Levine Act Campaign Contribution Disclosure Form

You must submit this completed Disclosure Form to the County of Ventura (County) if you or your company are seeking approval of a discretionary land use permit, subdivision map or approval, or other discretionary land use entitlement (collectively, Entitlement).

Land use-related Entitlement applications are potentially reviewed and decided by the Board of Supervisors, Planning Commission, and Cultural Heritage Board. In making the disclosures below, please see the following websites for a list of these current County officials:

Name:(Required)

Email:(Required)

Address:

Telephone:

Have you or your company, or an agent on behalf of you or your company, made campaign contributions totaling more than $500 to a County official in the past 12 months?

Yes

Name of each official to whom a contribution was made:

Name of contributor(s):

Date(s) of contributor(s):

Amount(s) of contribution(s):

If the applicant is a corporation, limited liability corporation, partnership, or other form of business entity, please identify any shareholder or owner that has more than a 50% ownership interest:

Attach separate pages if needed:

Max. file size: 200 MB.

While your application is pending, you must submit a supplemental form for any new campaign contributions totaling more than $500 that are made to a County official.

By typing my full legal name, I am electronically signing this form and certifying that the information provided is true and accurate.(Required)

Date:

Levine Act Campaign Contribution Disclosure Form

Translate Disclaimer