disclosures: 05cd99fa362b555c42da88c139ec569ff722b8cb49da1a4324206e6db1327933

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05cd99fa362b555c42da88c139ec569ff722b8cb49da1a4324206e6db1327933 2020/Sansoucy,_George_E._3.10.2020_-_6_-_3.pdf 2020 George E. Sansoucy   Massachusetts Department of Revenue DISCLOSURE BY NON-ELECTED STATE EMPLOYEE OF FINANCIAL INTEREST AND DETERMINATION BY APPOINTING AUTHORITY AS REQUIRED BY G. L. C. 268A, § 6 STATE EMPLOYEE INFORMATION Name: George E. Sansoucy Title or Position: Outside Expert Appraiser State Agency: Massachusetts Department of Revenue Agency Address: 100 Cambridge Street Boston, MA 02114 Office Phone: 603-788-4000 Office E-mail: gsansoucy@sansoucy.com My duties require me to participate in a particular matter, and I may not participate because of a financial interest that I am disclosing here. I request a determination from my appointing authority about how I should proceed. PARTICULAR MATTER Particular matter E.g., a judicial or other I work as an outside expert assessor for the Department of Revenue for the proceeding, application, Commonwealth of Massachusetts ("DOR"). In that capacity, I make recommendations for submission, request for a ruling or other the valuation of telecommunication property that is subject to the provisions of the "central determination, contract, valuation statute" set forth at G.L. C. 59, § 39. I additionally provide expert witness claim, controversy, services on behalf of the DOR concerning my recommended valuations. charge, accusation, arrest, decision, determination, or finding. My valuations affect every municipality in the Commonwealth of Massachusetts, including the Town of Shutesbury, MA. Your required participation in the Appraisal services through my company, George E. Sansoucy, P.E., LLC particular matter: E.g., approval, disapproval, decision, recommendation, rendering advice, investigation, other. FINANCIAL INTEREST IN THE PARTICULAR MATTER Write an X by all that apply. I have a financial interest in the matter. My immediate family member has a financial interest in the matter. My business partner has a financial interest in the matter. I am an officer, director, trustee, partner or employee of a business organization, and the business organization has a financial interest in the matter. I am negotiating or have made an arrangement concerning future employment with a person or organization, and the person or organization has a financial interest in the matter. Financial interest Please explain the financial interest and include a dollar amount if you know it. in the matter My company's potential future employment is with the Town of Shutesbury. George E Sansoucy PE, LLC is anticipating a contract with the Town of Shutesbury. The scope of services will involve an appraisal and consulting services relating to the electric utility property owned by Eversource/NSTAR, Massachusetts Electric, and New England Power Co. located in the Town of Shutesbury, MA. I believe this work will not negatively impact the central valuation telephone property work performed for Mass DOR. Pursuant to G.L. C. 59, § 39, municipalities are required to use the DOR's central valuation of telecommunication property for local taxation purposes. Accordingly, municipalities in the Commonwealth, including the Town of Shutesbury, often have an interest in the outcome of my work for the DOR. Employee Signature:. Georgiansourg Date: February 7, 2020 DETERMINAION BY APPOINTING OFFICIAL APPOINTING INFORMATION Name of Appointing Authority: Timothy Rooney Title or Position: Deputy Commissioner and(FO, Financial Services Agency/Department: Massachusetts Department of Revenue Agency Address: 100 Cambridge Street Boston, MA 02114 Office Phone: 617-626-3515 Office E-mail rooheyt@dov.state.ma.us DETERMINATION Determination by As appointing official, as required by G.L. C. 268A, § 6, I have reviewed the particular matter and the appointing authority: financial interest identified above by a state employee. Write an X I am assigning the particular matter to another employee, or by your selection. I am assuming responsibility for the particular matter, or I have determined that the financial interest is not so substantial as to be deemed likely to affect the integrity of the services which the Commonwealth may expect from the employee. Appointing Authority signature: Date: Twith 3/10/20 Rom Comment: Attach additional pages if necessary. File copy with: State Ethics Commission, One Ashburton Place, Room 619, Boston, MA 02108 Form Revised February, 2012 1266819.1 07685-000 1295988.1 07685-000 2020/Sansoucy,_George_E._3.10.2020_-_6_-_3.pdf