Fillable PERSONAL FINANCIAL DISCLOSURE STATEMENT (City of Glenwood Springs)

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PERSONAL FINANCIAL DISCLOSURE STATEMENT (City of Glenwood Springs)

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The PERSONAL FINANCIAL DISCLOSURE STATEMENT (City of Glenwood Springs) form is 2 pages long and contains:

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PERSONAL FINANCIAL DISCLOSURE STATEMENT
Personal financial disclosure statements filed for ballot access purposes must be filed within 10 days of filing a
candidate affidavit. A fine of $50 per day will be assessed for late filings related to ballot access.
[Art. XXVIII, Sec. 10 (2)(a), Colorado Constitution and 1-45-110, C.R.S.]
Please attach extra pages as necessary.
Name: _______________________________________________________________________
Mailing Address: _________________________ City: __________________ Zip:___________
Cell Phone: _____________________________ Home Phone:___________________________
Check () the appropriate response(s):
Filing as:
Status:
Council Candidate
(New Candidates & incumbents)
This is my first filing as a
candidate
Filing a Vacancy
This amends my previous
filing dated____________
INCOME:
List the source(s) of any income, including capital gains, whether or not taxable, of the person making disclosure and
such person’s spouse. (It is not necessary to list amounts.)
Recipient of Income (Individual receiving income)
Source of Income (Name of Employer)
ASSETS:
Indicate any financial interest in excess of $10,000 in any business entity for you or your spouse.
Name of Business, Insurance Company or Trust
Who is the person with this financial interest?
LEGAL:
List the legal description (as shown on the books of the county assessor) of all real property in Colorado (including an
option to buy) in which you or your spouse have a direct or indirect interest.
Legal Description of Property
Owner of Record
LIABILITIES:
List the name of each creditor to whom the person making disclosure or such person’s spouse owes money in excess
of $10,000.
Name of Creditor
Person Liable for Debt
Identify by name all offices and directorships held by the person making disclosure or such person’s spouse.
Name of Organization
Position Held
Person Holding the Position
List businesses with which the person making disclosure, or such person’s spouse, are associated that do business
with or are regulated by the City of Glenwood Springs and the nature of such business or regulation.
Name of Business
Person Associated
Provide any additional information which the person making disclosure might desire.
Signature:__________________________________________ Date: _____________________
City of Glenwood Springs – City Clerk’s Office
101 W 8
th
Street Glenwood Springs, CO, 81601
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PERSONAL FINANCIAL DISCLOSURE STATEMENT (City of Glenwood Springs)

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Completed 23 January 2021

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