SOUTH DAKOTA SECRETARY OF STATE ● ATTENTION ELECTIONS ● 500 E. Capitol Ave. ● Pierre, SD 57501
www.SDSOS.gov ● phone 605 773 3537 ● fax 605 773 6580 ●
ELECTIONS@STATE.SD.US Last updated 6/24/2019
Conflict of Interest
ELECTED OFFICIAL
Statement of Financial Interest
Deadline to file: Within 15 days after the person assumes office.
File with: The SECRETARY OF STATE except local candidates file with the office where they file their oath of office.
Elected Officials who file: State Office elected officials (governor, lieutenant governor, state treasurer, attorney general,
secretary of state, state auditor, public utilities commissioner, commissioner of school and public lands, state legislator,
circuit court judge and supreme court justice
SDCL 3-1A-2);
Gubernatorial Appointee for whom senate confirmation is required shall file with the secretary of state a statement of
financial interest before confirmation SDCL 3-1A-3
.
Local Office officials (county commissioner, school board member in a school district with a total enrollment of more than
2,000 students, or commissioner, council member, or mayor in any 1
st
class municipality SDCL 3-1A-4)
Please print:
Full Name __________________________________________________________________________________________
Complete Address ___________________________________________________________________________________
Office (list District number if applicable) ___________________________________________________________
What is your occupation/profession? _____________________________________________________________________
**If there are no changes from your previously filed CANDIDATE Financial Interest Statement check the box and
sign and date below.
NO Changes
List any source of funds (business or economic relationship) which contributes more than 10% of or more than $2,000
to your family’s (includes spouse, minor children living at home) gross income in the preceding calendar year. This also
includes any enterprise in which you or an immediate family member(s) controls more than 10% of the capital or stock.
Identify who receives the income from each enterprise but do not include the value. (SDCL 3-1A-1
)
*The intent of this form is to collect specific information, not generalities. Do not put N/A or leave the grid blank.
Name of Candidate or
Family Member
(Ex: current employer, SD Legislature, 401K,
(Ex: employee, officer, director, associate, partner,
shareholder, owner, member, proprietor, etc.)
I declare and affirm under the penalties of perjury that the information above has been examined by me and to the best of
my knowledge and belief is a true, correct and complete representation of myself and my immediate family’s financial
interests for the preceding calendar year.
________________________________________________ _______________________________
(Signature) (Date)
