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

Universal Citation: LA Admin Code I-1919

Current through Register Vol. 49, No. 12, December 20, 2023

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: $_______________________________

2)

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: $ ________________________________

3)

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: $_______________________________

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

SCHEDULE A: EXPENDITURES FOR RETIREMENT SYSTEM OFFICIALS

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.

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

Promulgated by the Department of Civil Service, Board of Ethics, LR 30:2696 (December 2004).

AUTHORITY NOTE: Promulgated in accordance with R.S. 42:1134(A).

Disclaimer: These regulations may not be the most recent version. Louisiana may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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