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LOUISIANA BOARD OF ETHICS <br /> Mail: P.O. Box 4368, Baton Rouge, LA 70821 <br /> Fax: 225-381-7271 <br /> Upload: https://eap.ethics.la.gov/FileUpload <br /> FINANCIAL DISCLOSURE STATEMENT <br /> (Pursuant to La. R.S.42:1114) <br /> DISCLOSURE STATF.MENTS ARE FILED ANNUt1LLY ON OR BEFORE MAY 1Sth. <br /> CALENDAR YEAR COVERED: <br /> FILER: <br /> ❑PUBLIC SFRVANT ❑SPOUSE OF PUBLIC SERVANT ❑IMMEDIA'CE FAMILY MEMBER OF PUBLIC SERVANT <br /> ❑LEGISLATOR ❑SPOUSE OF LF.GISLATOR ❑IMMEDIATE FAMII,Y MEMBER Or LF.GISLATOR <br /> ❑EI.EC'I'F.D OPPICIAI. ❑SPOUSE OF F.LI:CTF.D OFi�ICIAL ❑BUSINESS ENTERPRISE OF ELECTED OFFICIAI. <br /> Name of Filer(p�-int): <br /> Relationship to Public Servant: <br /> Add�-ess: <br /> City, State,Z.ip: — -- <br /> Name af Public Servant(print): <br /> Position Held: <br /> Name af Department/t�gency/Division: <br /> Signature of Piler <br /> Date <br /> "Public Servant"means a piiblic employee or an elected c�fficiaL <br /> "Elected Official"means any person holding an office in a governmental entity which is filled Uy the vote of the appropriate electorate.It <br /> shall also include any person appoinYed to fil]a vacancy in such offices. <br /> "Immediate Family,"as the term relates to a publAc servant;means his children,the spouses of his children,his brothers and their <br /> spouses,his sisters and their spouses,his�arents,his spouse arid the parents ot'his spouse. <br /> "Legislator"means any person holding office in the Senate or the House of Representatives of the Louisiana Legislature which is filled by <br /> the vote of the appropriate electorate. <br /> 'Business Enterprise"sha11 be included in the disclasure statement only if the eiected official and/or his spouse owns at least ten percent of <br /> such enterprise. <br /> l�evised f3/1/2024 Form 405 www.ethics.la.yov <br />