Section 15-A:5 Form of Disclosure.

NEW HAMPSHIRE STATUTES AND CODES

The secretary of state shall establish a uniform statement of financial interests, which may be in paper or electronic form.
   I. The statement of financial interest shall include:
      (a) The full text of RSA 15-A.
      (b) The full name, work address, work phone number, primary occupation, and, if different, the office, appointment, or employment with government held by person filing the statement of financial interest.
      (c) The name, address, and type of any profession, business, or other organization in which the reporting individual or family member was an officer, director, associate, partner, proprietor, or employee, or served in any other professional or advisory capacity, and from which any income in excess of $10,000 was derived during the preceding calendar year. Sources of retirement benefits other than federal retirement and/or disability benefits shall be included. If the person filing the financial interest statement has no qualifying income he or she shall report this by writing his or her initials following the statement ""My income does not qualify ___.''
      (d) A statement of whether the person reporting or a family member has a special interest in any of the following businesses, professions, occupations, groups, or matters. A person has a reportable special interest in an item on this list if a change in law, a change in administrative rule, a decision whether or not to award a contract, grant a license or permit, discipline a licensee or permittee, or other decision by government affecting the listed business, profession, occupation, group, or matter would potentially have a greater financial effect on the person reporting the financial interest or a family member than it would on the general public:
         (1) Any profession, occupation, or business licensed or certified by the state of New Hampshire, listing each such profession, occupation, or category of business.
         (2) Health care.
         (3) Insurance.
         (4) Real estate, including brokers, agents, developers, and landlords.
         (5) Banking or financial services.
         (6) State of New Hampshire, county, or municipal employment.
         (7) The New Hampshire retirement system.
         (8) The current use land assessment program.
         (9) Restaurants and lodging.
         (10) The sale and distribution of alcoholic beverages.
         (11) The practice of law.
         (12) Any business regulated by the public utilities commission.
         (13) Horse or dog racing, or other legal forms of gambling.
         (14) Education.
         (15) Water resources.
         (16) Agriculture.
         (17) New Hampshire taxes, specifying if business profits tax, business enterprise tax, or interest and dividends tax.
         (18) The reporting official may, but is not required by this chapter to specify any other area for which he or she has a special interest.
      (e) The following statement followed by a line for the person filing the form to sign and date the form: ""I have read RSA 15-A and hereby swear or affirm that the foregoing information is true and complete to the best of my knowledge and belief.''
   II. The secretary of state may also require information such as home phone numbers, home addresses, and other information pertinent to the administration and enforcement of laws relating to financial disclosure. This information shall be non-public and shall not be subject to the provisions of RSA 91-A.
   III. The statement of financial interests, if filed on paper, shall be completed by typewriting or legible hand printing, and shall be verified, dated, and signed by the reporting individual personally.
   IV. The secretary of state shall maintain the statement of financial interests for 6 years, after which time the statement may be destroyed. The public information on the forms shall be available to the public in the form of a photocopy or an electronic record. The secretary of state shall, as soon as is practical, implement an electronic record keeping system that makes the public information on statements of financial interest available to the public through the internet.