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Reset FormUNIFORM CONFLICT OF INTEREST DISCLOSURE STATEMENT State Form 54266 (R2 / 615) / Form 236 STATE BOARD OF ACCOUNTSIndiana Code 3544.114 A public servant who knowingly or intentionally has.

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How to fill out the UNIFORM CONFLICT OF INTEREST DISCLOSURE STATEMENT - Forms In online

The UNIFORM CONFLICT OF INTEREST DISCLOSURE STATEMENT is a crucial document for public servants to disclose any potential conflicts of interest related to contracts or purchases. This guide provides clear and supportive instructions on how to complete the form online, ensuring that you provide all necessary information accurately.

Follow the steps to complete the disclosure statement online.

  1. Click the ‘Get Form’ button to access the disclosure statement. This will allow you to open the form in your chosen editing interface.
  2. In the first section, provide your full name and address. This identifies you as the public servant submitting the statement.
  3. Indicate your title or position within the governmental entity. This is important for understanding your role.
  4. Complete the governmental entity field with the name of the organization you are serving. Additionally, specify the county where it is located.
  5. Select whether this is a 'single transaction' or 'annual' disclosure statement by marking the appropriate checkbox.
  6. List the name(s) of contractor(s) or vendor(s) involved in the contracts or purchases in question.
  7. In the description section, provide detailed information about the contract(s) or purchase(s). Include the effective date and term if known. If applicable, indicate the name and relationship of any dependents.
  8. Describe your financial interest in the contract or purchase, including any expected profit or financial benefit. If possible, estimate the dollar value.
  9. If applicable, complete the approval section with the name and title of the appointing officer or governing body, indicating their approval of your participation.
  10. Make sure to sign and date the form, affirming the truth and completeness of your statements.
  11. After filling out the form, save your changes. You can download, print, or share the completed document per your requirements.

Complete your UNIFORM CONFLICT OF INTEREST DISCLOSURE STATEMENT online today for smooth submission.

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Some examples of a conflict of interest could be: Representing a family member in court. Starting a business that competes with your full-time employer. Advising a client to invest in a company owned by your spouse.

Indiana Code 35-44.1-1-4 A public servant who knowingly or intentionally has a pecuniary interest in or derives a profit from a contract or purchase connected with an action by the governmental entity served by the public servant commits conflict of interest, a Class D Felony.

The authors have no conflicts of interest to declare. All co-authors have seen and agree with the contents of the manuscript and there is no financial interest to report. We certify that the submission is original work and is not under review at any other publication.

Disclosure is typically a more formal and documented process that most organizations have adopted in policy to address conflicts of interest. The disclosure process is intended to help the work force be transparent and accountable for (explain or justify) their actions and decisions.

A conflict of interest occurs when an individual's personal interests – family, friendships, financial, or social factors – could compromise his or her judgment, decisions, or actions in the workplace. Government agencies take conflicts of interest so seriously that they are regulated.

I confirm that neither I nor any of my relatives nor any business with which I am associated have any personal or business interest in or potential for personal gain from any of the organizations or projects linked to XYZ AIS.

This Conflict of Interest Form should indicate whether the nominator(s) has an economic interest in, or acts as an officer or a director of, any outside entity whose financial interests would reasonably appear to be affected by the addition of the nominated condition to the newborn screening panel.

I confirm that neither I nor any of my relatives nor any business with which I am associated have any personal or business interest in or potential for personal gain from any of the organizations or projects linked to XYZ AIS.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232