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HomeMy WebLinkAboutForbisRob Affidavit Disclosure 2009 CITY OF LANSING FFIDAVIT OF DISCLOSURE OV DATE: TO: CITY CLERK, Lansing City Attorney CITY ATTORNEY, or BOARD OF ETHICS I ll?n-112 . 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. ❑ I am an ❑ elected or❑ appointed X officer or❑ employee of the City of Lansing holding the position of. 000/iGL in the L,f.✓fiv ,p�.lc� department ❑ l I am an immediate family member related to an elected or appointed officer or employee. of the City of Lansingnamed holding the position of in the. department. ❑ 1 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. ❑ �'. I may derive income or benefit directly from a contract with the.City or from- any City action detailed below. (Charter 5-505.1) ❑ I may have a conflict between a personal interest and the public interest, the nature of which is disclosed below (Charter 5-505.2) [Chapter #29.0.04(l) of-the Code of Ordinances] ❑ l 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 in 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: ❑ Full time lei Part time (less than 25 hours/wk) ❑ Unpaid 4. My Address is: 5. My Business (daytime) Phone#is: CONTINUED ON PAGE 2 AFFIDAVIT OF DISCLOSURE-PAGE 2 i 6. PLEASE DESCRIBE IN DETAIL YOUR REASON(S) FOR SUBMITTING THIS DISCLOSURE AND EXPLAIN WHY YOU THINK CONFLICT MAY/MAY NOT EXIST. �'x f���,1!/� ,/2�S-s' s� .��✓ as/�:✓✓r ,.}r✓� �'�/,mac G�lv£lL �DIL ���/�r�l✓/ice` / ��i� y�ir9.v�'� /T %f az i I 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 day -of. .7>rJ�rf�,33,go a 91 Signed State (Michigan, County of Subscribed and sworn to before me this !day of 20 N tary Public%r Deputy Clerk County, Michigan My Commission Expires: 68l2y�.w PLEAS LUDE AND SUBMIT A COPY.OF YOUR CURRENT JOB DESCRIPTION James!i.tae6.fne, Ivry PLOC DRAFT5A;REVISED 11-05-04 5uft0f moftm,cow*dfngtom �H Commission! &24 �11 MUM in the County a VEL: I its ' �;�< CITY OF LANSING .I 0 i_'''IAFFIDAVIT OF DISCLOSURE ;.. LRI- 1 =C'' DATE: TO: CITY CLERK, City Attorney CITY ATTORNEY, or BOARD OF ETHICS l 120-15F make the following disclosure under oath: (Name) PLEASE CHECK THE APPROPRIATE BOX OR FILL IN THE BLANKS FOR EACH O.F THE FOLLOWING ITEMS Yes No ❑ I am an ❑ elected or❑ appointed X officer or❑ employee of the City of Lansing holding the position of. 000//zE in the Zll,fiG- 10o 1* department ❑ l I am an immediate family member related to an elected or appoirited officer or employee.of the City of.Lansing named holding the position of in the- department. ❑ q' 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. ❑ I may derive income-or benefit directly from a contract with the.City or from- any City action detailed below. (Charter 5-505.1) ❑ I 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(1) 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(1) of the Code of Ordinances] ❑ . ( I 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 or Ordinances and in the City Charter 3. This position Is: ❑ Full time 0 Part time (less than 25 hours/wk) ❑ Unpaid 4. My Address is: 5. My Business (daytime) Phone#is: CONTINUED ON PAGE 2 AFFIDAVIT OF DISCLOSURE-PAGE 2 PLEASE DESCRIBE IN DETAIL YOUR REASON(S) FOR SUBMITTING THIS 6. DISCLOSURE AND EXPLAIN WHY YOU THINK CONFLICT MAY/MAY NOT EXIST. �--r ,-9-� J� rl� ��.2e7G€SS Gam'" Si�r9i�Ti.��- ��-✓ -2am ��a T.�i�°2rir9-/ /'�<'tfTJ.-'�� o .TrG�.frb�✓,�-/ �' J7`�� .. . . ... ��1'OGr:•i�� T� J��/� Gj Gd= L��fr"�G ar=" :�©d Z�" i I hereby certify that this disclosure is complete and accurate to the best of-my knowledge, information and belief. Ail The foregoing Affidavit of Disclosure was executed on this day -of Signed f StateMichigan, County of Subs r►bed and sworn to before me this day of ✓ 20 N tary Public%r Deputy Clerk k) V-- County, Michigan My Commission Expires: b?jZgA11 PLEAS LUDEE AND SUBMIT A COPY.OF YOUR CURRENT JOB DESCRIPTION imm R DeLirm, Notary Pubk DRAF75A;REVISED 11-05-04 Stmof couraydtrlgtom Ed C,omntiasion $l?I01Act t11e County of 1 •- EIV RE G_ E_I_VE CITY OF LANSING AFFIDAVIT OF DISCLOSURE - NOV 2 3 2009 DATE: TO: CITY CLERK, Lansing City Attorney CITY ATTORNEY, or - BOARD OF ETHICS I 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. ❑ I am an ❑ elected or❑ appointed X officer or ❑ employee of the City of Lansing holding the position of '0011z- in the �h�✓J� �%- a��.Gc� department ❑ 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. ❑ �'. I may derive income-or benefit directly from a contract with the.City or from any City action detailed below. (Charter 5-505.1) ❑ i I 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 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 in 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 ls: o Full time V Part time (less than 25 hours/wk) ❑ Unpaid 4. My Address is: 5. My Business (daytime) Phone#is: CONTINUED ON PAGE 2 AFFIDAVIT OF DISCLOSURE-PAGE 2 ' I 6. PLEASE DESCRIBE IN DETAIL YOUR REASON(S) FOR SUBMITTING THIS DISCLOSURE AND EXPLAIN WHY YOU THINK A CONFLICT MAY/MAY NOT EXIST. -/�1�.,,�.��i�� L��✓��-G f�c1',,n%�'sS, -.� �✓�/� fly€Gf�'/%�£' ��a T.Li��L��9 /'f��T!"7G , /T�i j�ir�t✓,,y�/ 1' t���OG.° ice /�1 G/` GAG �,�^�f✓' /G G �O diZ� .I Qze9llp_�Ib__71 I f ' � �D 1�G� !✓rG�lGfL � �fj^� �/��CSa'r���� �G✓�� I Gvi✓1 -115-f- f 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 day .of. lvd;tfin3�0�. . Signed r , Staterf Michigan, County of Subs ribed and sworn to before me this day of KL20 N itary Public%r Deputy Clerk k) v--\ County, Michigan My Commission Expires: b8�2�t�iV PLEAS LLUDE AND SUBMIT A COPY.OF YOUR CURRENT JOB DESCRIPTION wwl....■.r>wrn..� irm R ovum,m, Flotaiy Pubic DRAFT 5A;REVISED 11-05-04 Shls of Mich W'County d Ingham W Com ftsion E*k"8W=1 I AcIJng in the County of l"�