Paxtang, PA · Dauphin County
Act 44 Standard Disclosure Form
This form collects required disclosures from contractors providing professional services to the Borough of Paxtang’s municipal pension system.
What this form is
The Borough of Paxtang identifies this form as required for contractors providing professional pension services and receiving payment from its pension fund. Contractors identify the pension plan involved and answer questions about personnel, relationships, contributions, gifts, and potential conflicts of interest. The form also includes a verification for an authorized contractor representative to sign and date.
Who needs it
Contractors providing professional services to the Borough of Paxtang’s pension system and receiving payment from its pension fund must complete this disclosure.
How to submit it
Return the completed form to Borough of Paxtang, Attn: Keldeen Stambaugh, 3423 Derry Street, Harrisburg, PA 17111, or email [email protected].
About notarization
This form is signed and dated without a notary; its verification refers to unsworn falsification to authorities, and no notarized attachment is listed.
How to submit this form
- 1
Download the Form
Download the Act 44 Standard Disclosure Form PDF.
- 2
Complete the Disclosures
Identify the applicable pension plan, answer the disclosure questions, and provide details for any Yes or Applies responses.
- 3
Gather Any Attachments
If more room is needed, include a separate page with the question number and corresponding answer.
- 4
Sign and Return
Sign and date the verification, then return the form to the Borough of Paxtang by mail or email.
Frequently asked questions
- Do I need a notary for the Act 44 Standard Disclosure Form?
- No. The form’s verification is signed and dated without a notary and refers to unsworn falsification to authorities; no notarized attachment is listed.
- Who completes the Act 44 Standard Disclosure Form?
- The form is for contractors providing professional services to the Borough of Paxtang’s municipal pension system and receiving payment from its pension fund.
- How do I submit the Act 44 Standard Disclosure Form?
- Return the completed form to the Borough of Paxtang, Attn: Keldeen Stambaugh, at 3423 Derry Street, Harrisburg, PA 17111, or email it to [email protected].