Toshiba Business Solutions, a division of Toshiba America Business Solutions, Inc.
Name of local government officer with whom the filer has an employment of business relationship:
Is the local government officer named in this section receiving or likely to receive taxable income, other than investment income, from the filer of the questionnaire?
Is the filer of the questionnaire receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer named in this section AND the taxable income is not received from the local governmental entity?
Is the filer of this questionnaire affiliated with a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership of 10 percent or more?
Describe each affiliation or business relationship with the local government officer.