HomeMy WebLinkAboutDouglasJester Affidavit Disclosure 2019 ti ti SS j r .G... z : -Sam.
" CITY OF LANSING
AFFIDAVIT OF DISCLOSURE
G �' _
TO: CITY CLERK DATE: /-),��;
I �i v 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. 0 ❑ 1 am an ❑elected or j9appointed Kofficer or❑employee of the City of
Lansing holding the position of y;tea, m js;a es--
in the A)�
❑ j , 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
❑ ,� 1 am a Business Associate of an elected or appointed offzCsf or .
employee of the City of Lansing named
holding the position of in the
Department.
2. ❑ 1 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)
❑ ,4 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]
❑ ( 1 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]
❑ 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 Ordinande
as provided for in the Code of Ordinances and in the City Charter.
3. My City of Lansing position is:
❑ Full-time ❑ Part-time (less than 25 hours/wk) Unpaid
4. PLEASE DESCRIBE IN DETAIL YOUR REASON(S)FOR SUBMITTING THIS DISCLOSURE
AND EXPLAIN WHY YOU THINK A CONFLICT MAWMAYNOT 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 lo -A day of Aor
20_4 .
igned
State of Michigan, County of=-'�2f
Subscribed and sworn to before me this /C) day of A-1 20 c
V , Notary Public/or Deputy Clerk
MONICAZUCHOWSW � +G il.�- County,Michigan
NOTARY PUBUC-STATE OF WCHM"
COUNTY OF R4W' tiM
My CQA��i'� 5 N r r,2025 My Commission Expires:
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?
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■ Are you self-employed? —
■ Who is your employer, if applicable? -5- LaJ AEne r
■ What are the things you actually do in the business? m rn�n
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■ Who are your clients and who receives your goods or services? 7j4-.pj,5 e,
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■ How and where are your services performed? Z q c r a-k 1 v ✓'>oa ,� �n a H
■ How often do you do outside work? a a„ G .� n ✓
■ Does your business or employer contract with the City? ke— X-
■ In performing your business or outside employment, do you use any City facilities or equipment?
If so, describe:
■ Is any of your business or employment conducted in the City? Yew If so, describe:
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■ Does your business advertisement or circulars,if any, contain any reference to the City or your
City employment?
■ Is there any additional information that you believe would assist the Board of Ethics in its review
of your business or personal activities for potential conflicts of interest? Yc3 If so,please
describe: n o,n - vo 7 " 'life m , �` s- d-- fie sU Z��J
►ier n, ;n e� ,� y ��e �,�y 1 a� � a.n�i as , lz ) Tli
In providing this additional information, the Board of Ethics asks that you give special attention to the
Conflicts of Interest section of the Charter found at 5-505.1 — 5-505.3. A copy is enclosed for your
convenience.