HomeMy WebLinkAboutCochranThomas Affidavit Disclosure 2019 (2) CITY OF LANSING
AFFIDAVIT OF DISCLOSURE, .
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TO: CITY CLERK DATE: 3-8-2019
I Thomas Dominic Cochran make the following disclosure under oath:
(Name)
PLEASE CHECK THE BOX AND FILL IN THE APPROPRIATE BLANKS FOR EACH OF THE
FOLLOWING ITEMS
Yes No
1. ❑ I am an❑elected or❑appointed❑officer oroO employee of the City of
Lansing holding the position of Director,Lansing Public Media Center
in the Office of Community Media Department
❑ IV I am an immediate family member related to an elected or appointed
officer or employee of the City of Lansing named ,
holding the position of in the
Department
❑ LV I am a Business Associate of an elected or appointed officer or
employee of the City of Lansing named
holding the position of in the
Department.
2. ❑ JV I may derive income or benefit directly or indirectly from the bidding of,
negotiation of, solicitation of or entry into a contract with the City or from
and City action detailed below. (Charter 5-505.1)
❑ 1 may have a conflict between a personal interest and the public
interest, the nature of which is disclosed below. (Charter 5-505.2)
[Chapter 290.04(I) of the Code of Ordinances]
❑ I may have a financial interest in a matter proposed to be acted upon
by the City of Lansing as described below. [Chapter 290.04(I) of the
Code of Ordinances]
pg ❑ 1 make this disclosure because of a possible appearance that I may be
in violation of or in conflict with the City of Lansing Ethics Ordinance
as provided for in the Code of Ordinances and`•iri theCity Charter.
ATTACHMENT TO AFFIDAVIT OF DISCLOSURE
Please provide, additional information about your outside business or employment. Of special
interest to the: Board is how the activities of the business or employment may directly or
indirectly affect the City. This disclosure is about information and is not an indication of any
anticipated conflict of interest or suspected wrongdoing. Therefore,please describe for the Board
what it is you actually do and be detailed and specific. You are not required to limit your
disclosure only to the following questions. For each business, include in your answer such things
as:
■ What is the form of your business entity and what percentage do you own?
Ahptic Productions, LLC
33 %
■ Are you self-employed? No
■ Who is your employer,if applicable? City of Lansing
■ What are the things you actually do in the business? Produce TV commercials
■ Who are your clients and who receives your goods or services? Advertising agencies
■ How and where are your services performed? Production on location all over the midwest
and post-production in Lansing(95%by employees
and partners, not myselo.
CITY OF LANSING
AFFIDAVIT OF DISCLOSURE
DATE:
TO: CITY CLERK,
CITY ATTORNEY, or
BOARD OF ETHICS
I, R �ocG ran1 -, make the following disclosure under oath:
(Name)
PLEASE CHECK THE APPROPRIATE BOX OR FILL IN THE BLANKS FOR EACH OF THE
FOLLOWING ITEMS
Yes No
1. CR ❑ I am an ❑elected, or Rappointed officer or employee of the City of
Lansing
❑ ❑ I am an immediate family member related to an elected or appointed
officer or employee of the City of Lansing named ,
holding the position of in the
department.
❑ ❑ I am a Business Associate of an elected or appointed officer or
employee of the City of Lansing named
Holding the position of in the
Department.
2. lb ❑ I may derive income or benefit directly from a contract with the City or
from any City action detailed below. (Charter 5-505.1)
❑ ❑ 1 may have a conflict between a personal interest and the public
interest, the nature of which is disclosed below (Charter 5-505.2)
[Chapter#290.04(I) of the Code of Ordinances]
❑ Cl I may have a financial interest in a matter proposed to be acted upon
by the City of Lansing as described below [Chapter 290.04(I) of the
Code of Ordinances]
❑ ❑ I make this disclosure because.of a possible appearance that I may be
ih,,violation of or in conflict with the City of Lansing Ethics Ordinance as
provided for. in the Code or Ordinances and in the City Charter
3. This position is: K Full time ❑ Part time (less than 25 hours/wk) ❑ Unpaid
4. My Address is:
CONTINUED ON PAGE 2
AFFIDAVIT OF DISCLOSURE-PAGE 2
5. My Business (daytime) Phone # is: y S3 -05 G
PLEASE DESCRIBE IN DETAIL YOUR REASON(S)FOR SUBMITTING THIS DISCLOSURE
6. AND EXPLAIN WHY YOU THINK A CONFLICT MAY/MAY NOT EXIST.
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I hereby certify that this disclosure is complete and accurate to the best of my
knowledge, information and belief.
The foregoing Affidavit of Disclosure was executed on this 3 day of &A u,54
. 2001
Signed
State of Michigan, County of
Subscribed and sworn to before this 5 day of 2001
Notary Public%r Deputy Clerk
County, Michigan
My Commission Expires: fl m unty, M1
my Comm. Exo1res Dec. 12,2003
DRAFT 4A;REVISED 5-09-01