Modesto, CA · Stanislaus County
California Levine Act Disclosure
This disclosure form asks a company or applicant to report political contributions connected with a proposal or contract involving the City of Modesto.
What this form is
The form asks whether the company, applicant, or an agent made or plans to make political contributions of more than $500 to a City officer within specified 12-month periods related to a proposal or Council action. It is used in connection with proposals or anticipated Council action related to a contract, and asks the signer to identify Council members if either answer is yes.
Who needs it
A company or applicant submitting a proposal or involved in a contract related to Council action completes the disclosure about contributions by itself or its agents.
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 authorized individual signs and dates a certification made under penalty of perjury.
How to submit this form
- 1
Download the Form
Download the California Levine Act Disclosure PDF.
- 2
Answer the Questions
Answer both questions about political contributions by you, your company, or an agent.
- 3
Identify Council Members
If you answer yes to either question, identify the Council member or members.
- 4
Sign and Submit
Enter the date, have an authorized individual sign, and submit the form to the city department named on it.
Frequently asked questions
- What does the California Levine Act Disclosure ask?
- It asks whether the company, applicant, or an agent made or anticipates political contributions of more than $500 to a City officer within the specified 12-month periods.
- Who completes the Levine Act Disclosure?
- The party making the certification—such as a company or applicant involved in a proposal or contract related to Council action—completes the form.
- Do I need a notary for the California Levine Act Disclosure?
- No. The authorized individual signs and dates the form without a notary; the certification is made under penalty of perjury.
- How do I submit the Levine Act Disclosure?
- 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 doesn’t need a notary — but if you have another Modesto form that does, a commissioned online notary can help.