1. Name, mailing address, work place telephone number and electronic mail address of the filer;

2. Name of state office held by filer;

3. Beginning date of term of office;

4. Expiration date of term of office;

5. Acknowledgements of the jurisdiction of the Commission, the Ethics Rules, and educational opportunities provided by the Commission;

6. Acknowledgements of understanding of certain conflicts of interest Rules applicable to state officers;

7. Disclosure of all material financial interests as defined in subsection C of this Rule by disclosing the full name and address of the entity or entities; and

8. Any other information required by the Executive Director of the Commission that is consistent with the intent and purpose of these Rules.

1. An ownership interest in a private business including but not limited to, a closely held corporation, limited liability company, Subchapter S corporation or partnership for which the filer, the filer's spouse or a dependent is a director, officer, owner, manager, employee, or agent or any private business, closely held corporation or limited liability company in which the filer, the filer's spouse or a dependent owns or has owned stock, another form of equity interest, stock options, debt instruments, or has received dividends or income worth Twenty Thousand Dollars ($20,000.00) or more at any point during the preceding calendar year;

2. An ownership interest of five percent (5%) or more in a publicly traded corporation or other business entity by a filer, the filer's spouse, or a dependent at any point during the preceding calendar year;

3. An ownership interest in a publicly traded corporation or other business entity from which dividends or income, not to include salary, of Fifty Thousand Dollars ($50,000.00) or more were derived during the preceding calendar year by the filer, the filer's spouse, or a dependent;

4. An interest that arises as a result of the filer's, the filer's spouse, or a dependent's service as a director or officer of a publicly traded corporation or other business entity at any time during the preceding calendar year; or

5. Any sources of income derived from employment, other than compensation pertaining to the office for which the state officer is subject to election or retention, in the amount of Twenty Thousand Dollars ($20,000.00) or more by the filer, the filer's spouse or a dependent not otherwise disclosed herein.