Free Updated Ethics.p65 - Wyoming

File Size: 30.0 kB
Pages: 4
Date: April 21, 2009
File Format: PDF
State: Wyoming
Category: Secretary of State
Author: ksmari
Word Count: 425 Words, 4,773 Characters
Page Size: Letter (8 1/2" x 11")

Download Updated Ethics.p65 ( 30.0 kB)

Preview Updated Ethics.p65
State Elected Officials Financial Disclosure W.S. 9-13-101 through 109
This form can be accessed on the Secretary of State's Website at:

In accordance with W.S. 9-13-101 - 109, each of the state's five elected officials and each member of the Wyoming legislature shall file a financial disclosure form with the Secretary of State. This includes elected officials and legislators who have not sought re-election but have served in an elected position during the previous filing period. The financial disclosure form shall contain information current as of January 15th of each year. As prescribed in W.S. 9-13-108(b), forms may be submitted by facsimile transmission during regular business hours provided an original statement is sent by mail. Anyone violating the provisions of the Government Ethics Act is guilty of a misdemeanor punishable upon conviction by a fine of not more than one thousand dollars ($1,000.00). W.S. 9-13-109(a). Violation of any provision of the Government Ethics Act constitutes sufficient cause for termination of a public employee's employment or for removal of a public official or public member from his office or position. W.S. 9-13-109(b). ____________________________________________________________________________________ FILING DEADLINE: FILING OFFICE: January 31st of each year Secretary of State's Office The Capitol Building 200 West 24th Street Cheyenne, WY 82002-0020



State Elected Official Financial Disclosure Form

Name of Official: Office Held:

_______________________________________________________________ _______________________________________________________________

Business Address: Business City, State and Zip: Business Phone:

_________________________________________________________ _________________________________________________________ (______)______________________

Home Address: Home City, State and Zip: Home Phone:

_________________________________________________________ _________________________________________________________ (______)______________________

Ethics - Rev. 3/09


I. Offices, Directorships and Employment
a) List the offices held in business enterprises. This includes partnerships. Office Held ______________________________ Name and Address of Enterprise _______________________________________ _______________________________________ _______________________________________


_______________________________________ _______________________________________ _______________________________________


List any directorship positions held in business enterprises. Name and Address of Enterprise _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________


Salaried Employment Job Title _________________________________ Name and Address of Enterprise _________________________________ _________________________________ _________________________________


_________________________________ _________________________________ _________________________________


II. Sources of Income
a) Employment Name and Address of Employer _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________


Business Interests - list the names and addresses of all business entities in which you have a business interest (W.S. 9-13-108 (c) states: "Name and address of all business entities but excluding interests if less than ten percent (10%) of the entity is owned, or sole proprietorship from which income is earned. . . .") Name and Address of Business Entity _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________


Investments Income Earned A. B. Any security or interest earnings Real estate, leases, royalties _____ Yes _____ Yes _____ No _____ No


Other (describe generally):


___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ On this _______________ day of _____________________, ________, I affirm that the preceding information is accurate. __________________________________________ Signature 4