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1 | | of the end of the preceding calendar year and is: (i) held |
2 | | in the filer's name, (ii) held jointly by the filer with |
3 | | his or her spouse, or (iii) held jointly by the filer with |
4 | | his or her minor child or children. For a beneficial |
5 | | interest in a trust, the value is based on the total value |
6 | | of the assets either subject to the beneficial interest, |
7 | | or from which income is to be derived for the benefit of |
8 | | the beneficial interest, regardless of whether any |
9 | | distributions have been made for the benefit of the |
10 | | beneficial interest; |
11 | | (2) excluding the income from the position that |
12 | | requires the filing of a statement of economic interests |
13 | | under this Act, each source of income in excess of $7,500 |
14 | | during the preceding calendar year (as required to be |
15 | | reported on the filer's federal income tax return covering |
16 | | the preceding calendar year) for the filer and his or her |
17 | | spouse and, if the sale or transfer of an asset produced |
18 | | more than $7,500 in capital gains during the preceding |
19 | | calendar year, the transaction date on which that asset |
20 | | was sold or transferred; |
21 | | (3) each creditor of a debt in excess of $10,000 that, |
22 | | during the preceding calendar year, was: (i) owed by the |
23 | | filer, (ii) owed jointly by the filer with his or her |
24 | | spouse or (iii) owed jointly by the filer with his or her |
25 | | minor child or children; |
26 | | (4) the name of each unit of government of which the |
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1 | | filer or his or her spouse was an employee, contractor, or |
2 | | office holder during the preceding calendar year other |
3 | | than the unit or units of government in relation to which |
4 | | the person is required to file and the title of the |
5 | | position or nature of the contractual services; |
6 | | (5) each person known to the filer to be registered as |
7 | | a lobbyist with any unit of government in the State of |
8 | | Illinois: (i) with whom the filer maintains an economic |
9 | | relationship, or (ii) who is a member of the filer's |
10 | | family; |
11 | | (6) each source and type of gift or gifts, or |
12 | | honorarium or honoraria, valued singly or in the aggregate |
13 | | in excess of $500 that was received during the preceding |
14 | | calendar year, excluding any gift or gifts from a member |
15 | | of the filer's family that was not known to the filer to be |
16 | | registered as a lobbyist with any unit of government in |
17 | | the State of Illinois; and |
18 | | (7) the name of any spouse or immediate family member |
19 | | living with such person employed by a public utility in |
20 | | this State and the name of the public utility that employs |
21 | | such person ; and . |
22 | | (8) the name of each spouse, sibling, child, or parent |
23 | | who is an employee, contractor, or office holder in the |
24 | | same unit of local government as the filer of this |
25 | | statement and the title of the individual's position or |
26 | | the nature of the contractual services the individual |
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1 | | provided to the unit of local government. |
2 | | For the purposes of this Section, the unit of local |
3 | | government in relation to which a person is required to file |
4 | | under item (e) of Section 4A-101.5 shall be the unit of local |
5 | | government that contributes to the pension fund of which such |
6 | | person is a member of the board. |
7 | | (b) Beginning December 1, 2025, and for every 5 years |
8 | | thereafter, the Secretary of State shall adjust the amounts |
9 | | specified under this Section that prompt disclosure under this |
10 | | Act for purposes of inflation as determined by the Consumer |
11 | | Price Index for All Urban Consumers as issued by the United |
12 | | States Department of Labor and rounded to the nearest $100. |
13 | | The Secretary shall publish this information on the official |
14 | | website of the Secretary of State, and make changes to the |
15 | | statement of economic interests form to be completed for the |
16 | | following year. |
17 | | (c) The Secretary of State shall develop and make publicly |
18 | | available on his or her website written guidance relating to |
19 | | the completion and filing of the statement of economic |
20 | | interests upon which a filer may reasonably and in good faith |
21 | | rely.
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22 | | (Source: P.A. 101-221, eff. 8-9-19; 102-662, eff. 9-15-21; |
23 | | 102-664, eff. 1-1-22; 102-813, eff. 5-13-22.)
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24 | | (5 ILCS 420/4A-103) (from Ch. 127, par. 604A-103)
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25 | | Sec. 4A-103.
The statement of economic interests required |
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1 | | by this Article to be filed
with the Secretary of State or |
2 | | county clerk shall be verified, dated, and signed by the
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3 | | person making the statement and shall contain substantially |
4 | | the following:
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5 | | STATEMENT OF ECONOMIC INTERESTS |
6 | | INSTRUCTIONS: |
7 | | You may find the following documents helpful to you in |
8 | | completing this form: |
9 | | (1) federal income tax returns, including any related |
10 | | schedules, attachments, and forms; and |
11 | | (2) investment and brokerage statements. |
12 | | To complete this form, you do not need to disclose |
13 | | specific amounts or values or report interests relating either |
14 | | to political committees registered with the Illinois State |
15 | | Board of Elections or to political committees, principal |
16 | | campaign committees, or authorized committees registered with |
17 | | the Federal Election Commission. |
18 | | The information you disclose will be available to the |
19 | | public. |
20 | | You must answer all 6 questions. Certain questions will |
21 | | ask you to report any applicable assets or debts held in, or |
22 | | payable to, your name; held jointly by, or payable to, you with |
23 | | your spouse; or held jointly by, or payable to, you with your |
24 | | minor child. If you have any concerns about whether an |
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1 | | interest should be reported, please consult your department's |
2 | | ethics officer, if applicable. |
3 | | Please ensure that the information you provide is complete |
4 | | and accurate. If you need more space than the form allows, |
5 | | please attach additional pages for your response. If you are |
6 | | subject to the State Officials and Employees Ethics Act, your |
7 | | ethics officer must review your statement of economic |
8 | | interests before you file it. Failure to complete the |
9 | | statement in good faith and within the prescribed deadline may |
10 | | subject you to fines, imprisonment, or both. |
11 | | BASIC INFORMATION: |
12 | | Name: ........................................................ |
13 | | Job title: ................................................... |
14 | | Office, department, or agency that requires you to file this |
15 | | form: ........................................................ |
16 | | Other offices, departments, or agencies that require you to |
17 | | file a Statement of Economic Interests form: ................ |
18 | | Full mailing address: ........................................ |
19 | | Preferred e-mail address (optional): ......................... |
20 | | QUESTIONS: |
21 | | 1. If you have any single asset that was worth more than |
22 | | $10,000 as of the end of the preceding calendar year and is |
23 | | held in, or payable to, your name, held jointly by, or payable |
24 | | to, you with your spouse, or held jointly by, or payable to, |
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1 | | you with your minor child,
list such assets below. In the case |
2 | | of investment real estate, list the city and state where the |
3 | | investment real estate is located. If you do not have any such |
4 | | assets, list "none" below. |
5 | | ................................. |
6 | | ............................................................. |
7 | | ............................................................. |
8 | | ............................................................. |
9 | | ............................................................. |
10 | | 2. Excluding the position for which you are required to |
11 | | file this form, list the source of any income in excess of |
12 | | $7,500 required to be reported during the preceding calendar |
13 | | year. If you sold an asset that produced more than $7,500 in |
14 | | capital gains in the preceding calendar year, list the name of |
15 | | the asset and the transaction date on which the sale or |
16 | | transfer took place. If you had no such sources of income or |
17 | | assets, list "none" below. |
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18 | | Source of Income / Name of |
Date Sold (if applicable) |
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19 | | Asset | |
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20 | | ............................... |
............................... |
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21 | | ............................... |
............................... |
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22 | | ............................... |
............................... |
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23 | | 3. Excluding debts incurred on terms available to the |
24 | | general public, such as mortgages, student loans, and credit |
25 | | card debts, if you owed any single debt in the preceding |
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1 | | calendar year exceeding $10,000, list the creditor of the debt |
2 | | below. If you had no such debts, list "none" below. |
3 | | List the creditor for all applicable debts owed by you, |
4 | | owed jointly by you with your spouse, or owed jointly by you |
5 | | with your minor child. In addition to the types of debts listed |
6 | | above, you do not need to report any debts to or from financial |
7 | | institutions or government agencies, such as debts secured by |
8 | | automobiles, household furniture or appliances, as long as the |
9 | | debt was made on terms available to the general public, debts |
10 | | to members of your family, or debts to or from a political |
11 | | committee registered with the Illinois State Board of |
12 | | Elections or any political committee, principal campaign |
13 | | committee, or authorized committee registered with the Federal |
14 | | Election Commission. |
15 | | ........................................ |
16 | | ............................................................. |
17 | | ............................................................. |
18 | | ............................................................. |
19 | | 4. List the name of each unit of government of which you or |
20 | | your spouse were an employee, contractor, or office holder |
21 | | during the preceding calendar year other than the unit or |
22 | | units of government in relation to which the person is |
23 | | required to file and the title of the position or nature of the |
24 | | contractual services. |
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25 | | Name of Unit of Government |
Title or Nature of Services |
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1 | | ............................... |
............................... |
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2 | | ............................... |
............................... |
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3 | | ............................... |
............................... |
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4 | | 5. If you maintain an economic relationship with a |
5 | | lobbyist or if a member of your family is known to you to be a |
6 | | lobbyist registered with any unit of government in the State |
7 | | of Illinois, list the name of the lobbyist below and identify |
8 | | the nature of your relationship with the lobbyist. If you do |
9 | | not have an economic relationship with a lobbyist or a family |
10 | | member known to you to be a lobbyist registered with any unit |
11 | | of government in the State of Illinois, list "none" below. |
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12 | | Name of Lobbyist |
Relationship to Filer |
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13 | | ............................... |
............................... |
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14 | | ............................... |
............................... |
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15 | | ............................... |
............................... |
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16 | | 6. List the name of each person, organization, or entity |
17 | | that was the source of a gift or gifts, or honorarium or |
18 | | honoraria, valued singly or in the aggregate in excess of $500 |
19 | | received during the preceding calendar year and the type of |
20 | | gift or gifts, or honorarium or honoraria, excluding any gift |
21 | | or gifts from a member of your family that was not known to be |
22 | | a lobbyist registered with any unit of government in the State |
23 | | of Illinois. If you had no such gifts, list "none" below. |
24 | | .... |
25 | | ............................................................. |
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1 | | ............................................................. |
2 | | 7. List the name of any spouse or immediate family member |
3 | | living with the person making this statement employed by a |
4 | | public utility in this State and the name of the public utility |
5 | | that employs the relative. |
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6 | | Name and Relation |
Public Utility |
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7 | | ............................... |
............................... |
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8 | | ............................... |
............................... |
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9 | | ............................... |
............................... |
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10 | | 8. List the name of each spouse, sibling, child, or parent |
11 | | who is an employee, contractor, or office holder in the same |
12 | | unit of local government as the filer of this statement and the |
13 | | title of the individual's position or the nature of the |
14 | | contractual services the individual provided to the unit of |
15 | | local government. |
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16 | | Name and Relation |
Position or Nature of Service |
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17 | | ............................... |
............................... |
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18 | | ............................... |
............................... |
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19 | | ............................... |
............................... |
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20 | | VERIFICATION: |
21 | | "I declare that this statement of economic interests |
22 | | (including any attachments) has been examined by me and to the |
23 | | best of my knowledge and belief is a true, correct and complete |
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1 | | statement of my economic interests as required by the Illinois |
2 | | Governmental Ethics Act. I understand that the penalty for |
3 | | willfully filing a false or incomplete statement is a fine not |
4 | | to exceed $2,500 or imprisonment in a penal institution other |
5 | | than the penitentiary not to exceed one year, or both fine and |
6 | | imprisonment." |
7 | | Printed Name of Filer: ....................................... |
8 | | Date: ........................................................ |
9 | | Signature: ................................................... |
10 | | If this statement of economic interests requires ethics |
11 | | officer review prior to filing, the applicable ethics officer |
12 | | must complete the following: |
13 | | CERTIFICATION OF ETHICS OFFICER REVIEW: |
14 | | "In accordance with law, as Ethics Officer, I reviewed |
15 | | this statement of economic interests prior to its filing." |
16 | | Printed Name of Ethics Officer: .............................. |
17 | | Date: ........................................................ |
18 | | Signature: ................................................... |
19 | | Preferred e-mail address (optional): .........................
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20 | | (Source: P.A. 102-662, eff. 9-15-21; 102-664, eff. 1-1-22.)".
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