Louisiana Administrative Code › Title 52 - ETHICS › Part I - Board of Ethics › Chapter 19 - Legislative Branch Lobbyist Disclosure Act › Section I-1919 - Retirement System Financial Disclosure Report

Current through Register Vol. 50, No. 6, June 20, 2024
RETIREMENT SYSTEM FINANCIAL DISCLOSURE REPORT
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.
Reports may be mailed or delivered to:
Board of Ethics, 2415 Quail Dr., 3rd Floor, Baton Rouge, LA
				  70808
OR
Faxed to:
(225)763 8787 or (225)763
				  8780
REPORT COVERING:
[] JANUARY 1 through JUNE 30, _________ -
DUE BY AUGUST
				  15
[] JANUARY 1 through DECEMBER 31, ________ -
DUE BY
				  FEBRUARY 15
FOR OFFICE USE ONLY
Postmark Date:__________
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: $_______________________________