Pdc Form F 1 PDF Details

Navigating the complexities of financial disclosure in the public sphere brings us to the essential PDC Form F-1, also known as the Personal Financial Affairs Statement. Housed under the vigilant watch of the Public Disclosure Commission in Olympia, Washington, this form serves as a cornerstone for maintaining transparency and trust in the public sector. The crux of this document lies in its detailed compilation of an individual's personal finances, requiring a thorough declaration from incumbent elected officials, candidates, and appointed officials among others. By stipulating deadlines for different statuses—April 15 for incumbents and within two weeks for new candidates or appointees—it emphasizes timely accountability. From income sources and real estate interests to assets, investments, and debts, the form encompasses a comprehensive overview, ensuring that any potential conflicts of interest can be identified and addressed. Instructions within the form guide filers through the labyrinth of disclosure requirements, including the mandatory identification of immediate family members who play a significant part in the financial landscape of the filer. Additionally, the form prods into the filer’s engagement with entities by requiring disclosure of significant ownerships or positions held. Not just a formality, the F-1 mandates a reflection on the participation in proposing or challenging state legislation for personal compensation, capturing any outside influence on policy-making. Concluding with a certification of the veracity of the information provided, under the stern warning of perjury, the form underlines the gravity and legal implications of the submission process. This exhaustive approach not only fosters an environment of integrity within Washington's public offices but also fortifies the public's trust in their elected and appointed officials.

QuestionAnswer
Form NamePdc Form F 1
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesRM, officeholders, FILER, Divested

Form Preview Example

PUBLIC

DISCLOSURE COMMISSION

 

PDC FORM

 

 

 

 

 

 

 

 

P

M PDC OFFICE USE

 

711 CAPITOL WAY RM 206

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

F-1

 

PERSONAL FINANCIAL

O

A

 

 

 

 

 

 

 

 

 

 

PO BOX 40908

 

 

 

S

R

 

OLYMPIA WA 98504-0908

 

 

 

AFFAIRS STATEMENT

T

K

 

(360) 753-1111

 

 

 

 

 

 

(2/07)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TOLL FREE 1-877-601-2828

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Refer to instruction manual for detailed assistance and examples.

 

 

 

 

DOLLAR

 

 

 

 

 

R

 

 

 

 

 

 

 

 

 

CODE

AMOUNT

E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A

$1 to $2,999

C

 

 

 

 

 

Deadlines:

Incumbent elected and appointed officials -- by April 15.

 

 

E

 

 

 

 

 

 

Candidates and others -- within two weeks of becoming a

 

 

B

$3,000 to $14,999

I

 

 

 

 

 

 

candidate or being newly appointed to a position.

 

 

 

 

C

$15,000 to $29,999

V

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D

$30,000 to $74,999

E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D

 

 

 

 

 

SEND REPORT TO PUBLIC DISCLOSURE COMMISSION

 

 

 

 

E

$75,000 or more

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Last Name

First

 

Middle Initial

Names of immediate family members. If there is no

 

 

 

 

 

 

 

 

 

 

 

 

 

reportable information to disclose for dependent children, or

 

 

 

 

 

 

 

 

 

 

 

 

 

other dependents living in your household, do not identify

 

 

 

 

 

 

 

 

 

 

 

 

 

them. Do identify your spouse. See F-1 manual for details.

Mailing Address (Use PO Box or Work Address)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

County

 

Zip + 4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Filing Status (Check only one box.)

 

 

 

 

 

 

Office Held or Sought

 

 

 

 

 

 

 

An elected or state appointed official filing annual report

 

 

 

 

 

 

Office title:

 

 

 

 

 

 

 

Final report as an elected official. Term expired:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

County, city, district or agency of the office,

Candidate running in an election: month

 

 

 

year

 

 

 

 

 

 

name and number:

 

 

 

 

 

 

 

Newly appointed to an elective office

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Position number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Newly appointed to a state appointive office

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Term begins:

 

 

ends:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Professional staff of the Governor’s Office and the Legislature

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1

Show Self (S)

Spouse (SP)

Dependent (D)

List each employer, or other source of income (pension, social security, legal judgment, etc.) from which you or a family

INCOME

member received $1,500 or more during the period. (Report interest and dividends in Item 3 on reverse)

 

 

 

 

Name and Address of Employer or Source of Compensation

Occupation or How Compensation

Amount:

 

 

Was Earned

(Use Code)

Check Here

if continued on attached sheet

2

 

List street address, assessor’s parcel number, or legal description AND county for each parcel of Washington

REAL ESTATE

real estate with value of over $7,500 in which you or a family member held a personal financial interest during the

 

 

reporting period. (Show partnership, company, etc. real estate on F-1 supplement.)

 

 

Property Sold or Interest Divested

 

Assessed

Name and Address of Purchaser

Nature and Amount (Use Code) of Payment or

 

 

 

Value

 

 

Consideration Received

 

 

 

 

(Use Code)

 

 

 

 

 

 

 

 

 

 

 

 

Property Purchased or Interest Acquired

 

Creditor’s Name/Address

Payment Terms

Security Given

Mortgage Amount - (Use Code)

 

 

 

 

 

 

 

Original

Current

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

All Other Property Entirely or Partially Owned

 

 

 

 

 

 

Check here

if continued on attached sheet

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CONTINUE ON NEXT PAGE

3

ASSETS / INVESTMENTS - INTEREST / DIVIDENDS

List bank and savings accounts, insurance policies, stock, bonds and other

intangible property held during the reporting period.

 

 

A.

Name and address of each bank or financial institution in which you

Type of Account or Description of Asset

Asset Value

Income Amount

 

or a family member had an account over $15,000 any time during the

 

 

(Use Code)

(Use Code)

 

report period.

 

 

 

 

 

 

 

B. Name and address of each insurance company where you or a family

 

 

 

 

 

 

member had a policy with a cash or loan value over $15,000 during

 

 

 

 

 

 

the period.

 

 

 

 

 

 

 

C. Name

and address of each company, association, government

 

 

 

 

 

 

agency, etc. in which you or a family member owned or had a

 

 

 

 

 

 

financial interest worth over $1,500. Include stocks, bonds,

 

 

 

 

 

 

ownership, retirement plan, IRA, notes, and other intangible property.

 

 

 

 

 

Check here

if continued on attached sheet.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4

CREDITORS

List each creditor you or a family member owed $1,500 or more any time during the period.

AMOUNT

Don’t include retail charge accounts, credit cards, or mortgages or real estate reported in Item 2.

(USE CODE)

 

 

 

Creditor’s Name and Address

 

Terms of Payment

Security Given

Original

Present

Check here

if continued on attached sheet.

 

 

 

 

 

 

 

 

 

 

 

 

5

All filers answer questions A thru D below. If the answer is YES to any of these questions, the F-1 Supplement must also be completed as

part of this report. If all answers are NO and you are a candidate for state or local office, an appointee to a vacant elective office, or a state

executive officer filing your initial report, no F-1 Supplement is required.

Incumbent elected officials and state executive officers filing an annual financial affairs report also must answer question E. An F-1 Supplement is required of these officeholders unless all answers to questions A thru E are NO.

A.At any time during the reporting period were you, your spouse or dependents (1) an officer, director, general partner or trustee of any corporation, company, union, association, joint venture or other entity or (2) a partner or member of any limited partnership, limited liability partnership, limited liability company or similar entity including but not limited to a professional limited liability company? __ If yes, complete Supplement, Part A.

B.Did you, your spouse or dependents have an ownership of 10% or more in any company, corporation, partnership, joint venture or other business at any time during the reporting period? __ If yes, complete Supplement, Part A.

C.Did you, your spouse or dependents own a business at any time during the reporting period? __ If yes, complete Supplement, Part A.

D.Did you, your spouse or dependents prepare, promote or oppose state legislation, rules, rates or standards for current or deferred compensation (other than pay for a currently-held public office) at any time during the reporting period? __ If yes, complete Supplement, Part B.

E.Only for Persons Filing Annual Report. Regarding the receipt of items not provided or paid for by your governmental agency during the previous calendar year: 1) Did you, your spouse or dependents (or any combination thereof) accept a gift of food or beverages costing over $50 per occasion? __ or 2) Did any source other than your governmental agency provide or pay in whole or in part for you, your spouse and/or dependents to travel or to attend a seminar or other training? __ If yes to either or both questions, complete Supplement, Part C.

ALL FILERS EXCEPT CANDIDATES. Check the appropriate box.

I hold a state elected office, am an executive state officer or professional staff. I have read and am familiar with RCW 42.52.180 regarding the use of public resources in campaigns.

I hold a local elected office. I have read and am familiar with RCW 42.17.130 regarding the use of public facilities in campaigns.

CERTIFICATION: I certify under penalty of perjury that the information contained in this report is true and correct to the best of my knowledge.

Signature

Date

Contact Telephone: (

)

 

Email:

 

 

(work)

Email:

 

 

(Home)

REPORT NOT ACCEPTABLE WITHOUT FILER’S SIGNATURE

Information Continued

F-1

Name

 

 

 

1

Show Self (S)

Spouse (SP)

Dependent (D)

INCOME

(continued)

 

 

 

 

 

Name and Address of Employer or Source of Compensation

Occupation or How Compensation

Amount:

 

 

Was Earned

(Use Code)

 

 

 

 

2

REAL ESTATE

(continued)

 

 

 

 

 

 

Property Sold or Interest Divested

Assessed

Name and Address of Purchaser

Nature and Amount (Use Code) of Payment or

 

 

Value

 

Consideration Received

 

 

(Use Code)

 

 

Property Purchased or Interest Acquired

Creditor’s Name/Address

Payment Terms

Security Given

Mortgage Amount - (Use Code)

 

 

 

Original

Current

All Other Property Entirely or Partially Owned

3

ASSETS / INVESTMENTS - INTEREST / DIVIDENDS

(continued)

 

 

 

 

 

A.

Name and address of each bank or financial institution

Type of Account or Description of Asset

Asset Value

Income Amount

 

 

 

(Use Code)

(Use Code)

B.Name and address of each insurance company

C.Name and address of each company, association, government agency

4

CREDITORS

(continued)

 

 

AMOUNT

 

 

(USE CODE)

 

 

 

 

 

Creditor’s Name and Address

Terms of Payment

Security Given

Original

Present

 

 

 

 

 

 

 

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