WOODFORD COUNTY CODE OF ETHICS
STATEMENT OF FINANCIAL DISCLOSURE
STATEMENT OF FINANCIAL DISCLOSURE
Check here and attach additional sheets if necessary.
Number of sheets attached.
To be filed not later than June 30 of each year, complete through December 31 of the preceding year.
Name
Business Address
Business Telephone
Home Address
Title of public position, or office sought
Other occupation(s) of filer
Occupation(s) of spouse
Positions held by filer in any business, partnership, corporation for profit, or corporation not for profit from which the filer receives compensation in excess of $5,000.00, and the name and address of the business, partnership, or corporation
Positions held by filer's spouse in any business, partnership, corporation for profit, or corporation not for profit from which the filer receives compensation in excess of $5,000.00, and the name and address of the business, partnership, or corporation
Names and addresses of all business, investments, or securities in which the filer, filer's spouse, or filer's minor children had at any time during the reporting year an interest of $10,000.00 at fair market value, or 5% ownership interest or more
The name and address of any business located outside of the state, if the business has engaged in any business transactions with the county during the past three (3) years, or which is anticipated to engage in any business transactions with the county in which the filer or any member of the filer's immediate family had at any time during the preceding calendar year an interest of ten thousand ($10,000.00) at fair market value or five percent (5%) ownership interest or more
Each source by name and address of gifts or honoraria having an aggregate fair market value of one hundred dollars ($100.00) or more from any single source, excluding gifts received from family members, received by the filer or the filer's immediate family during the preceding calendar year
A designation as commercial, residential, or rural, and the location of all real property other than the filer's primary residence, in which there is an interest of $10,000.00 or more held by the filer, filer's spouse, or filer's minor children
Sources and form of gross income in excess of $5,000.00 of the filer (List sources by name. Filer is not required to disclose specific dollar amounts or the names of individual clients or customers of businesses listed as sources of income.)
1.
2.
3.
4.
5.
Sources and form of gross income in excess of $5,000.00 of the filer's spouse. (List sources by name. Filer is not required to disclose specific dollar amounts or the names of individual clients or customers of businesses listed as sources of income.)
1.
2.
3.
4.
5.
The name and address of any creditor owed more than five thousand dollars ($5,000.00), except debts arising from the purchase of a primary residence or the purchase of consumer goods which are bought or used primarily for personal, family or household purposes
Do you or any member of your immediate family have any private financial interest, directly or indirectly, in any contract or matter pending before or within any department or agency of the county government or independent agency or special district? Yes No
If yes, explain:
(Ord. 9-95, passed 2-16-1995)