"State Elected Official Financial Disclosure Form Name of Official:
Office held:
Business address:
Business phone number:
Home address:
Home phone number:
Office | Name and address of business enterprise |
Name and address of business enterprise |
Job Title | Name and address of business enterprise |
a. Employment | Name and address of Employer | |
b. Business interests | Name and address of all business entities but excluding interests if less than ten percent (10%) of the entity is owned, or sole proprietorship from which income is earned, or describe generally | |
c. Investments | Income earned | |
Yes | No | |
i. Any security or interest earnings | ___ | ___ |
ii. Real estate, leases, royalties | ___ | ___ |
d. Other (Describe generally) |
W.S. 9-13-108