5517
MONTGOMERY COUNTY

FORMS FOR USE IN THE FILING OF THE STATEMENTS REQUIRED BY
THIS CHAPTER TO THE PERSONS REQUIRED TO FILE SUCH
STATEMENTS. FORMS SHALL BE MADE INITIALLY AVAILABLE BY
THE CHIEF ADMINISTRATIVE OFFICER NO LATER THAN JULY 15,
197 4 AND NO LATER THAN THE 1ST DAY OF JANUARY, EACH YEAR
THEREAFTER. THE CHIEF ADMINISTRATIVE OFFICER SHALL
REQUIRE THAT ANY PERSON EXAMINING OR COPYING SUCH
STATEMENTS SHALL RECORD THAT PERSON'S NAME, HOME ADDRESS,
AND THE NAME OF THE PERSON WHOSE DISCLOSURE STATEMENT WAS
EXAMINED OR COPIED.

(J) NO STATEMENT REQUIRED BY THIS CHAPTER SHALL BE
USED IN ANY WAY FOR OR BE MADE AVAILABLE FOR, COMMERCIAL
PURPOSES.

20A-5 CONTENT OF STATEMENT OF FINANCIAL INTERESTS.

THE SWORN STATEMENT REQUIRED TO BE FILED BY THIS
CHAPTER SHALL CONTAIN SCHEDULES DISCLOSING THE FOLLOWING
INTERESTS OF THE PERSON MAKING THE STATEMENT, AND THE
INTERESTS OF THAT PERSON'S SPOUSE, OR DEPENDENT CHILD,
TOGETHER WITH THE SPECIFIED INFORMATION, FOR THE CALENDAR
YEAR FOR WHICH THE REQUIRED STATEMENT IS TO BE FILED:

(A) A SCHEDULE OF ALL INTERESTS (INCLUDING
LEASEHOLD INTERESTS AND INTERESTS IN AN OIL, CAS OR OTHER
MINERAL ROYALTY OR LEASE) IN OR WITH RESPECT TO ANY REAL
PROPERTY WHEREVER SITUATED. THIS SCHEDULE, AS TO EACH
INTEREST, SHALL INCLUDE:

(1)    THE NATURE OF THE PROPERTY AND THE
LOCATION BY STREET ADDRESS, MAILING ADDRESS OR LEGAL
DESCRIPTION OF THE PROPERTY;

(2)    THE NATURE AND EXTENT OF THE INTEREST
HELD, INCLUDING ANY CONDITIONS THERETO AND ENCUMBRANCES
THEREON;

(3)    THE DATE WHEN, THE MANNER IN WHICH, AND
THE IDENTITY OF THE PERSON FROM WHOM THE INTEREST WAS
ACQUIRED;

(4)    THE NATURE AND AMOUNT OF THE
CONSIDERATION GIVEN IN EXCHANGE FOR THE INTEREST OR, IF
ACQUIRED OTHER THAN BY PURCHASE, THE FAIR MARKET VALUE OF
THE INTEREST AT THE TIME REQUIRED;

(5)    WITH RESPECT TO ANY INTEREST
TRANSFERRED, IN WHOLE OR IN PART, AT ANY TIME DURING THE
YEAR FOR WHICH THE STATEMENT IS FILED, A DESCRIPTION OF
THE INTEREST TRANSFERRED, THE NATURE AND AMOUNT OF THE
CONSIDERATION RECEIVED IN EXCHANGE THEREFOR AND THE
IDENTITY OF THE PERSON TO WHOM THE INTEREST WAS
TRANSFERRED; AND