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If the form is submitted as an Amendment answer only the question to which there is a change in information. Please read the General Instructions on the reverse side before completing this form. Prior Calendar Year for Which Filing is made ORIGINAL AMENDMENT Date of Filing Name Last Telephone First Middle Home Business Home Address Street City State Zip Code E-Mail Address Business Address Position for Which Filing See Reverse Side Report Status ...
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An individual, other than a registered lobbyist, public employee or candidate, who is a public official in the District of Columbia whether paid or unpaid, whether elected by the people from a special election or appointed pursuant to Law or by another agency, to the office of a public official is required to file this statement as a public official under this Act. The disclosure statement required by this section shall contain the following information each time such Public Official files a statement under this act. Name of individual making report. Date and signature of Public Official. Age. Name of employer. Principal occupation. City and zip code of principal employment. Employment at the time of the filing of the report. Job title. Position title. D.C. Official Code Section 1-1105.02 (2001 Edition), requires public officials who do not wish to use the electronic filing system described in Section 2-118.02 of this Code to be required to file a paper disclosure statement each time any of the following occurs: · A written statement is received in the office of either the Ethics Commission, or the Office of Campaign Finance, or other applicable office of District Government with respect to a financial disclosure statement filed under the District of Columbia Campaign Finance Reform and Conflict of Interest Act of 1974, as amended, 21 U.S.C. § 6015 et seq., or any successor law. · Publication of a report required under the District of Columbia Official Code, or its predecessor code, section 1-1310, or any successor law, with any of the required reports having been received or filed. Publication of a financial disclosure statement required under the District of Columbia Official Code, or its predecessor code, section 1-1105.02, or any successor law, with any of the required reports having been received or filed in accordance with this Chapter or any successor law. A Public Official. A public official is subject to the requirements of this Act if he is a registered lobbyist, public employee, or candidate for public office in the District of Columbia, whether paid or unpaid. A person who receives compensation for personal services or other gain, is subject to reporting requirements under this Act with respect to such compensation or gain: a. For the first five of every month, for each calendar month if the person's gross income does not exceed 500 per month and 1,000 per month if the person's gross income exceeds 500. b. For the first 15 of every month, for each calendar month if the person's gross income exceeds 500. c.

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