South Gate, CA · Los Angeles County
California Levine Act Disclosure Statement
Businesses or parties involved in a City of South Gate contract use this form to disclose certain political contributions to Council Members.
What this form is
This statement records whether the party, its company, or an agent made political contributions over $250 to a Council Member during the 12 months before proposal submission or anticipated Council action, or plans such contributions in the following three months. If answering yes, the filer identifies the contributor and recipient. The signer certifies the information under penalty of perjury.
Who needs it
A business or party involved in a City of South Gate contract uses this statement to disclose the contributions it reports on the 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 signer certifies the statement under penalty of perjury and signs and dates it.
How to submit this form
- 1
Download The Form
Download the two-page California Levine Act Disclosure Statement PDF.
- 2
Complete Both Pages
Answer both contribution questions and identify contributors and Council Member recipients if you answer yes.
- 3
Sign And Date
Print your name and title, provide your company, and sign and date the certification.
- 4
Submit To The City
Submit it to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- Do I need a notary for the Levine Act Disclosure Statement?
- No. The document has no notary block; the signer certifies the statement under penalty of perjury and signs and dates it.
- What contributions does the form ask about?
- It asks whether the party, company, or an agent made contributions over $250 to a Council Member in the prior 12 months, or plans such contributions in the following three months.
- 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 California Levine Act Disclosure Statement doesn’t need a notary — but if you have another South Gate form that does, a commissioned online notary can help.