Form ADM4173 "Supplemental Nepotism Statement" - Ohio

What Is Form ADM4173?

This is a legal form that was released by the Ohio Department of Administrative Services - a government authority operating within Ohio. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 1993;
  • The latest edition provided by the Ohio Department of Administrative Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form ADM4173 by clicking the link below or browse more documents and templates provided by the Ohio Department of Administrative Services.

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Download Form ADM4173 "Supplemental Nepotism Statement" - Ohio

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State of Ohio
Supplemental Nepotism Statement
I have no known relatives or business associates currently employed by the State of Ohio.
I have relatives or business associates currently employed by the State of Ohio and have listed
them below:
Relatives or Business Associates
Name
Relationship
Position
Department
I have no interest in any business which currently or has in the past done business with the
State of Ohio.
I have business interests which are or have been involved in state business and have listed
them below:
Business Interests
Name of Business
My Interest
Summary of Services
Date
Signature
ADM 4173 (New 7/93)
State of Ohio
Supplemental Nepotism Statement
I have no known relatives or business associates currently employed by the State of Ohio.
I have relatives or business associates currently employed by the State of Ohio and have listed
them below:
Relatives or Business Associates
Name
Relationship
Position
Department
I have no interest in any business which currently or has in the past done business with the
State of Ohio.
I have business interests which are or have been involved in state business and have listed
them below:
Business Interests
Name of Business
My Interest
Summary of Services
Date
Signature
ADM 4173 (New 7/93)