Conflict of Interest Disclosure Form
For Political Candidates
Full Name
Position Sought
Email
Date
1. Do you or your immediate family members have any financial interests, ownership, or relationships with any individual, organization, or business that may present a conflict of interest regarding your candidacy or future official duties?
Yes
No
If "Yes," please provide details:
2. Are you currently, or have you within the past 5 years, held any positions (paid or unpaid) with another governmental body, political party, or organization that could create a potential conflict?
Yes
No
If "Yes," please specify:
3. Are there any other circumstances, relationships, or activities that might reasonably be perceived as a conflict of interest if you are elected?
Yes
No
If "Yes," please describe:
Signature