Annual Statement Of Financial Disclosure: Request For Delayed Filing Of Information Effected By An I.r.s. Individual Income Tax Return Extension Form - New York Page 2
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2Instructions
Public Officers Law § 73-a (2) (a) (i) permits reporting individual to request an extension on the
May 15 due date for a complete Annual Statement of Financial Disclosure for that information
dependent on the filing of individual federal income tax return, provided the individual has
timely applied to the I.R.S. for an automatic extension.
1. Name: Include your full name.
2. LEGISLATIVE OFFICE: Identify your position, title, and the name of the legislative office
in which you serve. Candidates need to report the house (Senate or Assembly) and district
number of the legislative office they are seeking to hold. Position: Identify your legislative title,
or indicate that you are a candidate.
3. PREFERRED MAILING ADDRESS: Provide the complete mailing address for the location
(home or office) at which you would like to receive correspondence on this matter.
4. DAYTIME PHONE: List a preferred telephone number at which you may be contacted
during the day.
***
In order for the Legislative Ethics Commission to determine whether you should be given this
filing extension, you must provide the following information by the due date for the statement:
(1) Attach the completed Annual Statement of Financial Disclosure, representing all
information not affected by your extension to file a federal income tax return.
(2) Attach a copy of the form you filed with the I.R.S. to request an extension on the due date
of your income taxes.
(3) Identify the questions on the Annual Statement of Financial Disclosure which are affected
by your tax extension, describe the information that you are requesting an extension on
disclosing, and identify who ( you, your spouse, or your unemancipated child(ren) ) holds the
financial interest in question.
You will be notified in writing of the Commission’s action on this request. If you are granted an
extension based on tax filing information, you must file a supplemental statement no later than
August 22 of the current filing year.
***
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