Instructions for financial disclosure statements

              November 2012
This Financial Disclosure handbook aids
in the understanding of filing requirements for
Financial Disclosure Reports as a candidate
and as a public officer in Arizona.
Our staff is available to help you understand
your filing requirements with this office.
KEN BENNETT
Instructions for Financial Disclosure Statements Office Revision 2 November 2012
FINANCIAL DISCLOSURE STATEMENTS
A PUBLICATION OF
THE ARIZONA SECRETARY OF STATE’S OFFICE
ELECTION SERVICES DIVISION
INTRODUCTION
This booklet provides instructions on how to prepare financial disclosure statements that are filed with
this office.
As a candidate and public officer you must follow guidelines established in Arizona Revised Statutes.
These statutes have been provided for your review. We’ve also included a sample financial disclosure
statement to help you understand how to fill out the form.
If you have any questions feel free to contact our office. Our staff is ready to help and assist you with
your filing needs.
Sincerely,
KEN BENNETT
Arizona Secretary of State
CONTACT US
Office of the Secretary of State
The Honorable Ken Bennett
1700 W. Washington Street, 7th Floor
Phoenix, Arizona 85007
Telephone:
(602) 542-4285
Toll-free (in Arizona)
1-877-THE VOTE
TDD: (602) 255-8683
Election Services
Telephone:
(602) 542-8683
Facsimile number:
(602) 542-6172
e-mail address:
elections@azsos.gov
For additional copies of this booklet
send your request to:
Secretary of State
Attention: Election Services Division
1700 W. Washington Street, 7th Floor
Phoenix, Arizona 85007
Visit us on the World Wide Web at
www.azsos.gov
The Office of the Secretary of State is an equal opportunity employer. Requests for alternate formats or
accommodations can be made five days in advance by contacting the
Secretary of State ADA coordinator at (602) 542-4285.
The Election Services Division strives for accuracy in its publications.
If the user finds a misprint or error, please contact our office at (602) 542-8683.
Rev. November 30, 2012
KEN BENNETT
Office Revision November 2012 Instructions for Financial Disclosure Statements 3
TABLE OF CONTENTS
I TRODUCTIO  .................................................................................................................................................................................. 2
CO TACT US ........................................................................................................................................................................................ 2
COMMO  QUESTIO S A D A SWERS ........................................................................................................................................ 4
ABOUT FINANCIAL DISCLOSURE STATEMENTS ..................................................................................................................................... 4
1. Who must file a Financial Disclosure Statement?........................................................................................................................ 4
2. Do public officers and candidates in counties, cities, and towns have to file Financial Disclosure Statements? ........................ 4
3. When do I have to file my Annual Financial Disclosure Statement? ............................................................................................ 4
Public Officers .................................................................................................................................................................................................. 4
Newly Appointed Public Officers ..................................................................................................................................................................... 4
Newly Appointed Justices and Judges .............................................................................................................................................................. 4
Candidates for Public Office and Superior Court .............................................................................................................................................. 5
4. Where do I get a Financial Disclosure Statement? ....................................................................................................................... 5
Public Officers .................................................................................................................................................................................................. 5
Newly Appointed Public Officers, Justices and Judges .................................................................................................................................... 5
Candidates for Public Office and Superior Court .............................................................................................................................................. 5
County, City, and Town Public Officers and Candidates .................................................................................................................................. 5
5. What laws govern Financial Disclosure Statements? ................................................................................................................... 5
6. What is the penalty for failing to file a Financial Disclosure Statement? ..................................................................................... 6
7. Where do I file my Financial Disclosure Statement? .................................................................................................................... 6
8. (ote to Public Officers:............................................................................................................................................................... 6
ARIZO A REVISED STATUTES ....................................................................................................................................................... 7
TITLE 38 PUBLIC OFFICERS AND EMPLOYEES ....................................................................................................................................... 7
Chapter 3.1 Standards for Financial Disclosure .............................................................................................................................. 7
Article 1. General Provisions ............................................................................................................................................................................ 7
§ 38-541. Definitions ........................................................................................................................................................................................ 7
§ 38-542. Duty to file financial disclosure statement; contents; exceptions ....................................................................................................... 7
§ 38-543. Duty to file financial disclosure statement by candidate for public office ......................................................................................... 9
§ 38-544. Violation; classification .................................................................................................................................................................... 9
§ 38-545. Local public officers financial disclosure ....................................................................................................................................... 10
ATTOR EY GE ERAL OPI IO  78-18 (R78-9) ............................................................................................................................ 11
AZ SUPREME COURT ADMI ISTRATIVE ORDER 95-1 ............................................................................................................ 13
SAMPLE: FI A CIAL DISCLOSURE STATEME T ................................................................................................................... 15
KEN BENNETT
Instructions for Financial Disclosure Statements Office Revision 4 November 2012
COMMON QUESTIONS AND ANSWERS
ABOUT FINANCIAL DISCLOSURE STATEMENTS
1. WHO MUST FILE A FINANCIAL DISCLOSURE STATEMENT?
If at any time during the past calendar year you held one of the positions listed below, you must file a
Financial Disclosure Statement with the Secretary of State:
  a statewide officer, whether elected or appointed
  a member of the Arizona legislature, whether elected or appointed
  a justice or judge of the Arizona Supreme Court, Arizona Court of Appeals or superior court,
whether elected or appointed
  a judge pro tempore, commissioner, or juvenile hearing officer serving the appellate courts
or the superior court full time or on a continuing, scheduled and compensated basis
If you are a candidate for a statewide or legislative office, you must also file a Candidate’s Financial
Disclosure Statement with the Secretary of State at the same time as and as part of your nomination
papers.
2. DO PUBLIC OFFICERS AND CANDIDATES IN COUNTIES, CITIES, AND TOWNS HAVE
TO FILE FINANCIAL DISCLOSURE STATEMENTS?
Probably–but the forms may not be the same as the ones the Secretary of State provides. Section 38-
545, A.R.S., says counties, incorporated cities and towns must adopt their own standards for Financial
Disclosure Statements. Check with the clerk or the filing office where you filed your nomination papers.
3. WHEN DO I HAVE TO FILE MY ANNUAL FINANCIAL DISCLOSURE STATEMENT?
Public Officers
If you were a public officer at any time during a calendar year (even for a day), you must file an
annual Financial Disclosure Statement between January 1 and January 31 of the following calendar year.
Public officers whose final terms expire less than 31 days into the immediately following calendar year
may file their final financial disclosure statement between January 1 and January 31 of the year in which
they leave office. That Financial Disclosure Statement covers the entire year in which you served, January
1 through December 31, even if you only served for a day and later left office due to resignation,
retirement or another reason. If you additionally run for the same or any other office, you must file an
additional candidate Financial Disclosure Statement on the day you file your nomination papers and
petitions.
Newly Appointed Public Officers
If you are newly appointed to fill a vacancy in a statewide or a legislative office, you must file a
Financial Disclosure Statement within 60 days of the date you take office. That Financial Disclosure
Statement covers the 12 month period ending with the last full month prior to the date of taking office. If
you also run for that or any other office, you must file a second Financial Disclosure Statement on the day
you file your nomination papers and petitions.
Newly Appointed Justices and Judges
If you are newly appointed as a Justice of the Arizona Supreme Court, a Judge on the Arizona Court of
Appeals, or a Judge of the Superior Court, you must file a Financial Disclosure Statement within 60 days of
KEN BENNETT
Office Revision November 2012 Instructions for Financial Disclosure Statements 5
the date you take office. That Financial Disclosure Statement covers the 12 month period ending with the
last full month prior to the date of taking office.
Full time judges pro tempore, commissioners and juvenile hearing officers shall file a financial
disclosure statement as provided by A.R.S. § 38-541 et. seq. upon appointment and annually. Financial
disclosure statements cover the entire year served, January 1 through December 31, even if service was
for only one day.
Candidates for Public Office and Superior Court
If you are a candidate for a statewide or legislative office, or for a judgeship on the Superior Court in a
county where judges are elected, you must file a Financial Disclosure Statement at the same time and as
part of your nomination papers. If you are applying for merit selection to the Superior Court, you do not
need to file a Financial Disclosure Statement with the Secretary of State until 60 days from the date you
take office, if appointed. The Financial Disclosure Statement covers the 12 months prior to the date you
file your nomination papers.
4. WHERE DO I GET A FINANCIAL DISCLOSURE STATEMENT?
Public Officers
Statewide officers, legislators, justices of the Arizona Supreme Court and judges of the Arizona Court
of Appeals receive a Financial Disclosure packet from the Secretary of State’s office. The packets are
mailed or delivered in late November to the office address of the public officer. Also in November, the
Secretary of State sends Financial Disclosure Statements to each presiding judge or court administrator of
the superior court for distribution to the judges and the appropriate judges pro tempore in that court.
Newly Appointed Public Officers, Justices and Judges
Statewide officers, legislators, Arizona Supreme Court justices, and Arizona Court of Appeals judges
newly appointed to fill vacancies receive a Financial Disclosure packet in the mail from the Secretary of
State Election Services office. Newly appointed judges and judges pro tempore to the superior court
receive the packet from the presiding judge or court administrator or upon request from the Secretary of
State Election Services office by calling (602) 542-8683 or by sending an e-mail to elections@azsos.gov.
Printable versions are available through the Web site www.azsos.gov.
Candidates for Public Office and Superior Court
A copy of the Financial Disclosure Statement is included in the packet of nomination materials provided
to you by the Secretary of State Election Services office or can be picked up from the Secretary of State’s
Election Services counter. Additional copies will be sent out upon request by calling (602) 542-8683 or by
sending an e-mail to elections@azsos.gov. Printable versions are available through the Web site
www.azsos.gov.
County, City, and Town Public Officers and Candidates
Public officers and candidates for offices in counties, cities and towns should contact the appropriate
clerks or election filing offices for information on obtaining Financial Disclosure Statements. The forms
provided by the Secretary of State may not be acceptable to those filing offices.
5. WHAT LAWS GOVERN FINANCIAL DISCLOSURE STATEMENTS?
Arizona Revised Statutes §§ 38-541 through 38-545 and Attorney General Opinion No. I 78-018
govern the filing of financial disclosure statements by public officers. The Arizona Code of Judicial
Conduct, Canon 3, Rule 3.15; Arizona Code of Judicial Administration, Section 1-307; and Administrative
Order 95-1 further govern the filing of Financial Disclosure Statements by Arizona justices, judges and
appropriate commissioners and judges pro tempore.
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Instructions for Financial Disclosure Statements Office Revision 6 November 2012
Counties, cities and towns may have additional ordinances, rules, resolutions or regulations that
govern the filing of Financial Disclosure Statements by their public officers and candidates.
6. WHAT IS THE PENALTY FOR FAILING TO FILE A FINANCIAL DISCLOSURE
STATEMENT?
Upon referral by the Secretary of State, the Attorney General enforces the filing requirement against
public officers who fail to file by the deadline. Enforcement may include a civil penalty of $50 for each day
the Statement is late, until it is filed.
In addition, if any public officer or candidate is found to have knowingly filed an incomplete or a false
Financial Disclosure Statement, the public officer or candidate may be found guilty of a class 1
misdemeanor.
The Secretary of State can refuse to accept nomination papers from candidates who fail to include a
Financial Disclosure Statement. If you are a candidate in a county, city or town that requires Financial
Disclosure Statements, your filing officer can refuse to accept your nomination packet if you do not include
the Statement.
7. WHERE DO I FILE MY FINANCIAL DISCLOSURE STATEMENT?
If you are one of the public officers or candidates discussed above, deliver or mail it to:
Arizona Secretary of State
Attn: Election Services Division
1700 West Washington Street, 7th Floor
Phoenix, Arizona 85007
If you are a county, city, town or special district public officer or candidate, contact your clerk or
election office for information on where to file.
8. NOTE TO PUBLIC OFFICERS:
Gifts as defined in Title 38 must be reported, even if it was given by a lobbyist who properly reported it
under Title 41.
KEN BENNETT
Office Revision November 2012 Instructions for Financial Disclosure Statements 7
ARIZONA REVISED STATUTES
TITLE 38 PUBLIC OFFICERS AND EMPLOYEES
CHAPTER 3.1 STANDARDS FOR
FINANCIAL DISCLOSURE
Article 1. General Provisions
§ 38-541. Definitions
In this chapter, unless the context otherwise
requires:
1. "Business" includes any enterprise,
organization, trade, occupation or profession,
whether or not operated as a legal entity or for
profit, including any business trust, corporation,
partnership, joint venture or sole proprietorship.
2. "Compensation" means anything of value
or advantage, present or prospective, including
the forgiveness of debt.
3. "Controlled business" means any business
in which the public officer or any member of his
household has an ownership or beneficial
interest, individually or combined, amounting to
more than a fifty per cent interest.
4. "Dependent business" means any business
in which the public officer or any member of his
household has an ownership or beneficial
interest, individually or combined, amounting to
more than a ten per cent interest, and during the
preceding calendar year the business received
from a single source more than ten thousand
dollars and more than fifty per cent of its gross
income.
5. "Gift" includes any gratuity, special
discount, favor, hospitality, service, economic
opportunity, loan or other benefit received
without equivalent consideration and not
provided to members of the public at large.
6. "Local public officer" means a person
holding an elective office of an incorporated city
or town, a county or a groundwater
replenishment district established under title 48,
chapter 27.
7. "Member of household" means a public
officer's spouse and any minor child of whom the
public officer has legal custody.
8. "Public officer" means a member of the
legislature and any judge of the court of appeals
or the superior court, or a person holding an
elective office the constituency of which
embraces the entire geographical limits of this
state. Members of Congress are not public
officers as defined in this paragraph.
§ 38-542. Duty to file financial
disclosure statement; contents;
exceptions
A. In addition to other statements and
reports required by law, every public officer, as a
matter of public record, shall file with the
secretary of state on a form prescribed by the
secretary of state a verified financial disclosure
statement covering the preceding calendar year.
The statement shall disclose:
1. The name and address of the public officer
and each member of his household and all names
and addresses under which each does business.
2. The name and address of each employer
and of each other source of compensation other
than gifts amounting to more than one thousand
dollars received during the preceding calendar
year by the public officer and members of his
household in their own names, or by any other
person for the use or benefit of the public officer
or members of his household, a description of the
services for which the compensation was received
and the nature of the employer's business. This
paragraph shall not be construed to require the
disclosure of individual items of compensation
that constituted a portion of the gross income of
the business from which the public officer or
members of his household derived compensation.
3. For a controlled business, a description of
the goods or services provided by the business,
and if any single source of compensation to the
business during the preceding calendar year
amounts to more than ten thousand dollars and
KEN BENNETT
Instructions for Financial Disclosure Statements Office Revision 8 November 2012
is more than twenty-five per cent of the gross
income of the business, the disclosure shall also
include a description of the goods or services
provided to the source of compensation. For a
dependent business the statement shall disclose
a description of the goods or services provided by
the business and a description of the goods or
services provided to the source of compensation
from which the dependent business derived the
amount of gross income described in section 38-
541, paragraph 4. If the source of compensation
for a controlled or dependent business is a
business, the statement shall disclose a
description of the business activities engaged in
by the source of compensation.
4. The names and addresses of all businesses
and trusts in which the public officer or members
of his household, or any other person for the use
or benefit of the public officer or members of his
household, had an ownership or beneficial
interest of over one thousand dollars at any time
during the preceding calendar year, and the
names and addresses of all businesses and trusts
in which the public officer or any member of his
household held any office or had a fiduciary
relationship at any time during the preceding
calendar year, together with the amount or value
of the interest and a description of the interest,
office or relationship.
5. All Arizona real property interests and real
property improvements, including specific
location and approximate size, in which the public
officer, any member of his household or a
controlled or dependent business held legal title
or a beneficial interest at any time during the
preceding calendar year, and the value of any
such interest, except that this paragraph does
not apply to a real property interest and
improvements thereon used as the primary
personal residence or for the personal
recreational use of the public officer. If a public
officer, any member of his household or a
controlled or dependent business acquired or
divested any such interest during the preceding
calendar year, he shall also disclose that the
transaction was made and the date it occurred. If
the controlled or dependent business is in the
business of dealing in real property interests or
improvements, disclosure need not include
individual parcels or transactions as long as the
aggregate value of all parcels of such property is
reported.
6. The names and addresses of all creditors to
whom the public officer or members of his
household, in their own names or in the name of
any other person, owed a debt of more than one
thousand dollars or to whom a controlled
business or a dependent business owed a debt of
more than ten thousand dollars which was also
more than thirty per cent of the total business
indebtedness at any time during the preceding
calendar year, listing each such creditor. This
paragraph shall not be construed to require the
disclosure of debts owed by the public officer or
any member of his household resulting from the
ordinary conduct of a business other than a
controlled or dependent business nor shall
disclosure be required of credit card transactions,
retail installment contracts, debts on residences
or recreational property exempt from disclosure
under paragraph 5 of this subsection, debts on
motor vehicles not used for commercial purposes,
debts secured by cash values on life insurance or
debts owed to relatives. It is sufficient disclosure
of a creditor if the name and address of a person
to whom payments are made is disclosed. If the
public officer, any member of his household or a
controlled or dependent business incurred or
discharged a debt which is reportable under this
subsection during the preceding calendar year,
the report shall disclose that the transaction was
made and the date it occurred.
7. The identification and amount of each debt
exceeding one thousand dollars owed at any time
during the preceding calendar year to the public
officer and members of his household in their
own names, or to any other person for the use or
benefit of the public officer or any member of his
household. The disclosure shall include the
identification and amount of each debt exceeding
ten thousand dollars to a controlled business or
dependent business which was also more than
thirty per cent of the total indebtedness to the
business at any time during the preceding
calendar year. This paragraph shall not be
construed to require the disclosure of debts from
the ordinary conduct of a business other than a
controlled or dependent business. If the public
officer, any member of his household or a
controlled or dependent business incurred or
discharged a debt which is reportable under this
KEN BENNETT
Office Revision November 2012 Instructions for Financial Disclosure Statements 9
subsection during the preceding year, the report
shall disclose that the transaction was made and
the date it occurred.
8. The name of each source of any gift, or
accumulated gifts from a single source, of more
than five hundred dollars received by the public
officer and members of his household in their
own names during the preceding calendar year,
or by any other person for the use or benefit of
the public officer or any member of his household
except gifts received by will or by virtue of
intestate succession, or received by way of
distribution from any inter vivos or testamentary
trust established by a spouse or by an ancestor,
or gifts received from any other member of the
household or relatives to the second degree of
consanguinity. Political campaign contributions
shall not be construed as gifts if otherwise
publicly reported as political campaign
contributions as required by law.
9. A list of all business licenses issued to, held
by or in which the public officer or any member
of his household had an interest at any time
during the preceding calendar year, including the
name in which the license was issued, the type of
business and its location.
10. A list of all bonds, together with their
value, issued by this state or any political
subdivision of this state and held at any time
during the preceding calendar year by the public
officer or any member of his household, which
bonds issued by a single entity had a value in
excess of one thousand dollars. If the public
officer or any member of his household acquired
or divested any bonds during the preceding
calendar year which are reportable under this
paragraph, the fact that the transaction occurred
and the date shall also be shown.
B. If an amount or value is required to be
reported pursuant to this section, it is sufficient
to report whether the amount or value of the
equity interest falls within:
1. Category 1, one thousand dollars to
twenty-five thousand dollars.
2. Category 2, more than twenty-five
thousand dollars to one hundred thousand
dollars.
3. Category 3, more than one hundred
thousand dollars.
C. This section does not require the disclosure
of any information that is privileged by law.
D. The statement required to be filed
pursuant to subsection A shall be filed by all
persons who qualified as public officers at any
time during the preceding calendar year on or
before January 31 of each year with the
exceptions that a public officer appointed to fill a
vacancy shall, within sixty days following his
taking of such office, file a financial disclosure
statement covering as his annual period the
twelve month period ending with the last full
month prior to the date of his taking office, and a
public officer whose final term expires less than
thirty-one days into the immediately following
calendar year may file the public officer's final
financial disclosure at the same time as the
disclosure for the last immediately preceding
year.
E. The secretary of state shall prepare written
guidelines, forms and samples for completing the
financial disclosure statement required by this
section. A copy of the guidelines, forms and
samples shall be distributed to each public officer
and shall be made available to each candidate
required to file a financial disclosure statement
pursuant to section 38-543.
§ 38-543. Duty to file financial
disclosure statement by candidate for
public office
A candidate for public office as specified in
section 38-541, paragraph 8 shall file a financial
disclosure statement covering the preceding
twelve month period and containing the
information described in section 38-542 on a
form prescribed by the secretary of state at the
time of filing of nomination papers.
§ 38-544. Violation; classification
A. Any public officer, local public officer or
candidate who knowingly fails to file a financial
disclosure statement required pursuant to section
38-542, 38-543 or 38-545, who knowingly files
an incomplete financial disclosure statement or
KEN BENNETT
Instructions for Financial Disclosure Statements Office Revision 10 November 2012
who knowingly files a false financial disclosure
statement is guilty of a class 1 misdemeanor.
B. Any public officer, local public officer or
candidate who violates this chapter is subject to
a civil penalty of fifty dollars for each day of
noncompliance but not more than five hundred
dollars that may be imposed as prescribed in
section 16-924.
§ 38-545. Local public officers
financial disclosure
Notwithstanding the provisions of any law,
charter or ordinance to the contrary, every
incorporated city or town or county shall by
ordinance, rule, resolution or regulation adopt
standards of financial disclosure consistent with
the provisions of this chapter applicable to local
public officers.
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Office Revision November 2012 Instructions for Financial Disclosure Statements 11
ATTORNEY GENERAL OPINION 78-18 (R78-9)
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Instructions for Financial Disclosure Statements Office Revision 12 November 2012
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Office Revision November 2012 Instructions for Financial Disclosure Statements 13
AZ SUPREME COURT ADMINISTRATIVE ORDER 95-1
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Office Revision November 2012 Instructions for Financial Disclosure Statements 15
SAMPLE: FINANCIAL DISCLOSURE STATEMENT
FINANCIAL DISCLOSURE STATEMENT
(For use by Public Officers and Candidates of the State of Arizona)
Name of Public Officer or Candidate Al Doe
Address 9130 North Ballot Avenue, Vote Falls, AZ 86000
Public Office Held or Sought Arizona State Representative
District # 32
Check one:
I am a public officer who is not in my final term, filing this statement covering the 12 months of calendar year
20 12 .
I have been appointed to fill a vacancy in a public office within the last 60 days and am filing this Financial
Disclosure Statement covering the 12 month period ending with the last full month prior to the date I took office.
I am a public officer whose final term expires less than thirty-one days into calendar year
20 . This is my final Financial Disclosure Statement covering the last 12 months plus the final days of my term
for the current year.
I am a candidate for a public office, and am filing this Financial Disclosure Statement covering the 12 months
preceding the date of this statement, from the month of 20 , to the month
of 20 .
VERIFICATION
I do solemnly swear that the Financial Disclosure Statement filed herewith is in all things true and correct, and fully shows all
information I am required to report pursuant to A.R.S. § 38-542.
Al Doe
Signature of Public Officer or Candidate
State of Arizona )
)
County of Drake )
Subscribed and sworn to (or affirmed) before me this 7th day of January , 2012 ,
Alberta Roberts
Notary Public
December 15, 2012
My Commission expires
(Seal)
OFFICIAL SEAL
ALBERTA ROBERTS
NOTARY PUBLIC
DRAKE COUNTY
My comm. Expires December 15, 2012
KEN BENNETT
Instructions for Financial Disclosure Statements Office Revision 16 November 2012
SECTION A: PERSONAL DISCLOSURE
1. Names
What to disclose: Your and your spouse’s names and the names of minor children of whom you have legal custody.
YOUR NAME
AL DOE
YOUR SPOUSE’S NAME
Martha Doe
CHILDREN’S NAMES
Robert Doe
Donna Doe
2. Sources of Personal Compensation
What to disclose: The name and address of each employer who paid you, your spouse, or any member of your household
more than $1,000 in salary, wages, commissions, tips or other forms of compensation during the period covered by this report.
Describe each employer's business and the services for which you or a member of your household were compensated.
Also, list anything of value that any other person, outside your household, received for your use or benefit of you or any
member of your household. For example, if a person was paid by your employer to be your housekeeper, list that person’s
wages and the name of the employer.
You need not disclose: Any money you or any member of your household received that was gross income paid to a business
you or your household member owned.
PUBLIC OFFICER OR
MEMBER OF
HOUSEHOLD
NAME AND ADDRESS OF
EMPLOYER OR OTHER
SOURCE OF COMPENSATION
OVER $1,000
DESCRIPTION OF EMPLOYER’S BUSINESS AND SERVICES
PROVIDED BY PUBLIC OFFICER OR MEMBER OF
HOUSEHOLD
Al Doe
State of Arizona
State Legislature
1700 West Washington
Martha Doe
Vote Falls Unified School Dist.
Principal
456 South 1st St., Vote Falls
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Office Revision November 2012 Instructions for Financial Disclosure Statements 17
3. Professional, Occupational and Business Licenses
What to disclose: List all licenses issued to or held by you or any member of your household at any time during the period
covered by this Statement.
TYPE OF LICENSE
OR PERMIT
NAME IN WHICH
LICENSE IS ISSUED
PUBLIC OFFICER OR
HOUSEHOLD MEMBER
HOLDING LICENSE, IF
NOT ISSUED IN OWN
NAME
JURISDICTION(S)
OF LICENSE
Location OF
Business
Real Estate Broker Al Doe
Arizona Inactive
Teaching Certificate Martha Doe Arizona Vote Falls
Food Handler Burgers to Go Robert Doe Vote Falls Vote Falls
4. Personal Creditors
What to disclose: The name and address of each creditor to whom you, or a member of your household owed a personal
debt over $1,000 during the period covered by this Statement. If the debt was incurred or discharged during this period, list
the date and whether it was incurred or discharged.
You need not disclose: Debts resulting from the ordinary conduct of a business (disclose those in Section C). Debts on
residences or recreational property, on motor vehicles not used for commercial purposes, on debts secured by cash values on
life insurance, or debts you owe to relatives, personal credit card transactions or installment contracts.
PERSONAL DEBTS OVER $1,000
NAME AND ADDRESS OF CREDITOR (OR
PERSON TO WHOM PAYMENTS ARE MADE)
PUBLIC OFFICER OR MEMBER OF
HOUSEHOLD OWING THE DEBT
DATE INCURRED
AND/OR DISCHARGED
Carol Winters
Martha Doe
05/02/2004
2398 North Elm Street, Vote Falls, AZ 86000   Incurred   Discharged
  Incurred   Discharged
  Incurred   Discharged
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Instructions for Financial Disclosure Statements Office Revision 18 November 2012
5. Personal Debtors
What to disclose: The name of each debtor who owed you or a member of your household a debt over $1,000 at any time
during the period covered by this Statement, and the approximate value of the debt (See last page of value categories). If the
debt was incurred or discharged during the period covered by this Statement, report the date and whether the debt was
incurred or discharged.
DEBTS OVER $1,000 OWED TO YOU PERSONALLY
NAME OF DEBTOR
PUBLIC OFFICER OR MEMBER
OF HOUSEHOLD TO WHOM
THE DEBT IS OWED
AMOUNT BY VALUE
CATEGORY
DATE INCURRED
AND/OR DISCHARGED
NONE
  Incurred   Discharged
  Incurred   Discharged
  Incurred   Discharged
6. Gifts
What to disclose: The name of the donor who gave you or a member of your household a single gift or an accumulation of
gifts with a value over $500, if that gift does NOT fit into a category below.
You need not disclose: Gifts you or a household member received by will, intestate succession, inter vivos (living) trusts, or
testamentary trusts established by a spouse or ancestor. Gifts received from any other member of the household or relatives to
the second degree of consanguinity (parents, grandparents, siblings, children and grandchildren) or political contributions
reported on campaign finance reports.
NAME OF DONOR OF GIFTS OVER $500
PUBLIC OFFICER OR MEMBER OF HOUSEHOLD –
RECIPIENT
City College Scholarship Fund
Robert Doe
Young Writers of America
Donna Doe
American Legislative Exchange Council
Al Doe
KEN BENNETT
Office Revision November 2012 Instructions for Financial Disclosure Statements 19
SECTION B: REPORTABLE INTERESTS
7. Offices or Fiduciary Relationships in Businesses, Nonprofit Organizations or Trusts
What to disclose: The name and address of each business, organization, trust or nonprofit organization or association in
which you or any member of your household held any office OR had a fiduciary relationship during the period covered by this
Statement. Describe the office or relationship.
NAME OF ORGANIZATION
AND ADDRESS
NAME OF PUBLIC OFFICER
OR MEMBER OF HOUSEHOLD
OFFICE OR
FIDUCIARY RELATIONSHIP
Tri-County Library Guild
Martha Doe
Chairwoman Publicity Committee
210 South Main, Vote Falls, AZ 86000
Vote Falls Good Citizens
Al Doe
Immediate Past President
1739 West Wicken Drive, Vote Falls,
AZ 86000
8. Ownership or Financial Interest in Trusts, or Investment Funds
What to disclose: The name and address of each business, trust, investment or retirement fund in which you or any member
of your household had an ownership or beneficial interest of over $1,000. This includes stocks, partnerships, joint ventures,
sole proprietorships, annuities, mutual funds and retirement accounts. List the percentage of ownership or interest, and
categorize the value of the equity. (See last page for value categories.)
NAME AND ADDRESS OF BUSINESS
OR TRUST
PUBLIC OFFICER OR MEMBER OF
HOUSEHOLD
DESCRIPTION OF
INTEREST
EQUITY BY
VALUE
CATEGORY
Old Town Retirement Fund
Al & Martha Doe
100%
3
New York, NY
Arizona State Elected Officials
Al & Martha Doe
100%
1
Phoenix, AZ
KEN BENNETT
Instructions for Financial Disclosure Statements Office Revision 20 November 2012
9. Bonds
What to disclose: Bonds issued by a single agency worth more than $1,000 that you or a member of your household hold, or
held during the period covered by this Statement. If the bonds were acquired or divested during the period, report the date
that occurred.
BONDS OVER $1,000
ISSUING AGENCY
PUBLIC OFFICER OR
MEMBER OF
HOUSEHOLD
VALUE
CATEGORY
DATE ACQUIRED
AND/OR DIVESTED
Waterworks City of Vote Falls Doe Family 2
05/02/2004
  Acquired   Divested
  Acquired   Divested
  Acquired   Divested
10. Real Property Ownership
What to disclose: Arizona real property and improvements to which you or a member of your household hold, or held title
during the period covered by this Statement. Describe the property’s location and approximate size. Using the value
categories (see last page) report the value of your equity. If that property was acquired or divested during the period covered
by this Statement, list the date and what occurred.
You need not disclose: Your primary residence or property you use for personal recreation.
LOCATION AND APPROXIMATE
SIZE OF ARIZONA REALTY
PUBLIC OFFICER OR MEMBER OF
HOUSEHOLD OR BUSINESS
EQUITY BY
VALUE
CATEGORY
DATE ACQUIRED OR
DIVESTED
Townhouse
1/16th lot
Central Phoenix
Al Doe
2
03/25/2004
  Acquired   Divested
  Acquired   Divested
  Acquired   Divested
KEN BENNETT
Office Revision November 2012 Instructions for Financial Disclosure Statements 21
SECTION C: BUSINESS INTERESTS
11. Business Names
What to disclose: The name of any business under which you or any member of your household did business during the
period covered by this Statement. Include corporations, limited liability companies, partnerships and trade names. Using the
definitions provided in statute, disclose if the business named is controlled or dependent. If the business is both controlled
and dependent, mark both boxes.
PUBLIC OFFICER OR
MEMBER OF HOUSEHOLD
BUSINESS NAME
BUSINESS ADDRESS
CONTROLLED AND/OR
DEPENDENT BUSINESS
Robert Doe Burgers to Go
910 North Ballot Drive
Vote Falls, AZ 86000
  Controlled
  Dependent
  Controlled
  Dependent
  Controlled
  Dependent
  Controlled
  Dependent
IMPORTANT: IF A BUSINESS LISTED ABOVE DID NOT GROSS MORE THAN $10,000 OR PROVIDE MORE
THAN 10% OF YOUR PERSONAL COMPENSATION DURING THE PERIOD COVERED BY THIS STATEMENT,
YOU DO NOT NEED TO COMPLETE THE REST OF THIS STATEMENT.
12. Controlled Business Information
What to disclose: The name of each controlled business you listed above, and the goods or services provided by the
business. If a single client or customer (person or business) accounts for more than $10,000 and 25% of the gross income,
describe what it is your business provides to that customer or client. Then, in column 4, describe what the client/customer’s
business does (if your major client is a person, leave the last column blank). If you do not have a major client, leave the last
two columns blank.
You need not disclose: The name of any customer or client, or the activities of any customer or client who is an individual
rather than a business.
NAME OF YOUR
CONTROLLED BUSINESS
GOODS OR SERVICES
PROVIDED BY YOUR
BUSINESS
WHAT YOUR BUSINESS
PROVIDES TO YOUR
MAJOR CUSTOMER OR
CLIENT
BUSINESS ACTIVITY OF
MAJOR CUSTOMER OR
CLIENT
NONE
KEN BENNETT
Instructions for Financial Disclosure Statements Office Revision 22 November 2012
13. Dependent Business Information
What to disclose: The name of each dependent business, the goods or services provided by the dependent business, the
goods or services provided to the major customer or client and the business activity if the major customer or client is a
business. If the dependent business is also a controlled business, disclose it only in response to #12, above.
You need not disclose: The name or identity of the customer or client, or the amount of income from the customer or
client. If the customer or client is an individual (rather than a business), you are not required to disclose that person’s activities.
NAME OF DEPENDENT
BUSINESS
GOODS OR SERVICES
PROVIDED BY THE
BUSINESS
GOODS OR SERVICES
PROVIDED TO THE MAJOR
CUSTOMER OR CLIENT
BUSINESS ACTIVITY OF
THE MAJOR CUSTOMER
OR CLIENT, IF A
BUSINESS
Burgers to Go Food and Beverage
14. Real Property Owned by Business
What to disclose: Arizona real property and improvements the titles to which were held by a controlled or dependent
business listed above. If the business is one that deals in real property and improvements, list the aggregate value of all parcels
held in the period covered by this Statement. Describe the property’s location and approximate size. Using the value
categories (see last page) report the value of equity in your business. If the property was acquired or divested during the
period covered by this Statement, list that and the date.
LOCATION AND APPROXIMATE
SIZE OF ARIZONA REALTY
PUBLIC OFFICER OR MEMBER OF
HOUSEHOLD OR BUSINESS
EQUITY BY
VALUE
CATEGORY
DATE ACQUIRED OR
DIVESTED
NONE
  Acquired   Divested
  Acquired   Divested
  Acquired   Divested
  Acquired   Divested
KEN BENNETT
Office Revision November 2012 Instructions for Financial Disclosure Statements 23
15. Business’ Creditors
What to disclose: The name and address of each creditor to which your business owed more than $10,000, if that amount
was also more than 30% of your total business indebtedness at any time during the period covered by this Statement. If the
debt was incurred or discharged during the period covered by this Statement, report that and the date.
You need not disclose: Debts resulting from a business other than a controlled or dependent business.
BUSINESS DEBTS OVER $10,000 AND 30%
NAME AND ADDRESS OF CREDITOR (OR
PERSON TO WHOM PAYMENTS ARE MADE)
NAME OF CONTROLLED OR
DEPENDENT BUSINESS (FROM ITEM 3
OR 4)
DATE INCURRED
AND/OR DISCHARGED
NONE
  Incurred   Discharged
  Incurred   Discharged
  Incurred   Discharged
16. Business’ Debtors
What to disclose: The name of the debtor for each debt exceeding $10,000 owed to a controlled or dependent business
which was also more than 30% of the total indebtedness to the business which was owed at any time during the preceding
calendar year. If the debt was incurred or discharged during the year, list that and the date. List value category.
DEBTS OVER $10,000 AND 30% OWED TO YOUR BUSINESS
NAME OF DEBTOR
NAME OF CONTROLLED OR
DEPENDENT BUSINESS TO WHOM
THE DEBT IS OWED
AMOUNT BY
VALUE
CATEGORY
DATE INCURRED
AND/OR DISCHARGED
NONE
  Incurred   Discharged
  Incurred   Discharged
Value Categories: (from A.R.S. § 38-542(B))
Category 1 - $1,000 to $25,000
Category 2 – More than $25,000 to $100,000
Category 3 - More than $100,000
Updated November 2012
INSTRUCTIONS FOR FINANCIAL
DISCLOSURE STATEMENTS
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