Executive Order 98-04
Employee and Relative Disclosure Report
 
Agency Information:
Submitter Name:
(First and Last Name)
Agency Number:
Agency Name:
For what quarter do you need to disclose? January 1 - March 31
April 1 - June 30
July 1 - September 30
October 1 - December 31
Year:
Do you have anything to report this quarter?: No Yes