State of New Jersey
Department of Community Affairs
Division of Local Government Services
Local Finance Board
Enter the Local Government Served:
Local Government Ethics Law
Financial Disclosure Statement
Year of Service:
This Financial Disclosure Statement is required annually of all local government officers
in accordance with N.J.S.A. 40A:9-22.1 et seq., the Local Government Ethics Law.
2013
* The Year that you are filing
the statement
b4c0698c-f0ba-4b33-8492-58f430cc6fe6
Milford Borough - County of Hunterdon
Section I. Personal Information - Local Government Officer
jr
Richard
Aller
E
First Name:
______________________________
Middle:_________________
Last Name:______________________________
Suffix: ____________
12 Stover Ave Milford N.J. 08848
Home Address: _____________________________________________
Telephone Numbers (optional*)
(Optional*)
_____________________________________________
Home:
______________________
908 995 2521
_____________________________________________
Business:
______________________
**Spouse’s
Susan
E
Aller
First Name:
______________________________
Middle:_________________
Last Name:______________________________
Suffix: ____________
* Optional information, if supplied, is subject to public disclosure as part of the Financial Disclosure Statement.
** Spouse includes a Civil Union partner.
Agency
Position Held
Milford Borough
water wastewater superintendent licensed operator
1. _________________________________________
________________________________________
Holland Township
licensed operator
2. _________________________________________
________________________________________
3. _________________________________________ ________________________________________
4. _________________________________________ ________________________________________
5. _________________________________________ ________________________________________
Term Expires (if applicable)
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________________
________________
________________
________________
Section II. Financial Information
Provide the following information for yourself and members of your immediate family for the prior calendar year. If none, please indicate NONE in the
space provided. If additional space is needed, please scroll down and use the Extension Forms that have been provided.
A.
List the name and address of each source of income, earned and unearned, which you received in excess of $2,000. If a publicly traded security is the source of
income, the security need not be reported unless you or a member of your immediate family has an interest in the business organization.
Name
1. Richard Aller
2.
3.
4.
5.
B.
Self Spouse
12 Stover Ave Milford N.J. 08848
Dependent Name
Susan Aller
List the name and address of each source of fees and honorariums having an aggregate amount exceeding $250 received from any single source for personal
appearances, speeches, or writing.
Name
1.
2.
3.
4.
5.
Address
Address
Page 1
Self Spouse
Dependent Name
C.
List the name and address of each source of gifts, reimbursements or prepaid expenses having an aggregate value exceeding $400 from any single source,
excluding relatives.
Name
Address
Self Spouse
Dependent Name
1.
2.
3.
4.
5.
D. List the name and address of all business organizations in which an interest was held.
Name
Address
1.
2.
3.
4.
5.
Self Spouse
Dependent Name
E. List the address and a brief description of all real property in the State of New Jersey in which an interest was held.
Municipality/County
Block
Lot
Qual.
Address (if applicable)
1.
2.
3.
4.
5.
% of
Self Spouse
Ownership
Dependent Name
F. Please add any other information you believe is necessary to complete this form.
Section III. Certification
I hereby certify that this Financial Disclosure Statement contains no willful misstatement of fact or omission of material fact and, together with any and all statements
previously submitted in writing to the clerk of my local government or the Local Finance Board, constitutes a full disclosure with respect to all matters required by N.J.S.A.
40A:9-22.1 et seq., to the best of my knowledge. I am aware that if any of the foregoing statements made by me are willfully false, I am subject to fines and possible
disciplinary action.
Date:_____________________
Type your name _____________________________________
4/29/2013
Richard Aller
To complete the online filing process: Enter the e-mail address that was provided to you by the municipal clerk, county clerk, or other representative for the
local government that you serve. LGA Email: ___________________________________________________________
[email protected]
Enter the Email address that you use as a local government officer (optional*). LGO Email: _______________________________________________________
[email protected]
E-Filing Statement – (a.) I have personally reviewed and approved the foregoing financial disclosure statement and any Extention forms attached hereto; (b.) I have
personally filed or somebody has been authorized by me to file this form electronically with my consent. Accept
Denied
After you click the “Submit” button below the system will populate the receipt form indicating the date and time that you electronically submitted your financial disclosure
statement and assigning a receipt number. You must print the receipt and deliver a signed original copy of the receipt to your local government agency representative.
SUBMIT
Page 2
Section I Personal Information - Extension Forms.
Agency
6. _________________________________________
7. _________________________________________
8. _________________________________________
9. _________________________________________
10. _________________________________________
11. _________________________________________
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41. _________________________________________
42. _________________________________________
43. _________________________________________
44. _________________________________________
45. _________________________________________
46. _________________________________________
47. _________________________________________
48. _________________________________________
49. _________________________________________
50. _________________________________________
Position Held
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Page 3
Term Expires (if applicable)
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Section II financial Information - Extension Forms.
List the name and address of each source of income, earned and unearned, which you received in excess of $2,000. If a publicly traded security is the source of
income, the security need not be reported unless you or a member of your immediate family has an interest in the business organization.
Name
6.
7.
8.
9.
10.
11.
12.
13.
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48.
49.
50.
Address
Page 4
Self Spouse
Dependent Name
Section II financial Information - Extension Forms.
List the name and address of each source of fees and honorariums having an aggregate amount exceeding $250 received from any single source for personal
appearances, speeches, or writing.
Name
Address
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
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25.
Page 5
Self Spouse
Dependent Name
Section II financial Information - Extension Forms.
List the name and address of each source of gifts, reimbursements or prepaid expenses having an aggregate value exceeding $400 from any single source,
excluding relatives.
Name
Address
Self Spouse
Dependent Name
6.
7.
8.
9.
10.
11.
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Page 6 ��
Extension Forms.
List the name and address of all business organizations in which an interest was held.
Name
Address
6.
7.
8.
9.
10.
11.
12.
13.
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50.
Page 7
Self Spouse
Dependent Name
Section II financial Information - Extension Forms.
List the address and a brief description of all real property in the State of New Jersey in which an interest was held.
Municipality/County
6.
7.
8.
9.
10
11
12
13
14
15
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Block
Lot
Qual.
Address (if applicable)
Page 8
% of
Self Spouse
Ownership
Dependent Name
State of New Jersey
Department of Community Affairs
Division of Local Government Services
Local Finance Board
Local Government Ethics Law
Financial Disclosure Statement
This Financial Disclosure Statement is required annually of all local government officers
in accordance with N.J.S.$ 40A:9-22.1 et seq., the Local Government Ethics Law.
Year of Service:
2013
*The year that you are
filing this statement
ELECTRONIC FILING RECEIPT
Read the instructions at the bottom of this page. Print this receipt; sign the receipt; and deliver the receipt to your local government representative.
Monday 29 April 13 11:31 am
Date and time your financial disclosure statement was submitted electronically: _______________________________________
Receipt Number:
99073882
_______________________
Name of Local Government Officer:
First Name:
Richard
E
Aller
jr
______________________________ Middle:_________________ Last Name:______________________________ Suffix: ____________
Milford Borough - County of Hunterdon
Local Government Served: _________________________________________
______________________________________
Signature of Local Government Officer
Please read these instructions:
1.
The system will automatically populate the fields contained on this receipt except for your signature.
2.
Your financial disclosure statement will not be considered FILED until you sign this receipt and deliver it to your local government representative (e.g., municipal clerk,
county clerk, ethics board secretary, etc.). The receipt must contain the receipt number that is generated automatically by the Local Finance Board’s online filing system when you submit
your FDS electronically. Do not submit this receipt to the Local Finance Board.
3.
If you are a local government officer for more than one local government agency you must deliver a separate receipt (containing a different receipt number) to the representative
of each such agency.