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THE BOARD OF SUPERVISORS OF THE COUNTY OF STANISLAUS BOARD ACTION SUMMARYDEPT:Chief Executive Noticeboard AGENDA:6. B.11 AGENDA DATE: December 19, 2023SUBJECT: Approval of the Third Amendment to the
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To fill out the Levine Act Disclosure UMR, follow these steps:
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Start by providing your personal information at the top of the form, including your name, address, phone number, and email.
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Fill in the date of the disclosure and the name of the recipient, usually the party you are disclosing the information to.
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Next, list out the information that you are disclosing. This may include details about your financial situation, assets, liabilities, or any other relevant information.
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Clearly label each section and provide a detailed description of the disclosed information.
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Sign and date the disclosure form to certify that the information provided is accurate to the best of your knowledge.
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Keep a copy of the completed form for your records and provide the original to the recipient as required.

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The Levine Act Disclosure UMR (Universal Medical Record) is a requirement for certain state officials in California to disclose their financial interests in medical or healthcare-related businesses.
State officials in California, including members of certain boards and commissions involved in health care regulation, are required to file the Levine Act Disclosure UMR.
To fill out the Levine Act Disclosure UMR, individuals must complete a standardized form provided by the state, disclosing relevant financial interests and affiliations with medical businesses or organizations.
The purpose of the Levine Act Disclosure UMR is to promote transparency and prevent conflicts of interest among state officials making decisions related to healthcare.
Individuals must report their financial interests, ownership stakes, and affiliations with healthcare businesses, including income sources and investment interests.
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