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DISCLOSURE OF FINANCIAL INTERESTS <br />DATE <br />NAME <br />(This date shall be <br />OFFICE HELD considered as the <br />date of filing and <br />TERii OF OFFICE: FROM the anniversary <br />TO date) <br />This form has been prepared as the <br />ordinance <br />guide to be used <br />pursuant to Ordinance titled "Ordinance <br />Lstablishing a Code of Ethics for the Public Officials of the <br />City of Roseville". <br />APPLICABILITY: Completion of a disclosure of financial interest <br />ublic Officials of the spouse, <br />ty oormoinor1child,It <br />is required of all P <br />is also pointed out that the interest of a <br />or other member of his/her immediate household shall be <br />considered to be an interest of yours. <br />DISCLOSURE: <br />I. Names of all business corporacompanies, <br />licenseessor <br />other business enterprises, partnerships, <br />permit holders, knowingly doing business with or in the <br />City of Roseville. <br />A. In which you are connected as an employee, <br />officer, director, trustee, partner, advisor, <br />consultant or licensee or <br />B. In which you have any nngetirementfinancial <br />plan, <br />interest, through a pension or <br />shared income or otherwise, as a result or business or any <br />current or prior employment <br />professional association, or <br />C. In which you have any financial <br />linterest through <br />the ownership of stocks, bondso <br />securities. (If you require additional space, <br />state the number of enclosures If this <br />section is not applicable, please initial �•) <br />