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. For filers using electronic signatures, please see the following agency policy.
FormSTATUTORY REQUIREMENT
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))
If you have problems viewing or using the fillable version, try downloading the non-fillable Form 411.
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. 42:1115.2)
If you have problems viewing or using the fillable version, try downloading the non-fillable Form 413.
Form 413 FAQs
Disclosure Form 414 Payment for Rendering Assistance Disclosure Statement (pursuant to LSA-R.S. 42:1111E(2)(a)) (Form Revised January 2019)
If you have problems viewing or using the fillable version, try downloading the non-fillable Form 414.
Tier 1 Annual Financial Disclosure
Personal Financial Disclosure form for Tier 1 officials filing their annual report.
To utilize the full functionality of the fillable forms, you must use Adobe PDF Reader.
If you have problems viewing or using the fillable version, try downloading the non-fillable Disclosure Form 415a
Tier 1 FAQs
Tier 1 Candidate Financial Disclosure
Personal Financial Disclosure form for Tier 1 officials filing their election report.
To utilize the full functionality of the fillable forms, you must use Adobe PDF Reader.
If you have problems viewing or using the fillable version, try downloading the non-fillable Disclosure Form 415b
Tier 1 FAQs
Tier 2 Annual Financial Disclosure
Personal Financial Disclosure form for Tier 2 officials filing their annual report.
To utilize the full functionality of the fillable forms, you must use Adobe PDF Reader.
If you have problems viewing or using the fillable version, try downloading the non-fillable Disclosure Form 416a

Tier 2 FAQs
Tier 2 Candidate Financial Disclosure
Personal Financial Disclosure form for Tier 2 officials filing their candidate report.
To utilize the full functionality of the fillable forms, you must use Adobe PDF Reader.
If you have problems viewing or using the fillable version, try downloading the non-fillable Disclosure Form 416b
Tier 2 FAQs
Tier 2 Tax Extension Notification
If you have problems viewing or using the fillable version, try downloading the non-fillable Disclosure Form 416c
Tier 2.1 Annual Financial Disclosure
Personal Financial Disclosure form for Tier 2.1 officials.
To utilize the full functionality of the fillable forms, you must use Adobe PDF Reader.
If you have problems viewing or using the fillable version, try downloading the non-fillable Disclosure Form 417
Tier 2.1 FAQs
Tier 3 Annual Financial Disclosure
Personal Financial Disclosure form for Tier 3 officials.
To utilize the full functionality of the fillable forms, you must use Adobe PDF Reader.
If you have problems viewing or using the fillable version, try downloading the non-fillable Disclosure Form 418a
Tier 3 FAQs
Tier 3 Candidate Financial Disclosure
Personal Financial Disclosure form for Tier 3 officials
To utilize the full functionality of the fillable forms, you must use Adobe PDF Reader.
If you have problems viewing or using the fillable version, try downloading the non-fillable Disclosure Form 418b
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)
Disclosure Form 421 Gubernatorially Declared Disasters and Emergencies Charitable Giving to Public Servants (pursuant to LA. R.S. 42:1111.1) - Statements are to be filed on or before February 15
Disclosure Form 422 Charter School Banking Disclosure Statement (pursuant to La. R.S. 17:3991(A)(1)(b)(ii))
Disclosure Form 423 Spousal Prohibited Income Disclosure Statement (pursuant to LSA-R.S. 42:1111C(5))
Disclosures Electronic Filing Affidavit Electronic filing affidavit for using the PFD E-Filing system. Mail your notarized affidavit to the Louisiana Board of Ethics.
If you already have a username and password for electronically filing campaign finance reports through Leaders Online, the same username and password can be used to log in and access the personal financial disclosure forms on the PFD E-file system.