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DEFINITIONS AND INSTRUCTIONS
Requirements concerning the filing of this form are
found in N.J.S.A. 40A:9-22.1 et seq.
DEFINITIONS
"Business
organization" means any corporation, partnership, firm, enterprise,
franchise, association, trust, sole proprietorship, union, or
other legal entity;
"Governing body" means, in the case of a municipality,
the commission, council, board or body, by whatever name it may
be known, having charge of the finances of the municipality, and,
in the case of a county, the board of chosen freeholders, or,
in the case of a county having adopted the provisions of the "Optional
County Charter Law," P.L. 1972, c. 154 (C.40:41A-1 et seq.), as
defined in the form of government adopted by the county under
the act;
"Interest" means the ownership or control of
more than 10% of the profits, assets or stock of a business organization
but shall not include the control of assets in a nonprofit entity
or labor union;
"Local government agency" means any agency, board, governing
body, including the chief executive officer, bureau, division,
office, commission or other instrumentality within a county or
municipality, and any independent local authority, including any
entity created by more than one county or municipality, which
performs functions other than of a purely advisory nature, but
shall not include a school board;
"Local government employee" means any person whether compensated
or not, whether part-time or full-time employed by or serving
on a local government agency who is not a local government officer,
but shall not mean any employee of a school district;
"Local government officer" means any person whether compensated
or not, whether part-time or full-time: (1) elected to any office
of a local government agency; (2) serving on a local government
agency which has the authority to enact ordinances, approve development
applications or grant zoning variances; (3) who is a member of
an independent municipal, county, or regional authority; or (4)
who is a managerial executive or confidential employee of a local
government agency, as defined in section 3 of the "New Jersey
Employer-Employee Relations Act," P.L. 1941, c. 100 (C. 34:13A-3),
but shall not mean any employee of a school district or member
of a school board;
"Local government officer or employee" means
a local government officer or a local government employee;
"Member of immediate family" means the spouse or dependent child
of a local government officer or employee residing in the same
household.
INSTRUCTIONS
All
local government officers must file this form annually. Forms
must be obtained from the municipal clerk if you serve a municipal
government or the county clerk if you serve a county government.
Other entities will receive their forms from the Local Finance
Board.
Please provide the information based on your prior calendar year financial information.
In addition, definitions used in the Local Government Ethics Law
necessary to complete this form are printed above. The phrases
that are defined appear in italics throughout the form. Most of
the information requested is self-explanatory, however, some particular
points are clarified below.
Section
I. Personal Information- Local Government Officer
Name
and Year
Enter
your name in the fields at the top of the page - if you are using
the fill-in feature it will automatically insert your name on
the second page. Then enter the Year of Service for which you
are submitting the form. The Year of Service is the current
year in which you are serving. The financial information
to be supplied in Section II reflects the year just
before the current one, i.e., the form filled out in 2004 includes
financial information for 2003. If you have a relative of the
same name in the same municipality, please be sure the names are
differentiated by middle initial, suffix, or however the names
differ.
Local
Government Served
Please
list the municipality or county you serve. If you serve a county,
leave the municipality blank. Do not fill in the name of the municipality
you live in unless it is the same name as the municipality you
serve. If you serve a regional authority or other local government,
please list that name under "other." An example would be a Regional
Sewerage Authority.
Positions
Held
Position
held refers to your title as a local government officer or employee.
If
you hold more than one position that qualifies you to complete
this form, please list the municipal/county agency, title and
term for each position, such as, council member, municipal sewerage
authority member, and planning board member. If you serve at different
levels of local government such as regional authority, county,
and municipal government, you must file separate forms with each
entity. An example would be city council and board of freeholders.
You may list both positions on one form if you serve at different
levels, however, the form must be filed in each local government.
If
you hold more than one position, but it is for the same municipality
or county, only one form must be completed and filed. An example
would be city council, planning board, and municipal authority.
As a point of further clarification, local government officers
and employees serving municipal or county authorities are deemed
to be serving the municipality or county respectively for purposes
of this act. Thus, authority officers must file with their local
government and Local Finance Board.
Section
II. Financial Information
Complete
this section based on information for the prior calendar year.
Information
is to be provided for the person filing and members of the immediate
family based on the definition above. Fill in each line and check
the appropriate box for yourself, your spouse or a dependent.
If a dependent's source is indicated, fill in that dependent's
name in the space provided.
If
you require more room for any of the sources requested in A through
E, please use Extension Forms, as necessary.
Sources
of Income
Consider
as income, all sources required to be reported to the New Jersey
Division of Taxation for income tax purposes. Earned and unearned
income is to be reported. Earned income is that received for one's
labor or services such as salaries and wages. Unearned income
is monetary compensation received where no labor or services are
exchanged, such as social security, pension, interest income or
rental property income. The threshold applies to each source whose
gross amount is over $2,000. If you are in business for yourself,
please list only the name of the business and not individual clients.
Fees
and Honorariums
List
each source of fees and honorariums received by the local government
officer or family member for any purpose. This would include those
received as a result of the public office and those received as
a result of personal business.
Sources
of Gifts, Reimbursements, or Prepaid Expenses
Sources
must be listed, excluding gifts made by relatives. Examples may
include mileage reimbursement, hotel and meal expenses, travel
expenses, vacations, etc. This includes amounts received as a
result of the public office and those received as a result of
personal business.
Business
Organizations
List
when you or members of the immediate family hold more than 10%
of profits, assets, or stocks.
Please
include additional information in Section F. as needed to clarify
data provided or indicate information not requested that you believe
is pertinent.
Section
III. Certification
Please
read the certification statement, date and sign in the space provided.
Signatures must be original on all copies required to be filed.
Please do not make copies of this form after it has been signed.
Make the copies, and then sign each one with an original signature.
Filing
Municipal
Local Government Officers
File
the original and one copy with original signature with the municipal
clerk. If a local ethics board has been established, a copy of
the Financial Disclosure Statement must also be filed with the
local ethics board.
County
Local Government Officers
File
the original and one copy with original signature with the county
clerk. If a local ethics board has been established, a copy of
the Financial Disclosure Statement must also be filed with the
local ethics board.
Members
of municipal or county authorities serving only one municipality
or county must file with the municipal clerk if a municipal authority
and the county clerk if a county authority.
Do
not file directly with the Local Finance Board. To facilitate the filing, the clerks
will forward all completed forms to the Board.
Regional
Authority and County College Officers
File
directly with the Local Finance Board and the authority or college
only. Send to:
Chairperson
Local Finance Board
P.O. Box 803
Trenton, New Jersey 08625
Filing
Deadline- April 30th each year.
We recommend that
you obtain a new copy of the form each year you file in case there
are changes made to the form between filing periods.
Questions:
If you have any questions regarding the completion of this
form, please contact the Local Finance Board at (609) 292-0479.
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