§ 125.13. Forms.
The following forms have been promulgated as a part of this chapter:
Financial Disclosure Statement
1. Describe and state the amount of income received from source(s) other than the Pennsylvania Crime Commission.
2. Do you have any outstanding judgments against you? Describe.
3. Have you ever been declared bankrupt? Explain.
4. Are you a co-maker or endorser of a note? Describe.
5. Are you a party in a law suit? Explain.
6. Are you obligated to pay alimony, child support, or separate maintenance? Explain.
7. List your checking and savings accounts. Include the names of the institutions, the account numbers, and the present balances.
8. List and describe your stock holdings and/or bond holdings. Include the cash or market values.
9. List and describe the net cash value of your life insurance. Include the face amount of the policy(s).
10. Describe the location and market value of any real estate in which you have an interest, direct or indirect. You do not have to include your primary place of residence.
11. List and describe any businesses or enterprises in which you have an interest, direct or indirect.
12. Describe your automobiles by make and year. Include the market value(s).
13. List the names of all your creditors, including but not limited to installment debts, revolving charge accounts, automobile loans, real estate loans, stock pledges, and other personal or business debts. Include term of the debt, the number of months left to pay the debt, the unpaid balance, and any amounts past due.
Source The provisions of this § 125.13 adopted April 18, 1980, 10 Pa.B. 1592.
Cross References This section cited in 37 Pa. Code § 125.12 (relating to staff).
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