Louisiana Regulations § 52-I-1919 Retirement System Financial Disclosure Report
Regulation Text
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RETIREMENT SYSTEM FINANCIAL DISCLOSURE REPORT
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Pursuant to LSA-
R.S.
42:1114.2
, each person who has or is seeking to obtain a contractual or other business or financial relationship with a state or statewide public retirement system shall file with the Board of Ethics a financial disclosure report semiannually if the person has made expenditures of five hundred dollars or more in a calendar year. Reports disclosing expenditures for retirement officials must be filed by August 15th, covering January 1 through June 30 of the calendar year and by February 15th, covering January 1-December 31 of the calendar year. Although there is no registration requirement under
R.S.
42:1114.2
, you may be required to register and report under LSA-
R.S.
49:71
et seq.
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OR
REPORT COVERING:
[] JANUARY 1 through JUNE 30, _________ -
DUE BY AUGUST 15
[] JANUARY 1 through DECEMBER 31, ________ -
DUE BY FEBRUARY 15
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FOR OFFICE USE ONLY
Postmark Date:__________
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1.
Name: _________________________________________________________________________
Last First MI
2.
Business Address: ________________________________________________________________
Street and No. City State Zip
Mailing Address: _________________________________________________________________
3.
Business Phone: _________________________________________________________________
Area Code and Telephone Number
4.
Employer: ______________________________________________________________________
5.
Employer's address: _______________________________________________________________
Street and No. City State Zip
6.
Did you make an expenditure exceeding $50 on one occasion for a retirement system official:
From January 1 through June 30? Yes [] No []
From July 1 through December 31? Yes [] No [] NA []
If the answer to either question in Number 6 above is YES, complete Schedule A and attach.
7.
Did you make expenditures exceeding the sum of $250 for a retirement system official:
From January 1 through June 30? Yes No
From July 1 through December 31? Yes No NA
If the answer to either question in Number 7 above is YES, complete Schedule A and attach.
8.
PROVIDE BELOW (a) the name of the state or statewide public retirement system; (b) the aggregate total of all expenditures attributable to the retirement system made during the January 1-June 30 reporting period; (c) the aggregate total of all expenditures attributable to the retirement system made during the July 1-December 31 reporting period when applicable; (d) the aggregate total of all expenditures made in a calendar year attributable to the retirement system.
1)
a.
Name of Retirement System: _____________________________________________________
b.
Total of all expenditures made January 1 through June 30: $ ________________________________
c.
Total of all expenditures made July 1 through December 31:$________________________________
(When applicable)
d.
Total of all expenditures made during the calendar year: $_______________________________
2)
a.
Name of Retirement System: _____________________________________________________
b.
Total of all expenditures made January 1 through June 30: $ ________________________________
c.
Total of all expenditures made July 1 through December 31:$ ________________________________
(When applicable)
d.
Total of all expenditures made during the calendar year: $ ________________________________
3)
a.
Name of Retirement System: _____________________________________________________
b.
Total of all expenditures made January 1 through June 30: $_______________________________
c.
Total of all expenditures made July 1 through December 31: $ ________________________________
(When applicable)
d.
Total of all expenditures made during the calendar year: $_______________________________
I hereby certify that the information contained herein is true and correct to the best of my knowledge, information, and belief; that all reportable expenditures have been included herein; and that no information required by LSA-
R.S.
42:1114.2
has been deliberately omitted.
_________________________________
Signature of Filer
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SCHEDULE A: EXPENDITURES FOR RETIREMENT SYSTEM OFFICIALS
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This schedule must be completed if you answered YES to either question 6 or 7on the Retirement System Financial Disclosure Report. If, during the period January 1 through June 30 or the period July 1 through December 31, you made either a) an expenditure for any retirement system official exceeding $50 on any one occasion or b) aggregate expenditures exceeding $250 for any one retirement system official during a reporting period, then you must provide the aggregate total of expenditures made on that individual in that reporting period.
NOTE: Report covering July-December is cumulative. You must include reportable expenditures from the first half of the year in Column #3.
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1.
OFFICIAL'S NAME
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2
. NAME OF RETIREMENT SYSTEM
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3
. AMOUNT OF EXPENDITURES MADE ON AN OFFICIAL FOR WHOM YOU EITHER SPENT OVER $50 ON ONE OCCASION OR MADE EXPENDITURES EXCEEDING $250
BETWEEN JANUARY 1 AND JUNE 30
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4
. AMOUNT OF EXPENDITURES MADE ON AN OFFICIAL FOR WHOM YOU EITHER SPENT OVER $50 ON ONE OCCASION OR MADE EXPENDITURES EXCEEDING $250
BETWEEN JULY 1 AND DECEMBER 31
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5. TOTAL OF COLUMNS 3 AND 4
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History
Promulgated by the Department of Civil Service, Board of Ethics, LR 30:2696 (December 2004).
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