in total value; and for which youneither paid nor rendered services in exchange? Account for entertainmentevents only if the average value per person attending the event exceeded $50in value. Account for all business entertainment (except if related to yourprivate profession or occupation) 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 salaryor wages in excess of $10,000 annually. (Exclude state or local government oradvisory agencies.)

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 ortogether, operate your own business, or own or control an interest in excessof $10,000 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.Didyourepresentanybusinessesbeforeanystategovernmental
agencies,excludingcourtsorjudges,forwhichyoureceivedtotal
compensationduringthepast12monthsinexcessof$1,000,excluding
compensationforotherservicestosuchbusinessesandrepresentation
consistingsolelyofthefilingofmandatorypapersandsubsequent
representationregardingthemandatorypapers?
EITHERcheckNO//ORcheckYES//andcompleteScheduleG-1.
8B.Subjecttothesameexceptionsasin8A,didpersonswithwhomyou
haveaclosefinancialassociation(partners,associatesorothers)represent
anybusinessesbeforeanystategovernmentalagencyforwhichtotal
compensationwasreceivedduringthepast12monthsinexcessof$1,000?
EITHERcheckNO//ORcheckYES//andcompleteScheduleG-2.
8C.Didyouorpersonswithwhomyouhaveaclosefinancialassociation
furnishservicestobusinessesoperatinginVirginia,pursuanttoanagreement
betweenyouandsuchbusinesses,orbetweenpersonswithwhomyouhavea
closefinancialassociationandsuchbusinessesforwhichtotalcompensation
inexcessof$1,000wasreceivedduringthepast12months?

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 apartnership interest, valued at $10,000 or more in real property (other thanyour principal residence) for which you have not already listed the fulladdress 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 morethan $10,000 in real estate, including a corporate, partnership, or trustinterest, option, easement, or land contract, which real estate is thesubject of a contract, whether pending or completed within the past 12months, with a state governmental agency? If the real estate contractprovides for the leasing of the property to a state governmental agency, doyou or a member of your immediate family hold an interest in the real estate,including a corporate, partnership, or trust interest, option, easement, orland contract valued at more than $1,000? Account for all such contractswhether or not your interest is reported in Schedule F or H. This requirementto disclose an interest in a lease does not apply to an interest derivedthrough an ownership interest in a business unless the ownership interestexceeds three percent of the total equity of the business.

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

Statements of Economic Interests are open for public inspection.


AFFIRMATION.
InaccordancewiththerulesofthehouseinwhichIserve,ifIreceivea
requestthatthisdisclosurestatementbecorrected,augmented,orrevisedin
anyrespect,IherebypledgethatIshallrespondpromptlytotherequest.I
understandthatifadeterminationismadethatthestatementisinsufficient,
Iwillsatisfysuchrequestorbesubjectedtodisciplinaryactionofmy
house.
Iswearoraffirmthattheforegoinginformationisfull,trueandcorrectto
thebestofmyknowledge.
Signature________________________________
CommonwealthofVirginia
________of________towit:
Theforegoingdisclosureformwasacknowledgedbeforeme
This________dayof____________,20____,by______________
NotaryPublic
Mycommissionexpires________________________
(ReturnonlyifneededtocompleteStatement.)
SCHEDULES
TO
STATEMENTOFECONOMICINTERESTS.
NAME________________________________________________________________

SCHEDULE A - OFFICES AND DIRECTORSHIPS.

Identify each business of which you or a member of your immediate family is apaid officer or paid director.


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NameofBusinessAddressofBusinessPositionHeld
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RETURNTOITEM2

SCHEDULE B - PERSONAL LIABILITIES.

Report personal liability by checking each category. Report only debts inexcess of $10,000. Do not report debts to any government. Do not report loanssecured 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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CheckCheckone
appropriate$10,001toMorethan
categories$50,000$50,000
Banks
Savingsinstitutions
Otherloanorfinancecompanies
Insurancecompanies
Stock,commodityorotherbrokerage
companies
Otherbusinesses:
(Stateprincipalbusinessactivityforeach
creditor.)
____________________________________________
____________________________________________
Individualcreditors:
(Stateprincipalbusinessoroccupationof
eachcreditor.)
____________________________________________
____________________________________________

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


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CheckCheckone
appropriate$10,001toMorethan
categories$50,000$50,000
Banks
Savingsinstitutions
Otherloanorfinancecompanies
Insurancecompanies
Stock,commodityorotherbrokerage
companies
Otherbusinesses:
(Stateprincipalbusinessactivityforeach
creditor.)
____________________________________________
____________________________________________
Individualcreditors:
(Stateprincipalbusinessoroccupationof
eachcreditor.)
____________________________________________
____________________________________________

RETURNTOITEM3
SCHEDULEC-SECURITIES.
"Securities"INCLUDESstocks,bonds,"Securities"EXCLUDES
mutualfunds,limitedpartnerships,certificatesofdeposit,
andcommodityfuturescontracts.moneymarketfunds,annuity
contracts,andinsurancepolicies.

Identify each business or Virginia governmental entity in which you or amember of your immediate family, directly or indirectly, separately ortogether, own securities valued in excess of $10,000. Name each entity andtype of security individually.

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

If no reportable securities, check here / / .


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Checkone
TypeofSecurity
Typeof(stocks,bonds,mutual$10,001toMorethan
NameofIssuerEntityfunds,etc.)$50,000$50,000
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RETURNTOITEM4

SCHEDULE D - PAYMENTS FOR TALKS, MEETINGS, AND PUBLICATIONS.

List each source from which you received during the past 12 months lodging,transportation, money, or any other thing of value (excluding meals or drinkscoincident with a meeting) with combined value exceeding $200 for yourpresentation of a single talk, participation in one meeting, or publicationof a work in your capacity as a legislator. List payments or reimbursementsby the Commonwealth only for meetings or travel outside the Commonwealth.List a payment even if you donated it to charity. Do not list informationabout a payment if you returned it within 60 days or if you received it froman employer already listed under Item 6 or from a source of income listed onSchedule F.

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


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TypeofPayment
(e.g.
Travelreimburse-
PayerApproximateValueCircumstancesment,etc.)
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RETURNTOITEM5

SCHEDULE E - GIFTS.

List each business, governmental entity, or individual that, during the past12 months, (i) furnished you with any gift or entertainment at a single eventand the value received by you exceeded $50 in value, or (ii) furnished youwith gifts or entertainment in any combination and the value received by youexceeded $100 in total value; and for which you neither paid nor renderedservices in exchange. List each such gift or event. Do not list entertainmentevents unless the average value per person attending the event exceeded $50in value. Do not list business entertainment related to your privateprofession or occupation. Do not list gifts or other things of value given bya relative or personal friend for reasons clearly unrelated to your publicposition. Do not list campaign contributions publicly reported as required byChapter 9.3 ( 24.2-945 et seq.) of Title 24.2 of the Code of Virginia.


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NameofBusiness,
Organization,orCityorGiftor
County
IndividualandStateEventApproximateValue
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RETURNTOITEM6

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, orcorporation in which you or a member of your immediate family, separately ortogether, own an interest having a value in excess of $10,000.

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


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NameofGrossincome
BusinessNatureof
CorporationEnterprise
Partnership,(farming,
Farm;law,
AddressofCityorrental$50,000$50,001More
RentalCountyproperty,orlesstothan
PropertyandStateetc.)$250,000$250,000
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RETURNTOITEM8

SCHEDULE F-2 - LOBBYIST RELATIONSHIPS.

Complete this Schedule for each lobbyist relationship with the following:

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

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


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ListeachpersonDescribeDatesof
orbusinesseachrelationship
relationship
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THE DISCLOSURE OF A LOBBYIST RELATIONSHIP SHALL NOT (I) CONSTITUTE A WAIVEROF ANY ATTORNEY-CLIENT OR OTHER PRIVILEGE, (II) REQUIRE A WAIVER OF ANYATTORNEY-CLIENT OR OTHER PRIVILEGE FOR A THIRD PARTY, OR (III) BE REQUIREDWHERE A MEMBER OR MEMBER-ELECT IS EMPLOYED OR ENGAGED BY A PERSON AND SUCHPERSON ALSO EMPLOYS OR ENGAGES A PERSON IN A LOBBYIST RELATIONSHIP SO LONG ASTHE MEMBER OR MEMBER-ELECT HAS NO FINANCIAL INTEREST IN THE LOBBYISTRELATIONSHIP.

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 compensationduring the past 12 months in excess of $1,000, excluding compensation forother services to such businesses and representation consisting solely of thefiling of mandatory papers and subsequent representation regarding themandatory papers filed by you.

Identify each business, the nature of the representation and the amountreceived 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 revealthe name of the business represented by you.


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AmountReceived
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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If you have received $250,001 or more from a single business within thereporting 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 governmentalagency, excluding any court or judge, by persons who are your partners,associates or others with whom you have a close financial association and whoreceived total compensation in excess of $1,000 for such representationduring the past 12 months, excluding representation consisting solely of thefiling of mandatory papers and subsequent representation regarding themandatory papers filed by your partners, associates or others with whom youhave a close financial association.

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


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TypeofBusinessNameofStateGovernmentalAgency
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SCHEDULE G-3 - PAYMENTS FOR REPRESENTATION AND OTHER SERVICES GENERALLY.

Indicate below types of businesses that operate in Virginia to which serviceswere furnished by you or persons with whom you have a close financialassociation pursuant to an agreement between you and such businesses, orbetween persons with whom you have a close financial association and suchbusinesses and for which total compensation in excess of $1,000 was receivedduring the past 12 months.

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


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ValueofCompensation
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
Electricutilities
Gasutilities
Telephoneutilities
Waterutilities
Cabletelevision
companies
Interstate
transportation
companies
Intrastate
transportation
companies
Oilorgasretail
companies
Banks
Savingsinstitutions
Loanorfinance
companies
Manufacturing
companies(state
typeofproduct,
e.g.,textile,
furniture,etc.)
Miningcompanies
Lifeinsurance
companies
Casualtyinsurance
companies
Otherinsurance
companies
Retailcompanies
Beer,wineorliquor
companiesor
distributors
Tradeassociations
Professional
associations
Associationsof
publicemployeesor
officials
Counties,citiesor
towns
Labororganizations
Other

RETURNTOITEM9

SCHEDULE H - REAL ESTATE.

List real estate other than your principal residence in which you or a memberof your immediate family holds an interest, including a partnership interest,option, easement, or land contract, valued at $10,000 or more. You may listeach parcel of real estate individually if you wish.


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ListthelocationDescribethetypeofrealIftherealestateis
(state,andcountyestateyouownineachownedorrecordedin
orcitywhereyoulocation(business,anameotherthanyour
ownrealestaterecreational,apartment,own,listthatname
commercial,openland,
etc.)
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RETURNTOITEM10

SCHEDULE I - REAL ESTATE CONTRACTS WITH STATE GOVERNMENTAL AGENCIES.

List all contracts, whether pending or completed within the past 12 months,with a state governmental agency for the sale or exchange of real estate inwhich you or a member of your immediate family holds an interest, including acorporate, partnership or trust interest, option, easement, or land contract,valued at $10,000 or more. List all contracts with a state governmentalagency for the lease of real estate in which you or a member of yourimmediate family holds such an interest valued at $1,000 or more. Thisrequirement to disclose an interest in a lease does not apply to an interestderived through an ownership interest in a business unless the ownershipinterest exceeds three percent of the total equity of the business.


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ListyourrealListeachStatetheannual
estateinterestandgovernmentalagencyincomefromthe
thepersonorentity,whichisapartytocontract,andthe
includingthetypeofthecontractandamount,ifany,of
entity,whichisindicatethecountyincomeyouorany
partytothecontract.orcitywheretheimmediatefamily
Describeanyrealestateismemberderives
management
roleandthelocated.annuallyfrom
percentage
ownershipinterestthecontract.
youoryourimmediate
familymemberhasin
therealestate
orentity.
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B. Any legislator who makes a knowing misstatement of a material fact on theStatement of Economic Interests shall be subject to disciplinary action forsuch violations by the house in which the legislator sits.

C. In accordance with the rules of each house, the Statement of EconomicInterests of all members of each house shall be reviewed. If a legislator'sStatement is found to be inadequate as filed, the legislator shall benotified in writing and directed to file an amended Statement correcting theindicated deficiencies, and a time shall be set within which such amendmentshall be filed. If the Statement of Economic Interests, in either itsoriginal or amended form, is found to be adequate as filed, the legislator'sfiling shall be deemed in full compliance with this section as to theinformation disclosed thereon.

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

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

(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.)

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