HomeMy WebLinkAboutEvansenPaul Affidavit Disclosure 2009 From the 6/15/09 Council Meeting Packet
fE D CITY OF LANSING REFERRED.TO THE BOARD OF AFFIDAVIT OF DISCLOSURE ETHICS
DATE: 0 -S C�
TO: CITY CLERK,
CITY ATTORNEY, or
BOARD OF ETHICS
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
-ate —E1 I am an Ei ele'.cted or El appointed El officer or eeMployee of the City Of
Lansing holding the position of, in the
- A department
❑ C21 1 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.
El 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. 11 El" I may derive income or benefit directly from a contract with the city or
from any City action detailed below. (Charter 5-505.1)
0 z I may have a conflict between a personal interest and the public-- interest,
the nature of which is disclosed below (Char-ter 5-505,2) [ChaptED;C
#290,04(1)-of-the Code of Ordinances]
11 1 may have a financial interest in a matter proposed try be arztec:!k upon
the City of Lansing as described below[Chapter 29Q.04(1) of
Ordinances]
1 make this disclosure because of a possible appf--iaranc--e kVN-a&\
in violation of or in conflict with the City of Lansing I Ethics
provided for in the Code or Ordinances and in the City
3. This position is., El Full time 0 Part time (less than 25 hour s/WK)
4. My Address is:
CONTINUED ON PAGE 2
AFFIDAVIT OF DISCLOSURE-PAGE 2
5, My Business (daytime) Phone # is;
PLEASE DESCRIBE IN DETAIL YOUR REASON(S) FOR SUBMITTING THIS DISCLOSURE
6, AND EXPLAIN WHY YOU THINK A CONFLICT MAYIMAY NOT EXIST.
ri V1 4 e-� i� In lo-. Li n 0 Lu 1— 1 I. , l IL a v-C r{ S)�11� l 1 Vt C 0
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Lo I-•u i I Su I ej 1,. Q P 2 0 l) A lzuia I Sp r V i r r. i
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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 S day of O.LA -�
20 c)c( -
Signed
State of Michigan, County of
Subscribed and sworn to before me this day o tv -cJ 20 o
'4 �.—v
Notary Puy blic%r Deputy Clerk
County, Michigan
My Commission Expires:
DRAFT 5A;REVISED 10-09-01