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DATE IS MISSING THIS FORM IS CONSIDERED DEFICIENT IF ANY BLOCK IS NOT COMPLETED OR IF SIGNATURE OR DATE IS MISSING SIGN THE FORM USING THE CURRENT DATE - DO NOT BACK DATE SIGNATURE SIGN THE FORM USING THE CURRENT DATE - DO NOT BACK DATE SIGNATURE MAKE A COPY FOR YOUR RECORDS AND ADDITIONAL FILINGS WHERE REQUIRED (see COPY FOR back of form) MAKE Afiling chart onYOUR RECORDS THIS FORM MUST BE COMPLETED AND FILED BY: A B C D A former public official or former public employee must file the year.

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  • capacities
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