Tlc Base Financial Disclosure Statement

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SECRETARY OF THE COMMONWEALTH
FINANCIAL DISCLOSURE STATEMENT
Members of certain boards of state and local government are required to file this Financial
Disclosure Statement as a condition of assuming office and, then, annually while serving as an
officeholder.
You must complete this form. Attached additional pages when necessary. You must sign and
date this form upon completion.
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The annual filing deadline is January 15
.
For State Board Members: If you have recently been appointed, you must file this form with
the Secretary of the Commonwealth prior to attending your first meeting.
For Local Board Members: If you have recently been appointed, you must file this form with
the Clerk of the appropriate governing body prior to attending your first meeting.
As an annual filing, this form constitutes a report of financial interests for the calendar year
beginning January 1 and ending December 31. As a condition for assuming an office, this form
constitutes a report of financial interests at the time of filing.
The information required on this form must be provided on the basis of the best knowledge,
information and belief of the individual filing the form as of the date of this report unless
otherwise stated.
This Financial Disclosure Statement is open for public inspection.

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