Directions for completing the annual Statement of Disclosure:
The Annual Statement of Disclosure was revised to simplify it. It has three questions for Clarence employees, Town Board members and volunteers.
Purpose:
The Annual Statement of Disclosure provides Clarence, through the Board of Ethics, information about Town employees, Board members and volunteers regarding their private financial interests that may influence or be perceived as influencing their actions. Town employees and volunteers are required to file an Annual Statement of Disclosure to avoid potential conflicts of interest, facilitate consideration of potential ethical problems before they arise, and minimize unwarranted suspicion.
How to File:
Filing is done by submitting a complete and accurate Annual Statement of Disclosure. Only one Annual Disclosure statement is required for each employee and/or volunteer even if that individual serves on multiple committees, boards or commissions. However, you must indicate all additional service.
When to File:
Annual Statements of Disclosure must be filed within 30 days of receiving same, or within 30 days of taking office, or within 30 days of any material change, as well as information about the interests held by the new spouse.
Where to File:
Employees should submit their completed Annual Statement of Disclosure to the Town Clerk for filing.
What Must be Disclosed:
Generally the Annual Statement of Disclosure requires information about the Town employee and his or her spouse. Answer all questions completely. List the Town position or positions held by the employee or volunteer as of the date of the Annual Disclosure form, including all Town boards and committees of which the employee is a member.
Instructions for Filing:
Name and Address:
Provide in the spaces indicated the employee’s last name, first name, and middle initial and the address of the employee’s principal residence. Include the street address, town and zip code.
Specific Town/Committee Position:
List your position(s), compensated and unpaid, with the Town.
Date of Hire/Appointment/Election:
Provide in the space indicated your date of hire/appointment or election.
Spouse:
Provide in the space indicated the name of the employee’s spouse.
Interests in any business or entity doing business with the Town:
If you answer “yes” to this question, describe the interest you or your spouse has in any business or entity doing business with the Town.
Interests in any contract made or executed by the Town within the past 12 months:
If you answer “yes” to this question, describe the interest you or your spouse has in any contract involving the Town.
Receive benefits derived directly or indirectly from your employment or association with the Town:
If you answered “yes” to this question, describe the benefit. These benefits may include gifts and honorariums, real estate, your employment or business, your spouse’s employment or business and your investments. The more common benefits are described below:
-Gifts and honorariums
List all the gifts the employee or close relative received from a person or organization having regulatory or financial relationship with the Town in excess of $75.00 in the aggregate, except gifts from a relative. Gifts include but are not limited to cash, property, personal items, services, payments to third parties on behalf of the employee, loans, forgiveness of debts, honorarium, travel, entertainment, hospitality, tickets, financial transactions not available to the general public and any other payment not reportable as “income”. An example would be a gift of tickets to a Buffalo Bills game.
-Real Estate
List the real estate properties within the Town or within five miles of the Town line owned by the employee or a family member. Give the name of the owner, his or her relation to the employee, address of the property, and the year the interest was acquired. The value of the property need not be disclosed.
-Your Employment or Business
Provide the name of your employer, the nature of its business, type of business and your relationship to that employer. For example, if a Town board member was employed as a real estate agent, the Board member would report the name of the employer, the nature of the business (real estate agency), the type of business (partnership) and his/her position with the agency. Your income from this employment or business need not be disclosed.
-Your Spouse’s Employment or Business
Provide same information used to answer above question. For example, if an employee’s spouse owned a restaurant, the employee would report that spouse’s employment, nature of the business (restaurant), type of business (single ownership), and the spouse’s relationship (wife). The spouse’s income from this employment or business need not be disclosed.
-Investments
List the interest you or your spouse have in an entity which has had (or is expected to have) a financial or regulatory activity with the Town. For example, if the employee owns 25% of a publicly traded company which has a bid on a public works project with the Town, the employee must disclose that ownership interest. Do not disclose personal savings or retirement accounts. Disclosure is by naming the person with the interest, their relationship to the employee, the name of the business entity in which that person has an interest, and the possible involvement of that entity with the Town (such as contractor, regulated business, or licensee). The value or size of the interest in the investments need not be disclosed.