Dublin, CA · Alameda County
Levine Act Disclosure Statement and Form
Applicants for City of Dublin licenses, permits, or other entitlements for use complete this form to disclose ownership, financial interests, and campaign contributions.
What this form is
The form collects information about the project, permit number, applicant, people with ownership or financial interests, and certain campaign contributions. The document says applicants for licenses, permits, and other entitlements for use must complete and file the disclosure form so the City and City Officials are aware of reportable contributions.
Who needs it
Applicants for a City of Dublin license, permit, or other entitlement for use must complete and file this disclosure form.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This document is signed without a notary; the applicant certifies the information under penalty of perjury and signs and dates the form.
How to submit this form
- 1
Download The Form
Download the Levine Act Disclosure Statement and Form.
- 2
Complete The Disclosure
Enter the project and permit details, applicant name, ownership or financial interests, and requested contribution information.
- 3
Sign And Date
Certify that the information is true and accurate to the best of your knowledge, then sign and date the form.
- 4
Submit To The City
Submit the completed form to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- Who completes the Levine Act Disclosure Statement?
- Applicants for City of Dublin licenses, permits, or other entitlements for use complete and file the form.
- What information does the form request?
- It asks for project and permit details, applicant name, ownership or financial interests, and information about certain campaign contributions.
- Do I need a notary for the Levine Act Disclosure Statement?
- No. The document has no notary block; the applicant certifies the information under penalty of perjury and signs and dates the form.
- How do I submit the Levine Act Disclosure Statement?
- Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This Levine Act Disclosure Statement and Form doesn’t need a notary — but if you have another Dublin form that does, a commissioned online notary can help.