SUBMISSION OF YOUR STATEMENT OF EMPLOYMENT AND FINANCIAL INTERESTS

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP80M00165A001300020005-4
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 6
• Document Creation Date: December 15, 2016
• Document Release Date: February 11, 2004
• Sequence Number: 5
• Publication Date: July 8, 1976
• Content Type: MF

ati
Approve0or Release 2004/03/15: CIA-RDP80,165A0013
OGC 76-3787
8 July 1976
MEMORANDUM FOR: Director of Central Intelligence
FROM: Anthony A. Lapham
General Counsel
Executive Regis
SUBJECT: Submission of Your Statement of Employment and
Financial Interests
1. The attached letter will do the trick if (a) all your securities (stocks,
bonds, options, etc.) are in a blind trust; (b) any continuing financial interests
you may have (pensions, etc.), arising from prior employment or business
associations, were reported in your last statement; (c) any positions you hold
as partner, director, or trustee of any profit or non-profit corporation or other
enterprise were reported in your last statement; (d) you have not incurred any
indebtedness subsequent to your last statement, other than a mortgage on a
personal residence or indebtedness related to ordinary household and living
expenses, and (e) you have not acquired any real estate interests, other than
interest in a personal residence, subsequent to your last statement.
2. If all the conditions above are not met, the form report must be
completed, at least in part.
An ony apham
Attachment
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Distribution:
Original - Addressee
,r- ER via Exec Secy
1-OGC
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 Approve r Release 2004/03/15 : CIA-RDP80M00165AO0130002000
'ANTRAL INTELLIGENCE AGENCI
WASHINGTON, D.C. 20505
JUL 1976
Honorable Robert E. Hampton, Chairman
United States Civil Service Commission
Washington, D. C. 20415
Dear Mr. Hampton:
Under section 401 of Executive Order 11222, I must sutmit a
statement of employment and financial interests annually to the Civil
Service Commission. Pursuant to that requirement, I hereby report
that as of 30 June 1976 there are no changes in or additions to my last.
statement.
Sincerely,
/s/ George Bush
George Bush
Director
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Distribution:
Original - Addressee
1-DCI
It-' ER via Exec Secy
1-OGC
l~'6-191rci .~
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 Approved For Release 2004/0311;5 :,Cl .-RDP OM00165A001300020005-4
DIRECTOR OF CENTRAL INTELLIGENCE -~i7-(
6j-
2 2 JUTJ 1976
Tony-
do I need to keepsending in this damn form
if my holdings are in a blind trust,as they
are?
please return.
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 Approved Release 2004/03/15: CIA-RDP80M165A0013000201
UNITED STATES CIVIL SERVICE COMMISSION
WASHINGTON, D.C. 20415
June 21, 1976
SUBJECT: Filing of Your Statement of Employment and
Financial Interests
TO: Heads of Agencies, Certain Presidential
Appointees in the Executive Office of the
President and Members of Committees,
Boards and Commissions Appointed by the
President
FROM: Robert E. Hampto
Chairman
Executive Regiatay
05 I
'7
It is time again for the annual submission of your statement of
employment and financial interests. This filing is required under
Section 401 of Executive Order 11222.
In the statement, a copy of which is enclosed, you must report any
,changes in or additions to the last statement you filed with my
office. You should report your holdings and interests as of
June 30th of this year. If there are no changes or additions, a
letter. to that effect will suffice.
Your reply before July 15 will be appreciated.
Enclosures. (2)
THE MERIT SYSTEM-A
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 Approved Release 2004/03/15: CIA-RDP80M 65A001300020005-4
PRIVACY ACT NOTICE
(Accompanying Confidential Statement
of Employment and Financial Interests)
This information is being provided pursuant to Public
Law 93-579 (Privacy Act of 1974) for agency heads, certain
Presidential appointees in the Executive Office of the .
President and Presidentially appointed members of Federal
committees, boards and commissions required by Executive
Order 11222 to file Confidential Statements of'Employment
and Financial Interests with the Chairman of the Civil
Service Commission.
Section 401 of Executive Order 11222 constitutes the
authority for collecting the personal data on the attached
Confidential Statement of Employment and Financial Interests.
Each official designated above must supply this data. If it
is not supplied, information to this effect will be reported
to the President for appropriate action.
The information collected on the Statement will be used to
determine whether there are any real or apparent violations
of statutory and other restrictions contained in 18 U.S.C.
? 201 et sue., Executive Order 11222, 5 CFR Part 735 and the
jurisdictional statutes and ethics regulations of the official's
agency.
Approved For Release 2004/03/15 : CIA-RDP80M00165A001300020005-4
 CONFIDENTIAL STATEMENT OF EMPLOYMENT AND FINANCIAL INTERESTS
F1. NAME OF APPOINTEE Approver a lease 2004103115 : - -
PART I. EMPLOYMENT AND FINANCIAL INTERESTS. List the names of all through a pension or retirement plan, shared income, or other arrangement as a
corporations, companies, firms, or other business enterprises, partnerships, non? result of any current or prior employment or business or professional association;
profit organizations, and educational, or other institutions: (a) with which you or (c) in which you have any financial interest through the ownership of stock,
are connected as an employee, officer, owner, director, member, trustee, partner, stock options, bonds, securities, or other arrangements including trusts.
adviser, or consultant; or (b) in which you have any continuing financial interest,
NAME & KIND OF ORGANI-
ZATION.
(Use port )
atlons when
applieab/e.l
ADDRESS
POSITION IN ORGANIZATION.
(11" poW I (a) designations,
if appi,po i../
NATURE OF FINANCIAL
INTERESTo-p., STOCK,PRIOR
BUSINESS INCOME. (Uee pert r (b)
& (e) deeipnatbne, U opplmbi.J
whom you may be indebted by reason of a mortgage on property which you
occupy as a personal residence or to whom you may be indebted for current and
CHARACTER OF INDEBTEDNESS, os.. PERSONAL
LOAN. NOTE, SECURITY
PART III. INTERESTS IN REAL PROPERTY. List your interest in real property or rights in lands, other than property which you occupy as a personal residence.
NATURE OF INTEREST, e.1..
OWNERSHIP, MORTGAGE, LIEN.
INVESTMENT TRUST
TYPE OF PROPERTY, e.g.,
RESIDENCE, HOTEL, APARTMENT,
FARM, UNDEVELOPED LAND
ADDRESS. ()(Runt, pine RFD,
County and SroN.)
formation is to be supplied by other persons, e. g., trustee, attorney, accountant,
relative, please indicate the name and address of such persons, the date upon
which you requested that the information be supplied, and the nature of subject
ordinary household and living expenses such as household furnishings, automo-
bile, education, vacation, and similar expenses.
matter involved. Extra forms are enclosed for use by such persons. Additional
copies may be obtained from the Office of the Chairman, United States Civil
Service Commission.
PART V. SPECIAL STATUTORY RESTRICTIONS. Give the citation of any Exchange Act of 1934, as amended, 48 Stat. 885, 15 U.S.C. 78d. Your agency's
statute or other authority or regulation applicable to your position that prohibits general counsel should be able to furnish you these citations.
outside holdings or business interests of any type, e. g., sec. 4(a) of the Securities
I certify that the statements I have made are true, complete and correct to the best of my knowledge and belief.
Civil Service Commission Review
Approval
{Initials) (Date
Comments if any:
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