This government document is issued by State Ethics Commission for use in Maryland
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https://www.google.com/url?client=internal-element-cse&cx=007821330218074952993:soh-ofbnzfm&q=https://ethics.maryland.gov/wp-content/uploads/filebase/Forms-Publicly-Available-1-1-19.pdf&sa=U&ved=2ahUKEwiz8IL6luKGAxUS8QIHHYpZC-s4HhAWegQIARAB&usg=AOvVaw3yLe3FkYYMXkpqiL_Pkqg9&arm=e&fexp=72519171,72519168