VIRGINIA CONFLICT OF INTEREST AND ETHICS ADVISORY COUNCIL
DISCLOSURE OF REAL ESTATE HOLDINGS
Pursuant to subsection G of § 2.2-3115, in each county and city and in towns with populations in excess of
3,500, members of planning commissions and boards of zoning appeals, real estate assessors, and all county,
city, and town managers or executive officers shall file this form as a condition to assuming office, and then
annually while serving as an officer.
The filing deadline is February 1 for the prior calendar year. Statements may not be dated or submitted prior
to January 1.
You must file this form with the clerk of the appropriate local governing body.
You may provide any additional comments you wish to include with this disclosure at the end of the form.
Please note that any such comments are a part of your filing and will be available to the public. You may not
add attachments as a substitute for properly filling out any part of this form.
REPORT TO THE BEST OF INFORMATION AND BELIEF Information required on this Disclosure must be
provided on the basis of the best knowledge, information, and belief of the individual filing the Disclosure as of
the date of this report.
As a condition for assuming an office, this form constitutes a report of real estate holdings at the time of filing.
You must sign and date this form upon completion.
This Disclosure of Real Estate Holdings is open for public inspection, as required by § 2.2-3115.
Please check one: Officeholder Employee
Title of Office
or Position
Held:
