Disclosure Forms

If you are faxing a disclosure statement, please keep the confirmation from your fax machine that your transmittal was successful. Due to the volume of statements and calls received, we are unable to confirm receipt of your fax.
FormDescription
Disclosure Form 401 Gaming Control Board Disclosure Statement for members and supervisor (pursuant to LSA-R.S. 27:12B and 27:63A)
Disclosure Form 402 Bank/Local Depositing Authority Recusal Disclosure Statement (pursuant to LSA-R.S. 39:1233.1)
Disclosure Form 403 School Board Disclosure Statement (pursuant to LSA-R.S. 42:1119B(2)(a))
Disclosure Form 404 Hospital Service District Disclosure Statement (pursuant to LSA-R.S. 42:1119B(2)(b))
Disclosure Form 405 Public Servant (or immediate family member) Financial Disclosure Statement (pursuant to LSA-R.S. 42:1114)
Disclosure Form 406 Retirement System Financial Disclosure Statement (pursuant to LSA-R.S. 42:1114.2)
Disclosure Form 407 Notice of Fundraiser Disclosure Statement (pursuant to LSA-R.S. 24:50 et seq)
Disclosure Form 408 Gaming Division Disclosure Statement for employees and agents (pursuant to LSA-R.S. 27:63B and 27:226B)
Disclosure Form 409 Exemption Disclosure Statement (pursuant to LSA-R.S. 42:1123(34))
Disclosure Form 410 Disaster or Emergency Contract Disclosure Statement (pursuant to LSA-R.S. 42:1114.3)
Disclosure Form 411 Contract Disclosure Statement (pursuant to 42:1113D(4)). Revised January 2012.
Disclosure Form 412 Gubernatorial Transition/Inauguration Disclosure Statement (pursuant to La R.S. 42:1125)
Disclosure Form 413 Complimentary Admission, Lodging, and/or Transportation Disclosure Statement (pursuant to LSA-R.S. 42:1123(41))
Disclosure Form 414 Payment for Rendering Assistance Disclosure Statement (pursuant to LSA-R.S. 42:1111E(2)(a))
Disclosure Form 415a Tier 1 Financial Disclosure (Annual)
Personal Financial Disclosure form for Tier 1 officials filing their annual report. This form is a fillable pdf form. To open this file, you must have Acrobat reader 7 or above. If you are unable to view the fillable form, you can download a non-fillable form here.
Tier 1 FAQs
Disclosure Form 415b Tier 1 Financial Disclosure (Candidate)
Personal Financial Disclosure form for Tier 1 officials filing their election report. This form is a fillable pdf form. To open this file, you must have Acrobat reader 7 or above. If you are unable to view the fillable form, you can download a non-fillable form here.
Tier 1 FAQs
Disclosure Form 416a Tier 2 Financial Disclosure (Annual)
Personal Financial Disclosure form for Tier 2 officials filing their annual report. This form is a fillable pdf form. To open this file, you must have Acrobat reader 7 or above. If you are unable to view the fillable form, you can download a non-fillable form here.
Tier 2 FAQs
Disclosure Form 416b Tier 2 Financial Disclosure (Candidate)
Personal Financial Disclosure form for Tier 2 officials filing their candidate report. This form is a fillable pdf form. To open this file, you must have Acrobat reader 7 or above. If you are unable to view the fillable form, you can download a non-fillable form here.
Tier 2 FAQs
Disclosure Form 417 Tier 2.1 Financial Disclosure (Annual)
Personal Financial Disclosure form for Tier 2.1 officials. This form is a fillable pdf form. To open this file, you must have Acrobat reader 7 or above. If you are unable to view the fillable form, you can download a non-fillable form here.
Tier 2.1 FAQs
Disclosure Form 418a Tier 3 Financial Disclosure (Annual)
Personal Financial Disclosure form for Tier 3 officials. This form is a fillable pdf form. To open this file, you must have Acrobat reader 7 or above. If you are unable to view the fillable form, you can download a non-fillable form here.
Tier 3 FAQs
Disclosure Form 418b Tier 3 Financial Disclosure (Candidate)
Personal Financial Disclosure form for Tier 3 officials. This form is a fillable pdf form. To open this file, you must have Acrobat reader 7 or above. If you are unable to view the fillable form, you can download a non-fillable form here.
Tier 3 FAQs
Disclosure Form 419 Elected Public Official/Performing Professional Musician Disclosure Statement (pursuant to LSA-R.S. 27:96A)
Disclosure Form 420 Legislator Receiving Food, Refreshment, Lodging, and/or Transportation Disclosure Statement (pursuant to LSA-R.S. 42:1123(16)