PERSONAL FINANCIAL DISCLOSURE STATEMENT

Revised December 2016LOUISIANA BOARD OF ETHICS Form 417www.ethics.la.gov Post Office Box 4368 Baton Rouge, Louisiana 70821 This Report Covers Calendar YearORIGINAL REPORTAMENDED REPORT I currently hold an office that would require me to file a Tier 3 Personal Financial Disclosure Statement. Name of Filer (print full name): I have filed for an extension of my federal income tax …

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