Donor’s Financial Disclosure Form

Donor's Financial Disclosure Form

According to San Francisco Campaign and Governmental Conduct Code Section 3.217 (Disclosure
of the Gifts to The City), all City departments must disclose to the Ethics Commission donations from
a non-City source along with donor’s information and any financial interest you may have with City
departments.

To provide transparency and to meet the City’s legal obligations, we request that you answer the
questions to report financial interests you may have with the City.

Donor financial interests may include contracts, grants, leases, or pending requests for or issued
licenses, permits, or other entitlements from the City within the past 12 months.

Name(Required)

First Last

Address

Street Address Address Line 2 City State ZIP Code

Phone

Email(Required)

I have no financial interest with the City.(Required)

Yes

I have one or more contracts, grants, or leases with City departments.(Required)

Yes

If so, please identify the department(s) and provide contract number(s):(Required)

I am seeking one or more license, permit, or other entitlement for use with City departments.(Required)

Yes

If so, please identify the department(s) and provide a brief description of these licenses or permits:(Required)

I have been issued one or more licenses, permits, or other entitlements for use by City separtments within the last 12 months.(Required)

Yes

If so, please identify the department(s) and provide a brief description of these licenses or permits:(Required)

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Donor's Financial Disclosure Form

Donor’s Financial Disclosure Form

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