HomeMy WebLinkAboutGifts Disclosure Statement Form (05/2022)Revised 05/2022
GIFTS DISCLOSURE STATEMENT
This statement covers the period from June 1 of the preceding calendar year through May 31 of this year and is due on June 30. Please submit this completed form to the Board of Ethics at 101 Aupuni Street, Suite 325, Hilo, HI 96720 or via email to the Board of Ethics: Boardofethics@hawaiicounty.gov
NAME: COUNTY POSITION:
COUNTY AGENCY: COUNTY TELEPHONE NO.:
COUNTY MAILING ADDRESS:
DONOR DESCRIPTION OF GIFT DATE
RECEIVED
GIFT
VALUE
AGG.
VALUE
Attach additional sheets if necessary. CERTIFICATION
I hereby certify that the above is a true, correct, and complete statement. __________________________________________
SIGNATURE DATE
BOARD OF ETHICS, County of Hawai‘i
101 Aupuni Street, Suite 325, Hilo, Hawai‘i 96720
Telephone: (808) 961-8251
Revised 05/2022
HAWAI‘I COUNTY CODE SECTION 2-91.5
Reporting of Gifts (a) Every officer and employee shall file a gifts disclosure statement with the County board of ethics on June 30 of each year if all the following conditions are met: (1) The officer or employee, or spouse or dependent child of an officer or employee,
received directly or indirectly from one source any gift or gifts valued singly or in the
aggregate in excess of $100, whether the gift is in the form of money, service, goods, or in any other form; (2) The source of the gift or gifts have interests that may be affected by official action or lack of action by the officer or employee; and
(3) The gift is not exempted by subsection (d) from reporting requirements under this
subsection. (b) The report shall cover the period from June 1 of the preceding calendar year through May 31 of the year of the report. (c) The gifts disclosure statement shall contain the following information:
(1) A description of the gift;
(2) A good faith estimate of the value of the gift; (3) The date the gift was received; and (4) The name of the person, business entity, or organization from whom, or on behalf of whom, the gift was received.
(d) Excluded from the reporting requirements of this section are the following:
(1) Gifts received by will or intestate succession; (2) Gifts received by way of distribution of any inter vivos or testamentary trust established by a spouse or ancestor; (3) Gifts from a spouse, fiancé, fiancée, any relative within four degrees of consanguinity
or the spouse, fiancé, or fiancée of such a relative. A gift from any such person is a
reportable gift if the person is acting as an agent or intermediary for any person not covered by this paragraph; (4) Political campaign contributions that comply with state law; (5) Anything available to or distributed to the public generally without regard to the official
status of the recipient;
(6) Gifts that, within thirty days after receipt, are returned to the giver or delivered to a public body or to a bona fide educational or charitable organization without the donation being claimed as a charitable contribution for tax purposes; and (7) Exchanges of approximately equal value on holidays, birthday, or special occasions.
(e) Failure of an officer or employee to file a gifts disclosure statement as required by this
section shall be a violation of this article. (1995, Ord. No. 95-21, sec. 2; Am. 2002, Ord. No. 02-109, secs. 6 and 7.)2