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. 3, March 20, 2024
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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. |
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
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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)
(When applicable)
2)
(When applicable)
3)
(When applicable)
CERTIFICATION OF ACCURACY
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 |
2 . NAME OF RETIREMENT SYSTEM |
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 |
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 |
5. TOTAL OF COLUMNS 3 AND 4 |
AUTHORITY NOTE: Promulgated in accordance with R.S. 42:1134(A).
