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Optional: Additional <br /> facts-e.g., why <br /> there is a low risk of <br /> undue favoritism or <br /> improper influence. <br /> WRITE AN X TO CONFIRM THE STATEMENT BELOW. <br /> If you cannot confirm <br /> this statement, -x-Taking into account the facts that I have disclosed above, I feel that I can perform my <br /> you should official duties objectively and fairly. <br /> recuse yourself. <br /> Employee signature: <br /> Date: <br /> 05.13.2024 <br /> Attach additional pages if necessary. <br /> Not elected to your public position—file with your appointing authority. <br /> Elected state or county employees—file with the State Ethics Commission. <br /> Members of the General Court—file with the House or Senate clerk or the State Ethics Commission. <br /> Elected municipal employee—file with the City Clerk or Town Clerk. <br /> Elected regional school committee member—file with the clerk or secretary of the committee. <br /> Form revised July, 2012 <br />