§ 812. Financial disclosure for local elected officials and certain officers and employees of counties, cities, towns and villages.

Attorney's Note

Under the New York Laws, punishments for crimes depend on the classification. In the case of this section:
ClassPrisonFine
Class A misdemeanorup to 364 daysup to $1,000
For details, see N.Y. Penal Law § 70.15

Ask a legal question, get an answer ASAP!
Click here to chat with a lawyer about your rights.

Terms Used In N.Y. General Municipal Law 812

  • Answer: The formal written statement by a defendant responding to a civil complaint and setting forth the grounds for defense.
  • Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
  • Contract: A legal written agreement that becomes binding when signed.
  • Contract: means any claim, account or demand against or agreement with a municipality, express or implied, and shall include the designation of a depository of public funds and the designation of a newspaper, including but not limited to an official newspaper, for the publication of any notice, resolution, ordinance, or other proceeding where such publication is required or authorized by law. See N.Y. General Municipal Law 800
  • Conviction: A judgement of guilt against a criminal defendant.
  • Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
  • Donor: The person who makes a gift.
  • Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
  • Gift: A voluntary transfer or conveyance of property without consideration, or for less than full and adequate consideration based on fair market value.
  • Guarantor: A party who agrees to be responsible for the payment of another party's debts should that party default. Source: OCC
  • Interest: means a direct or indirect pecuniary or material benefit accruing to a municipal officer or employee as the result of a contract with the municipality which such officer or employee serves. See N.Y. General Municipal Law 800
  • Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
  • Municipality: means a county, city, town, village, school district, consolidated health district, county vocational education and extension board, public library, board of cooperative educational services, urban renewal agency, a joint water works system established pursuant to chapter six hundred fifty-four of the laws of nineteen hundred twenty-seven, or a town or county improvement district, district corporation, or other district or a joint service established for the purpose of carrying on, performing or financing one or more improvements or services intended to benefit the health, welfare, safety or convenience of the inhabitants of such governmental units or to benefit the real property within such units, an industrial development agency but shall have no application to a city having a population of one million or more or to a county, school district, or other public agency or facility therein. See N.Y. General Municipal Law 800
  • Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
  • Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
  • Real property: Land, and all immovable fixtures erected on, growing on, or affixed to the land.
  • Trustee: A person or institution holding and administering property in trust.

1. (a) Any political subdivision or other county, city, town or village to which all of the provisions of this section are made applicable, whether as the result of the provisions contained in subdivision two of section eight hundred eleven of this article or as a result of an election to be subject to the provisions of this section as permitted by subdivision two of this section, shall require (i) each of its local elected officials and local officers and employees, (ii) each local political party official and (iii) each candidate for local elected official with respect to such political subdivision, to file an annual statement of financial disclosure containing the information and in the form set forth in subdivision five of this § of the real property tax law. Such statement shall be filed on or before the fifteenth day of May with respect to the preceding calendar year, except that:

(i) a person who is subject to the reporting requirements of this subdivision and who timely filed with the internal revenue service an application for automatic extension of time in which to file his or her individual income tax return for the immediately preceding calendar or fiscal year shall be required to file such financial disclosure statement on or before May fifteenth but may, without being subjected to any civil penalty on account of a deficient statement, indicate with respect to any item of the disclosure statement that information with respect thereto is lacking but will be supplied in a supplementary statement of financial disclosure, which shall be filed on or before the seventh day after the expiration of the period of such automatic extension of time within which to file such individual income tax return, provided that failure to file or to timely file such supplementary statement of financial disclosure or the filing of an incomplete or deficient supplementary statement of financial disclosure shall be subject to the notice and penalty provisions of this section respecting annual statements of financial disclosure as if such supplementary statement were an annual statement;

(ii) candidates for local elected official who file designating petitions for nomination at a primary election shall file such statement within seven days after the last day allowed by law for the filing of designating petitions naming them as candidates for the next succeeding primary election;

(iii) candidates for independent nomination for local elected official who have not been designated by a party to receive a nomination shall file such statement within seven days after the last day allowed by law for the filing of independent nominating petitions naming them as candidates for local elected official in the next succeeding general or special or village election; and

(iv) candidates for local elected official who receive the nomination of a party for a special election or who receive the nomination of a party other than at a primary election (whether or not for an uncontested office) shall file such statement within seven days after the date of the meeting of the party committee at which they are nominated.

(b) As used in this subdivision, the terms "party", "committee" (when used in conjuction with the term "party"), "designation", "primary", "primary election", "nomination", "independent nomination", "ballot" and "uncontested office" shall have the same meanings as those contained in section 1-104 of the election law.

(c) Such statement shall be filed with the appropriate body, as defined in section eight hundred ten of this article.

(d) The appropriate body, as defined in section eight hundred ten of this article, shall obtain from the "board of elections", as such term is defined in section 1-104 of the election law, lists of all candidates for local elected official, and from such lists, shall determine and publish lists of those candidates who have not, within ten days after the required date for filing such statement, filed the statement required by this subdivision.

(e) Local political party officials and any person required to file such statement who commences employment after May fifteenth of any year shall file such statement within thirty days after commencing employment or of taking the position of local political party official, as the case may be.

(f) A person who is subject to the filing requirements of both subdivision two of § 73-a of the public officers law and of this subdivision may satisfy the requirements of this subdivision by filing a copy of the statement filed pursuant to § 73-a of the public officers law with the appropriate body, as defined in section eight hundred ten of this article, on or before the filing deadline provided in such section seventy-three-a, notwithstanding the filing deadline otherwise imposed by this subdivision.

(g) A person who is subject to the filing requirements of this subdivision from more than one political subdivision within the same county may satisfy the requirements of this subdivision by filing only one annual statement of financial disclosure with the appropriate body (as is required in that county) for the county in which such political subdivisions are located or if such political subdivisions cross one or more county boundary lines, then such single filing may be made for any of the counties in which one of such political subdivisions is located provided, however, that the appropriate bodies (as required by such other counties) are notified of the name of the county of such compliance by the person who is subjected to the filing requirements of this subdivision, within the time limit for filing specified in this subdivision.

(h) A local elected official who is simultaneously a candidate for local elected official shall satisfy the filing deadline requirements of this subdivision by complying only with the deadline applicable to one who holds such local elected office.

(i) A candidate whose name will appear on both a party designating petition and on an independent nominating petition for the same office or who will be listed on the election ballot for the same office more than once shall satisfy the filing deadline requirements of this subdivision by complying with the earliest applicable deadline only.

2. The governing body of a county, city, town or village having a population of less than fifty thousand may by local law or ordinance elect to be subject to the provisions of this section. In such event, any such city, county, town or village shall be deemed to be a political subdivision under this section.

3. Any political subdivision or other county, city, town or village to which all of the provisions of this section are made applicable, whether as a result of the provisions contained in subdivision two of section eight hundred eleven of this article or as a result of an election to be subject to the provisions of this section as permitted by subdivision two of this section, may elect to remove itself from the ambit of all (but not some) provisions of this section (other than this subdivision) by adopting a local law, ordinance or resolution specifically referring to the authority conferred by this subdivision. Provided, however, that the terms of such local law, ordinance or resolution shall be subject to the following conditions and limitations:

(a) Such local law, ordinance or resolution must provide for the promulgation of a form of an annual statement of financial disclosure described in subdivision one of section eight hundred eleven of this article for use with respect to information the governing body requires to be reported for the calendar year next succeeding the year in which such local law, ordinance or resolution is adopted and for use with respect to information required to be reported for subsequent calendar years; and shall provide for the filing of completed statements with the board of ethics of the political subdivision or other municipality.

(b) Such removal shall not be effective with respect to the annual financial disclosure statement for the calendar year in which the local law, ordinance or resolution is adopted (the filing of which statement is due on May fifteenth of the next succeeding year with certain exceptions), nor shall such removal be effective with respect to any required annual financial disclosure statement for the immediately preceding calendar year (the filing of which statement is due on May fifteenth (with certain exceptions) of the calendar year in which such local law, ordinance or resolution is adopted), nor shall such removal be effective with respect to any other preceding year but such removal shall apply first to the statement which would have been due on May fifteenth (with certain exceptions) of the second year next succeeding the year in which such local law, ordinance or resolution is adopted, and such removal shall apply thereafter to subsequent statements otherwise due pursuant to this section.

(c) Such removal shall not affect the power to impose, or the imposition of, a penalty for failure to file, or for false filing, of any required annual financial disclosure statement.

(d) The local law, ordinance or resolution referred to in paragraph (a) of this subdivision or any other such local law, ordinance or resolution so adopted may make provision for any other right, power or privilege granted by subdivision one of such section eight hundred eleven.

4. Nothing contained in this section shall be construed as precluding the governing body of a political subdivision from requiring additional and/or more detailed items of financial disclosure than are set forth in subdivision five hereinbelow.

5. The annual statement of financial disclosure shall contain the information and shall be in the form set forth hereinbelow:

ANNUAL STATEMENT OF FINANCIAL DISCLOSURE FOR

(Insert Name of Political Subdivision) – (For calendar year ________) 1. Name ________________________________________________________________ 2. (a) Title of Position _______________________________________________

(b) Department, Agency or other Governmental Entity _________________

(c) Address of Present Office _______________________________________

(d) Office Telephone Number _________________________________________ 3. (a) Marital Status ______________. If married, please give spouse's

full name including maiden name where applicable.

________________________________________ .

(b) List the names of all unemancipated children.

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Answer each of the following questions completely, with respect to

calendar year _________, unless another period or date is otherwise

specified. If additional space is needed, attach additional pages.

Whenever a "value" or "amount" is required to be reported herein,

such value or amount shall be reported as being within one of the

following Categories: Category A – under $5,000; Category B – $5,000

to under $20,000; Category C – $20,000 to under $60,000; Category D –

$60,000 to under $100,000; Category E – $100,000 to under $250,000;

and Category F – $250,000 or over. A reporting individual shall

indicate the Category by letter only.

For the purposes of this statement, anywhere the term "local

agency" shall appear such term shall mean a local agency, as defined

in § 810 of the general municipal law, of the

political subdivision for which this financial disclosure statement

has been filed. 4. (a) List any office, trusteeship, directorship, partnership, or

position of any nature including honorary positions, if known, and

excluding membership positions, whether compensated or not, held by

the reporting individual with any firm, corporation, association,

partnership, or other organization other than the State of New York

or (insert name of political subdivision). If said entity was

licensed by any state or local agency, was regulated by any state

regulatory agency or local agency, or, as a regular and significant

part of the business or activity of said entity, did business with,

or had matters other than ministerial matters before, any state or

local agency, list the name of any such agency.

State or

Position Organization Local Agency

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

(b) List any office, trusteeship, directorship, partnership, or

position of any nature including honorary positions, if known, and

excluding membership positions, whether compensated or not, held by

the spouse or unemancipated child of the reporting individual, with

any firm, corporation, association, partnership, or other

organization other than the State of New York. If said entity was

licensed by any state or local agency, was regulated by any state

regulatory agency or local agency, or, as a regular and significant

part of the business or activity of said entity, did business with,

or had matters other than ministerial matters before, any state or

local agency, list the name of any such agency.

State or

Position Organization Local Agency

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________ 5. (a) List the name, address and description of any occupation,

employment, trade, business or profession engaged in by the reporting

individual. If such activity was licensed by any state or local

agency, was regulated by any state regulatory agency or local agency,

or, as a regular and significant part of the business or activity of

said entity, did business with, or had matters other than ministerial

matters before, any state or local agency, list the name of any such

agency.

State or

Name & Address Local

Position of Organization Description Agency

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

(b) If the spouse or unemancipated child of the reporting individual

was engaged in any occupation, employment, trade, business or

profession which activity was licensed by any state or local agency,

was regulated by any state regulatory agency or local agency, or, as

a regular and significant part of the business or activity of said

entity, did business with, or had matters other than ministerial

matters before, any state or local agency, list the name, address and

description of such occupation, employment, trade, business or

profession and the name of any such agency.

State or

Name & Address Local

Position of Organization Description Agency

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________ 6. List any interest, in excess of $1,000, excluding bonds and notes,

held by the reporting individual, such individual's spouse or

unemancipated child, or partnership of which any such person is a

member, or corporation, ten per centum or more of the stock of which

is owned or controlled by any such person, whether vested or

contingent, in any contract made or executed by a state or local

agency and include the name of the entity which holds such interest

and the relationship of the reporting individual or such individual's

spouse or such child to such entity and the interest in such

contract. Do not list any interest in any such contract on which

final payment has been made and all obligations under the contract

except from guarantees and warranties have been performed, provided,

however, that such an interest must be listed if there has been an

ongoing dispute during the calendar year for which this statement is

filed with respect to any such guarantees or warranties. Do not list

any interest in a contract made or executed by a state agency after

public notice and pursuant to a process for competitive bidding or a

process for competitive requests for proposals.

Entity Relationship Contracting Category

Self, Which Held to Entity State or of

Spouse or Interest in and Interest Local Value of

Child Contract in Contract Agency Contract

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________ 7. List any position the reporting individual held as an officer of any

political party or political organization, as a member of any

political party committee, or as a political party district leader.

The term "party" shall have the same meaning as "party" in the

election law. The term "political organization" means any party or

independent body as defined in the election law or any organization

that is affiliated with or a subsidiary of a party or independent

body.

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________ 8. (a) If the reporting individual practices law, is licensed by the

department of state as a real estate broker or agent or practices a

profession licensed by the department of education, give a general

description of the principal subject areas of matters undertaken by

such individual. Additionally, if such an individual practices with

a firm or corporation and is a partner or shareholder of the firm or

corporation, give a general description of principal subject areas of

matters undertaken by such firm or corporation. Do not list the name

of the individual clients, customers or patients.

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

(b) List the name, principal address and general description or the

nature of the business activity of any entity in which the reporting

individual or such individual's spouse had an investment in excess of

$1,000 excluding investments in securities and interests in real

property.

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________ 9. List each source of gifts, excluding campaign contributions, in

excess of $1,000, received during the reporting period for which this

statement is filed by the reporting individual or such individual's

spouse or unemancipated child from the same donor, excluding gifts

from a relative. Include the name and address of the donor. The term

"gifts" does not include reimbursements, which term is defined in

item 10. Indicate the value and nature of each such gift.

Category

Self, of

Spouse or Name of Nature Value of

Child Donor Address of Gift Gift

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________ 10. Identify and briefly describe the source of any reimbursements for

expenditures, excluding campaign expenditures and expenditures in

connection with official duties reimbursed by the political

subdivision for which this statement has been filed, in excess of

$1,000 from each such source. For purposes of this item, the term

"reimbursements" shall mean any travel-related expenses provided by

nongovernmental sources and for activities related to the reporting

individual's official duties such as, speaking engagements,

conferences, or factfinding events. The term "reimbursements" does

not include gifts reported under item 9.

Source Description

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________ 11. List the identity and value, if reasonably ascertainable, of each

interest in a trust, estate or other beneficial interest, including

retirement plans other than retirement plans of the state of New

York or the city of New York, and deferred compensation plans

established in accordance with the internal revenue code, in which

the reporting individual held a beneficial interest in excess of

$1,000 at any time during the preceding year. Do not report

interests in a trust, estate or other beneficial interest

established by or for, or the estate of, a relative.

Category

of

Identity Value*

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

_______________

* The value of such interest shall be reported only if reasonably

ascertainable. 12. (a) Describe the terms of, and the parties to, any contract,

promise, or other agreement between the reporting individual and any

person, firm, or corporation with respect to the employment of such

individual after leaving office or position (other than a leave of

absence).

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

(b) Describe the parties to and the terms of any agreement

providing for continuation of payments or benefits to the reporting

individual in excess of $1,000 from a prior employer other than the

political subdivision for which this statement is filed. (This

includes interests in or contributions to a pension fund,

profit-sharing plan, or life or health insurance; buy-out

agreements; severance payments; etc.)

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________ 13. List below the nature and amount of any income in excess of $1,000

from each source for the reporting individual and such individual's

spouse for the taxable year last occurring prior to the date of

filing. Nature of income includes, but is not limited to, salary

for government employment, income from other compensated employment

whether public or private, directorships and other fiduciary

positions, contractual arrangements, teaching income, partnerships,

honorariums, lecture fees, consultant fees, bank and bond interest,

dividends, income derived from a trust, real estate rents, and

recognized gains from the sale or exchange of real or other

property. Income from a business or profession and real estate rents

shall be reported with the source identified by the building address

in the case of real estate rents and otherwise by the name of the

entity and not by the name of the individual customers, clients or

tenants, with the aggregate net income before taxes for each

building address or entity. The receipt of maintenance received in

connection with a matrimonial action, alimony and child support

payments shall not be listed.

Category

Self/ of

Spouse Source Nature Amount

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________ 14. List the sources of any deferred income in excess of $1,000 from

each source to be paid to the reporting individual following the

close of the calendar year for which this disclosure statement is

filed, other than deferred compensation reported in item 11

hereinabove. Deferred income derived from the practice of a

profession shall be listed in the aggregate and shall identify as

the source, the name of the firm, corporation, partnership or

association through which the income was derived, but shall not

identify individual clients.

Category

of

Source Amount

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________ 15. List each assignment of income in excess of $1000, and each transfer

other than to a relative during the reporting period for which this

statement is filed for less than fair consideration of an interest

in a trust, estate or other beneficial interest, securities or real

property, by the reporting individual, in excess of $1000, which

would otherwise be required to be reported herein and is not or has

not been so reported.

Category

Item Assigned Assigned or of

or Transferred Transferred to Value

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________ 16. List below the type and market value of securities held by the

reporting individual or such individual's spouse from each issuing

entity in excess of $1,000 at the close of the taxable year last

occurring prior to the date of filing, including the name of the

issuing entity exclusive of securities held by the reporting

individual issued by a professional corporation. Whenever an

interest in securities exists through a beneficial interest in a

trust, the securities held in such trust shall be listed only if the

reporting individual has knowledge thereof except where the

reporting individual or the reporting individual's spouse has

transferred assets to such trust for his or her benefit in which

event such securities shall be listed unless they are not

ascertainable by the reporting individual because the trustee is

under an obligation or has been instructed in writing not to

disclose the contents of the trust to the reporting individual.

Securities of which the reporting individual or the reporting

individual's spouse is the owner of record but in which such

individual or the reporting individual's spouse has no beneficial

interest shall not be listed. Indicate percentage of ownership if

the reporting person or the reporting person's spouse holds more

than five percent of the stock of a corporation in which the stock

is publicly traded or more than ten percent of the stock of a

corporation in which the stock is not publicly traded. Also list

securities owned for investment purposes by a corporation more than

fifty percent of the stock of which is owned or controlled by the

reporting individual or such individual's spouse. For the purpose of

this item the term "securities" shall mean bonds, mortgages, notes,

obligations, warrants and stocks of any class, investment interests

in limited or general partnerships and certificates of deposits and

such other evidences of indebtedness and certificates of interest as

are usually referred to as securities. The market value for such

securities shall be reported only if reasonably ascertainable and

shall not be reported if the security is an interest in a general

partnership that was listed in item 8 (a) or if the security is

corporate stock, not publicly traded, in a trade or business of a

reporting individual or a reporting individual's spouse.

Category of

Market Value as

of the close of

the taxable year

last occurring Percentage

prior to the of corporate

Self/ Issuing Type of filing of this stock owned or

Spouse Entity Security statement controlled

__________ _________ __________ ______________ ______________

__________ _________ __________ ______________ ______________

__________ _________ __________ ______________ ______________

__________ _________ __________ ______________ ______________

__________ _________ __________ ______________ ______________ 17. List below the location, size, general nature, acquisition date,

market value and percentage of ownership of any real property in

which any vested or contingent interest in excess of $1,000 is held

by the reporting individual or the reporting individual's spouse.

Also list real property owned for investment purposes by a

corporation more than fifty percent of the stock of which is owned

or controlled by the reporting individual or such individual's

spouse. Do not list any real property which is the primary or

secondary personal residence of the reporting individual or the

reporting individual's spouse, except where there is a co-owner who

is other than a relative.

Self/ Category

Spouse/ of Percentage

Other General Acquisition Market of

Party Location Size Nature Date Value Ownership

______ ________ ____ ______ ___________ ________ ___________

______ ________ ____ ______ ___________ ________ ___________

______ ________ ____ ______ ___________ ________ ___________

______ ________ ____ ______ ___________ ________ ___________

______ ________ ____ ______ ___________ ________ ___________ 18. List below all notes and accounts receivable, other than from goods

or services sold, held by the reporting individual at the close of

the taxable year last occurring prior to the date of filing and

other debts owed to such individual at the close of the taxable year

last occurring prior to the date of filing, in excess of $1,000,

including the name of the debtor, type of obligation, date due and

the nature of the collateral securing payment of each, if any,

excluding securities reported in item 16 hereinabove. Debts, notes

and accounts receivable owed to the individual by a relative shall

not be reported.

Type of Obligation, Category

Date Due, and Nature of

Name of Debtor of Collateral, if any Amount

__________________ ____________________________ __________________

__________________ ____________________________ __________________

__________________ ____________________________ __________________

__________________ ____________________________ __________________

__________________ ____________________________ __________________ 19. List below all liabilities of the reporting individual and such

individual's spouse, in excess of $5,000 as of the date of filing of

this statement, other than liabilities to a relative. Do not list

liabilities incurred by, or guarantees made by, the reporting

individual or such individual's spouse or by any proprietorship,

partnership or corporation in which the reporting individual or such

individual's spouse has an interest, when incurred or made in the

ordinary course of the trade, business or professional practice of

the reporting individual or such individual's spouse. Include the

name of the creditor and any collateral pledged by such individual

to secure payment of any such liability. A reporting individual

shall not list any obligation to pay maintenance in connection with

a matrimonial action, alimony or child support payments. Revolving

charge account information shall only be set forth if liability

thereon is in excess of $5,000 at the time of filing. Any loan

issued in the ordinary course of business by a financial institution

to finance educational costs, the cost of home purchase or

improvements for a primary or secondary residence, or purchase of a

personally owned motor vehicle, household furniture or appliances

shall be excluded. If any such reportable liability has been

guaranteed by any third person, list the liability and name the

guarantor.

Category

Name of Creditor Type of Liability of

or Guarantor and Collateral, if any Amount

__________________ ____________________________ __________________

__________________ ____________________________ __________________

__________________ ____________________________ __________________

__________________ ____________________________ __________________

__________________ ____________________________ __________________

The requirements of law relating to the reporting of financial

interests are in the public interest and no adverse inference of

unethical or illegal conduct or behavior will be drawn merely from

compliance with these requirements.

_____________________________________ _____________________

(Signature of Reporting Individual) Date (month/day/year)

6. A reporting individual who knowingly and wilfully fails to file an annual statement of financial disclosure or who knowingly and wilfully with intent to deceive makes a false statement or gives information which such individual knows to be false on such statement of financial disclosure filed pursuant to this section shall be assessed a civil penalty in an amount not to exceed ten thousand dollars. Assessment of a civil penalty hereunder shall be made by the appropriate body, as such term is defined in section eight hundred ten of this article. For a violation of this subdivision, other than for conduct which constitutes a violation of subdivision twelve of § 73 of the public officers law, the board of ethics of the political subdivision or other municipality may, in lieu of a civil penalty, refer a violation to the appropriate prosecutor and upon such conviction, but only after such referral, such violation shall be punishable as a class A misdemeanor. A civil penalty for false filing may not be imposed hereunder in the event a category of "value" or "amount" reported hereunder is incorrect unless such reported information is falsely understated. Notwithstanding any other provision of law to the contrary, no other penalty, civil or criminal may be imposed for a failure to file, or for a false filing, of such statement, except that the appointing authority may impose disciplinary action as otherwise provided by law. Each appropriate body, as such term is defined in section eight hundred ten of this article, shall adopt rules governing the conduct of adjudicatory proceedings and appeals relating to the assessment of the civil penalties herein authorized. Such rules shall provide for due process procedural mechanisms substantially similar to those set forth in article three of the state administrative procedure act but such mechanisms need not be identical in terms or scope. Assessment of a civil penalty shall be final unless modified, suspended or vacated within thirty days of imposition and upon becoming final shall be subject to review at the instance of the affected reporting individual in a proceeding commenced against the appropriate body, pursuant to Article 78 of the civil practice law and rules.