Tier 3 Ethics Form PDF Details

Are you looking for a way to ensure that your business is following ethical principles and behaviors? Developing clear standards of conduct for employees can help organizations create high-quality businesses, customer experiences, and strong public images. One important part of this process is implementing a Tier 3 Ethics Form—an effective tool developed by many industries that provides guidelines on how companies should be operating in accordance with ethical standards. In this blog post, we'll discuss the purpose of Tier 3 Ethics Forms, provide an overview of what they contain, and share ideas on how to implement them in your own organization.

QuestionAnswer
Form NameTier 3 Ethics Form
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other nameslouisiana tier 3 personal financial disclosure statement, board of ethics tier 3, louisiana ethics tier 3 form, louisiana board of ethics tier 3 form

Form Preview Example

LOUISIANA BOARD OF ETHICS

Post Office Box 4368

Baton Rouge, Louisiana 70821

TIER 3 PERSONAL FINANCIAL DISCLOSURE STATEMENT

(ANNUAL)

Pursuant to La. R.S. 42:1124.3, each person holding a public office who represents a voting district having a population of fewer than 5,000, except any person who is required to file a financial statement by R.S. 42:1124, 1124.2, or 1124.2.1, is required to file a Tier 3 Personal Financial Disclosure Statement.

GENERAL INFORMATION

vYou are required to file a Tier 3 Personal Financial Disclosure Statement if you serve as an elected official representing a voting district having a population of fewer than 5,000.

vYou are required to file a Tier 3 Personal Financial Disclosure Statement if you serve as a member of the governing authority or management board of a charter school created pursuant to Chapter 42 of Title 17 of the Louisiana Revised Statutes.

vIf you hold another position/office that requires you to file a financial disclosure statement, you

are ONLY REQUIRED TO FILE ONE FINANCIAL DISCLOSURE STATEMENT. Such financial disclosure statement shall be filed under the highest tier. Tier levels (highest to lowest): Tier 1, Tier 2, Tier 2.1, Tier 3.

vIf additional copies of the form are needed, copies are available at www.ethics.state.la.us.

vLa. R.S. 42:1124.3 does not provide you the opportunity to request an extension in filing your personal financial disclosure statement.

vYou are required to file a financial disclosure statement ON OR BEFORE May 15 of each year you hold office, AND by May 15 of the year following the termination of the holding of such office.

vFor additional information, visit the Disclosure --Frequently Asked Questions section of our website, or view the information sheets provided under General Information --Publications.

vAcceptable methods for filing a personal financial disclosure statement:

O Fax: 225/381-7271

OMail: Board of Ethics, Post Office Box 4368, Baton Rouge, Louisiana 70821

OHand-deliver: 617 North 3rd Street, Suite 1036, Baton Rouge, Louisiana

Revised May 2011

Form 418A

www.ethics.state.la.us

Instructions

Cover Sheet

•You are required to disclose financial information related to the previous calendar year.

•You are required to disclose whether you have filed your federal and state income tax returns for the previous year.

•You are required to sign the cover sheet certifying that the information provided is true and correct to the best of your knowledge and belief.

•“Public Office” MEANS any state, parish, municipal, ward, district, or other office or position that is filled by election of the voters.

•“Public Office” DOES NOT MEAN office of the president or vice president of the United States, presidential elector, delegate to a political party convention, United States senator, United States congressman, or political party office.

Schedule A: Income from the State, Political Subdivisions, and/or Gaming Interests

•You are required to complete Schedule A if you or your spouse received income (which exceeded $250 from each source) from the State, a political subdivision, and/or a gaming interest, OR if a business in which you or your spouse owns AN INTEREST WHICH EXCEEDS 10% (either individually or collectively) received income (which exceeded $250 from each source) from the State, a political subdivision of the State, and/or a gaming interest.

•"Business" means any corporation, partnership, sole proprietorship, firm, enterprise, franchise, association, business, organization, self-employed individual, holding company, trust, or any other legal entity or person.

•"Income" (for a business) means gross income less costs of goods sold, and operating expenses.

•"Income" (for an individual) means taxable income and shall not include any income received pursuant to a life insurance policy.

•“Political Subdivision” MEANS a parish, municipality, or any other unit of local government, including a school board or a special district authorized by law to perform governmental functions, e.g., hospital service districts, school boards (and schools under its authority), police juries, parish councils, boards of aldermen, cities, towns, villages, clerks of court, special districts, etc.

•“Gaming Interest” MEANS [as defined in La. R.S. 18:1505.2L(3)(a)] (i) Any person who holds a license or permit as a distributor of gaming devices, who holds a license or permit as a manufacturer of gaming devices, who holds a license or permit as a device service entity, and any person who owns a truck stop or a licensed pari-mutuel or off-track wagering facility which is a licensed device establishment, all pursuant to the Video Draw Poker Devices Control Law; (ii)Any person who holds a license to conduct gaming activities on a riverboat, who holds a license or permit as a distributor or supplier of gaming devices or gaming equipment including slot machines, or who holds a license or permit as a manufacturer of gaming devices or gaming equipment including slot machines issued pursuant to the Louisiana Riverboat Economic Development and Gaming Control Act, and any person who owns a riverboat upon which gaming activities are licensed to be conducted; or (iii) Any person who holds a license or entered into a contract for the conduct of casino gaming operations, who holds a license or permit as a distributor of gaming devices or gaming equipment including slot machines, or who holds a license or permit as a manufacturer of gaming devices or gaming equipment including slot machines issued pursuant to the Louisiana Economic Development and Gaming Corporation Act, and any person who owns a casino where such gaming operations are licensed.

Revised May 2011

Form 418A

www.ethics.state.la.us

LOUISIANA BOARD OF ETHICS

Post Office Box 4368

Baton Rouge, Louisiana 70821

TIER 3 PERSONAL FINANCIAL DISCLOSURE STATEMENT

(ANNUAL)

ORIGINAL REPORT AMENDED REPORT

This Report Covers Calendar Year:

Office Held:

Name (print full name)

Address

City, State, Zip

Check all that apply:

I have filed my federal income tax return for the previous year.

I have filed for an extension of my federal income tax return for the previous year.

I have filed my state income tax return for the previous year.

I have filed for an extension of my state income tax return for the previous year.

NOTE: La. R.S. 42:1124.3 does not provide you the opportunity to request an extension in filing your personal financial disclosure statement.

Certification of Accuracy

I do hereby certify that the information contained in this personal financial disclosure statement

is true and correct to the best of my knowledge and belief.

________________________________________

Signature of Filer

Revised May 2011

Form 418A

www.ethics.state.la.us

LOUISIANA BOARD OF ETHICS

Post Office Box 4368

Baton Rouge, Louisiana 70821

 

 

 

 

 

 

 

 

Schedule A: Income from the State, Political

 

 

Check if not applicable

Subdivisions, and/or Gaming Interests

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(income which exceeded $250 from each source)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Filer

 

Spouse

 

 

Business (name of business)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Type of Income:

 

State

 

Political Subdivision

 

Gaming Interest

 

 

 

Name of Income Source:

 

 

 

 

 

 

 

 

 

 

Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City, State, Zip:

 

 

 

 

 

 

 

 

 

Amount of Income (exact dollar amount): $

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Filer

 

Spouse

 

 

Business (name of business)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Type of Income:

 

State

 

Political Subdivision

 

Gaming Interest

 

 

 

Name of Income Source:

 

 

 

 

 

 

 

 

 

 

Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City, State, Zip:

 

 

 

 

 

 

 

 

 

Amount of Income (exact dollar amount): $

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Filer

 

Spouse

 

 

Business (name of business)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Type of Income:

 

State

 

Political Subdivision

 

Gaming Interest

 

 

 

Name of Income Source:

 

 

 

 

 

 

 

 

 

 

Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City, State, Zip:

 

 

 

 

 

 

 

 

 

Amount of Income (exact dollar amount): $

*You are required to complete SCHEDULE A if you or your spouse received income from the State, any political subdivision, and/or a gaming interest OR if a business in which you or your spouse owns an interest which exceeds 10% (either individually or collectively) received income from the aforementioned sources.

*"Income" (for a business) means gross income less costs of goods sold, and operating expenses.

*"Income" (for an individual) means taxable income and shall not include any income received pursuant to a life insurance policy.

*The definition for (and examples of) political subdivision, gaming interest, and business are found in the INSTRUCTIONS SECTION of this form.

Revised May 2011

Form 418A

www.ethics.state.la.us

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louisiana board of ethics tier 3 form conclusion process explained (part 1)

2. The next stage would be to fill out the following blanks: ORIGINAL REPORT, AMENDED REPORT, Office Held, This Report Covers Calendar Year, Name print full name, Address, City State Zip, Check all that apply, I have filed my federal income tax, I have filed for an extension of, and I have filed my state income tax.

ORIGINAL REPORT, AMENDED REPORT, and Name print full name in louisiana board of ethics tier 3 form

3. This next step will be easy - fill out all the empty fields in I have filed my state income tax, I have filed for an extension of, NOTE La RS does not provide you, Certification of Accuracy, I do hereby certify that the, is true and correct to the best of, and Signature of Filer to complete this segment.

I have filed for an extension of, I do hereby certify that the, and is true and correct to the best of of louisiana board of ethics tier 3 form

4. Filling out Check if not applicable, Schedule A Income from the State, Subdivisions andor Gaming Interests, income which exceeded from each, Filer, Spouse, Business name of business, Type of Income, State, Political Subdivision, Gaming Interest, Name of Income Source, Address, City State Zip, and Amount of Income exact dollar is key in this step - you should definitely be patient and fill out each and every blank!

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5. As a final point, this last part is what you'll have to complete prior to finalizing the PDF. The blank fields in this case include the following: Address, City State Zip, Amount of Income exact dollar, Filer, Spouse, Business name of business, Type of Income, State, Political Subdivision, Gaming Interest, Name of Income Source, Address, City State Zip, Amount of Income exact dollar, and You are required to complete.

Filling out part 5 of louisiana board of ethics tier 3 form

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