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02B — Covered-person self-disclosure (optional)

This is not the main conflict audit. The transaction-party file comes first, from the attached record. This page is the optional sworn statement: yes or no, plus an amount band. Seats, not home addresses. Copy it. This page does not collect, store, or transmit a completed filing.

Issuer

{{PLACE}}

Project

{{PROJECT}}

Series

{{SERIES}}

Year

{{YEAR}}

Threshold

If a local statute is attached on the file, that statute’s threshold is the legal duty. If no statute is attached, the $5,000 or 5% line is a product rule, not law, and every seat stays not-proven until a filing exists. The website still does not receive the form.

Covered persons

• Elected officials who voted on the borrowing
• Chief executive of the administration
• Finance officer / treasurer
• Project vendors and their principals
• Spouse and dependent children of the above

When to file

• At issuance
• At material amendment
• Annually while the bonds are outstanding

Statement

Do you, your spouse, or a dependent child have an interest in these bonds above the threshold, directly or through an entity?

Yes / No

Amount band (if Yes)

I certify that the answers above are true to the best of my knowledge. I understand that a false statement, or a failure to file when required, is an ethics matter for the existing commission — not a missing world owner registry.

Print and file with the clerk. This website does not receive the completed form. No tax identification number, account number, or exact position size belongs on this page.