Secretary of State - Business Division
Dallas Divide, Colorado
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Conflict of Interest Filing

Please fill in all of the required fields:

Name of Elected Official or
Member with Potential Conflict
Last Name *   First Name * Middle Name Suffix

Business Address
Address 1: *
Address 2:
City: *
State: *
Zip: *

Additional Information
Position / Title: *
District or Office: *
Amount of Financial Interest: *
Other applicable information:
(max. 1000 characters, if more than 1000 characters, please use an attachment.)

Purpose and duration of services rendered: *
Please note: The box above must be left blank in order to attach a document
(max. 1000 characters, if more than 1000 characters, please use an attachment.)

 
OR
 
(Select 'Yes' to include one or more attachments with information about the purpose and duration of services rendered. Up to five attachments may be included.): Yes
No