HomeMy WebLinkAboutGarciaNoel Affidavit Disclosure 2012 CITY OF LANSING
AFFIDAVIT OF DISCLOSURE
DATE:
TO: CITY CLERK,
CITY ATTORNEY, or
BOARD OF ETHICS
I f�6L l/f���%I� , y�t 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. IV ❑ I am an ❑ elected or❑ appointed El officer or, employee of the City of
11
1 Lansing holding the position of L)E-V7 7' in the
PoL4 (,E department
❑ A 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 Jn .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. ❑ 1 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]
❑ 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 VPart 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 AC-ONFLICT MAY/MAY.NOT EXIST,
80 ry Ftj Ali Tqc Ci T ;-" /Yl r'lvT�sv z'/d1L---s
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O S S 0 &:g /9 f►0 p,�-(/ivC.T- '�rJ�'t�s C��'� ,l�r
Ent OCo��� H-7 8 F}�✓L- C�z. c�i� E fv D�/V
LL_� JL kV0 vi1__r1 Or 14 r ,1'0S/ /0/l/ 121Ci2E_
7V Cam/144 l/III_ moils C-6-b
� PEA°T
l 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
20 1 o
r^^
Signed
State of Michigan, County of J•��
Subscribed and sworn to before me this day of 20 10
Notary-Public%r Deputy Clerk
C I I h fiw, County,.Michigan ,
JASON M.PIERCE J
NOTARY PUBLIC-STATE OF MICHIGAN My ommission.Expires:.
COUNTY OF CLINTON Z— 12—= 2o.1-3
My CommissionfIngham0l
Acting in the county o
PLEASE INCLUDE AND SUBMIT A COPY OF YOUR CURRENT JOB DESCRIPTION
DRAFT 5A;REVISED 11-05-04
CITY OF LANSING
AFFIDAVIT OF DISCLOS
DATE:
CLERK, 201D
CITY ATTORNEY, or
BOARD OF ETHICS
AA)C-,ALA SLtK-0ViCH- make the followi
(Name)
PLEASE CHECK THE APPROPRIATE BOX OR FILL IN THE BLANKS FOR EACH OF THE
FOLLOWING ITEMS
Yes No
I am an El elected or 0 appointed Ei officer orXempioyee of the City of
—,-
Lansing holding the position of 420t-jC_t;::�7 Cq FIC�eT in the
CF, i5J0-t department
I am an immediate family member related to an elected or appointed
officer or employee of the City of Lansing named I
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. ❑ 1 may derive income or benefit directly from a contract with the City or from
any City action detailed below. (Charter 5-505.1)
El ;K 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(l) of the Code of Ordinances]
E] 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(l) of the Code of
Ordinances]
❑ I� 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: 0 Full time A Part time (less than 25 hours/wk) 0 Unpaid
4. My Address is:
5. My Business (daytime) Phone # is:
CONTINUED ON PAGE 2
AFFIDAVIT OF DISCLOSURE-PAGE 2
6. PLEASE DESCRIBE IN DETAIL YOUR REASON(S) FOR SUBMITTING THIS
DISCLOSURE AND EXPLAIN WHY YOU THINK A CONFLICT MAY/MAY NOT EXIST.
� 14A4 'C,!F3,L4 r rn Iu6 Tff( S lJ IS CLbSU�
I�Ccoe-p (JL)6 -0 LP-b r Zkl C yy "4'A)-D f'eo6e!�7'buee'
JZ) --tf tk)�L- -RiE�P-E lS 74- CD�t,��Ll LT
C�r.[S CAT- i.�,�G -{ 5 lit,),- � 7� U)r774
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 5 7'6 day of
20_Zo
Signed
State of Michigan, County of
Subscribed and sworn to before me this day of 20 C j
Notary Public%r Deputy Clerk
County, Michigan
Bro
Mtft
10�1 Publir ! U. U My Commission Expires:
Any Corrirniss;u,;.:,,,�,:.� +;d�I. 17,2011 / I
PLEASE INCLUDE AND SUBMIT A COPY OF YOUR CURRENT JOB DESCRIPTION
DRAFT 5A;REVISED 11.05.04
ATTACHMENT A
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? MO JE
■ Are you self-employed? fJ�
■ Who is your employer, if applicable? S -(/ !t. e
■ What are the things you actually do in the business?
p1?Ep AIJI). Sip u3 IL)(, .
■ Who are your clients and who receives your goods or services?
D,el Gu r-:1ot S
■ How and where are your services performed? VAP_1i5S
Page 1 of 3
■ How often do you do outside work? Z0 faVUPS 4 1��e
■ Does your business or employer contract with the City? I"o
■ In performing your business or outside employment, do you use any City
facilities or equipment?_ 1� If so, describe:
■ Is any of your business or employment conducted in the City? 1O If so,
describe:
■ Does your business advertisement or circulars, if any, contain any
reference to the City or your City employment? 02
■ If your business uses advertisements, circulars, applications, or order
forms that you have designed or have had designed for you, please attach
a copy of the applicable form(s).
Page 2 of 3
■ If you provide training or education as part of your business:
Do you identify yourself to your clients or students as being employed by
the City of Lansing? ��c7
Do you include in any of the written materials or aids or reference in any
way in your presentations reference to policies, procedures, methods or
materials as being those also used by the City of Lansing? kJb If so,
attach a copy of the material or aid and explain the reference in your
presentation.
■ Is there any additional information that you believe would assist the Ethics
Board in its review of your business or personal activities for potential
conflicts of interest? !u✓ If so, please describe:
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.
Page 3 of 3
CITY OF LANSING
AFFIDAVIT OF DISCLOSURE
DATE:
TO: CITY CLERK,
CITY ATTORNEY, or
BOARD OF ETHICS I r,
IKI G t L-. �(� make the following disclosure under oath:
(Name)
r„ m
PLEASE CHECK THE APPROPRIATE BOX OR FILL IN THE BLANKS FOR EACFr-bF TIE rn
FOLLOWING ITEMS `'
Yes No
1. ❑ I am an ❑ elected or ❑ appointedXofficer or ❑ employee of the City of
Lansing holding the position of L:)mEVT ENtYP--,T in the
Po U c.-E 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.
❑ ❑ 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. ❑ ❑ 1 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(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]
❑ ❑ 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 XPart 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
6. PLEASE DESCRIBE IN DETAIL YOUR REASON(S) FOR SUBMITTING THIS
DISCLOSURE AND EXPLAIN WHY YOU THINK A CONFLICT MAY/MAY NOT EXIST.
I W)LL BE T c n�1, G4r Mj Al L_ T .S c E s-71,0E-vT
�- rd✓S F�_ (_D DF Jrr1,/A/ t_ -7V -'
(rt%u✓ 6 Fdecf-1y2��ti7 LL -1�0 FLO
D S !Z� S�
DEG_
CC)t'1' C
/V
�✓� ALL CfJN70i/ � i v ��� S�/S� � �
0 .7D
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
4t4 US-I-, 201 .
r
Signed
State of Michigan, County of
Subscribed and sworn to before me this day of 4W VS 20 fa
Notary�Publficllor Deputy Clerk
Michelle R. Redals
h Notary Public � County, Michigan
w State of Michigan,County of Ingham
z My Commission Expires 10/3/2013
Acting in the County of_--- , My Commission Ex4r"eS: e13
PLEASE INCLUDE AND SUBMIT A COPY.OF YOUR CURRENT.JOB-DESCRIPTION
DRAFT 5A;REVISED 11-05-04
ATTACHMENT A
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? I WI LL f_�E i�W )njpT p�1c—r FP_6 FFsSQZ T EH-cFt ti4
U�D£Q Gr 2rtD1/�}-7 5 �DC,v7S G��'s5 E5 �✓ C�n'1/N�r c 'j'✓.S 'c E_
I�AJ� DU�/✓g�-Sl-Ji� �� %lV15 IS0S)NESs
■ Are you self-employed? /VD
Who is your employer, if applicable? !/C-'-"S1 Ty
What are the things you actually do in the business? TC�Gt7//✓G,
S i UD CA-175 �UNoa )CryoLly7-re5) T yei L,s ��/ Gil ,�)MT L_
-11
-J-Us-ri c,C 0-ND L6-IV tf yVRM
■ Who are your clients and who receives your goods or services?
F£ z4s VAA V6e—S)7 Y
S7 (2 o
■ How and where are your services performed? /AJl VEC5 l i 5'' CEiv72f
C Ll� 55 PI
Page 1 of 3
■ How often do you do outside work? �j T6 y' M-Cjyes PC—lL
wC- eK-
■ Does your business or employer contract with the City? /V0
■ In performing your business or outside employment, do you use any City
facilities or equipment? Alb If so, describe:
■ Is any of your business or employment conducted in the City? YESlf so,
describe: = rAJ) ram, 3 e 7��A-C L ,
■ Does your business advertisement or circulars, if any,,/contain any
reference to the City or your City employment? UvC�
■ If your business uses advertisements, circulars, applications, or order
forms that you have designed or have had designed for you, please attach
a copy of the applicable form(s).
Page 2 of 3
■ If you provide training or education as part of your business:
Do you identify yourself to your clients or students as being employed by
the City of.Lansing? U�5 /-A i T
LpLffsEA-/75 ()EPtJ-TyAJi i�C5 Ede n)E Try Lj F—
Ci) P5ACA1645�'s 74) 72A6- Tr)D► G c>9- s iyO
Do you include in any of the written materials or aids or reference in any
way in your presentations reference to policies, procedures, methods or
materials as being those also used by the City of Lansing? Mr) If so,
attach a copy of the material or aid and explain the reference in your
presentation.
■ Is there any additional information that you believe would assist the Ethics
Board in its review of your business or personal activities for potential
conflicts of interest? If so, please describe:
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.
Page 3of3
j
P14Sl�COFFICE OF THE CITY ATTORNEY
C H L G P MEMORANDUM �
TO: CHRIS SWOPE, City Clerk
FROM: DONALD J. KULHANEK, Assistant i or
DATE: August 28, 2012
SUBJECT: AFFIDAVIT OF DISCLOSURE; LPD EMPLOYEE
NOEL GARCIA
I have been asked by Officer Noel Garcia, to forward to you the attached affidavit about his
supplemental employment. I understand this is for the Ethics Board.
Thank you for your assistance.
/tls
Attachment
CITY OF LANSING
AFFIDAVIT OF DISCLOSURE
DATE:
TO: CITY CLERK,
CITY ATTORNEY, or
BOARD OF ETHICS
Ihl G tL �'q (_C (z-- make the following disclosure under oath: i-71
(Name) ,
PLEASE CHECK THE APPROPRIATE BOX OR FILL IN THE BLANKS FOR EACH--OF -THE, , t
FOLLOWING ITEMS ` =
✓ U
Yes No
1. ❑ I am an ❑ elected or ❑ appointed P(officer or ❑ employee of the City of
Lansing holding the position of L)£VT r✓ ffM in the
Po U LE 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.
❑ ❑ 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. ❑ ❑ 1 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(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]
❑ ❑ 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 or Ordinances and in the City Charter
3. This position is: ❑ Full time XPart 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
6. PLEASE DESCRIBE IN DETAIL YOUR REASON(S) FOR SUBMITTING THIS
DISCLOSURE AND EXPLAIN WHY YOU THINK A CONFLICT MAY/MAY NOT EXIST.
'I WILL BE I-EACHIA111 G4) /A1 t- 7-tJs c E S7vOFA.-7
n/ Id✓sEc� F N &_ .Tr/ -~ cam
(,6ri✓ ode c e-IY'l es--ti T. —'el r/GzC /vo F %1 S�xc---
l�� �D✓ T N ��GzPas E ���'I�s / dot/
�I�� �.n/G �S � sicJ�i Es � �� �E+✓�-c��
D 2 OLO IZ1127Lt S— C�`-7 2
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C�� C �e�i/io� ��sc�v f/ZE �✓ v�� r� �ft�
I�ifisT E D 0 i �� %�/L%
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`y )LL C 6iv7A/ E iv 64E SeA5e- ;ff-
i�G/f-T2S 7D
IDS//✓h /I/ LDS E AWN" ST` �112T
I hereby certify that this disclosure is complete and accurate to the best of my knowledge,
information and belief. G/
The foregoing Affidavit of Disclosure was executed on this J / day of
4�.4 U SZ, 2012,_.
r
Signed
State of Michigan, County of
Subscribed and sworn to before me this day of_4va ys 20 Q
R Notary Public%r Deputy Clerk
Michelle R. Reddish, Notary Public County, Michigan
- state of Michigan,county of Ingham
z My commission Expires 10/3/2013
Acting in the county of_- My Commission Ex i es:;�141-3
� ,,,,�,,,�.,..,�,��-`,,�.1•:. ter. ,� ,_.,....
PLEASE INCLUDE AND SUBMIT A COPY OF YOUR CURRENT JOB DESCRIPTION
DRAFT 5A;REVISED 11-05-04
ATTACHMENT A
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? L L( 9->E /� /fO.T(JA/CT 26 FEsScV_ i C qc Hj
UDJD£QG�2 0y�} 7� S%i10Cv75 C L/�s5�S -�✓ C�rr1/N�t� T✓S j/c-C-
■ Are you self-employed? /VU
■ Who is your employer, if applicable? FEU-1.5 S71-76=
■ What are the things you actually do in the business? Tef ctl/n/4
S y0 En�S aAAQa 76:-� TyPI cs moo✓ GJ2) M) L_
_TJ5Tl (.C �Nn Z-ao✓ elVRY CErYIfi✓T_
■ Who are your clients and who receives your goods or services?
F bs S VA/ Vci?-5)75'
S� Uo Ems
■ How and where are your services performed? UAJIVCe-S j7Y- Cif 2--Z
2) Q (A s)-JHgf Pf5t5 / 01. 7N A
C c,A.ss �v C)/,I
Page 1 of 3
■ How often do you do outside work? �j TC) P C—(L
WEEK
■ Does your business or employer contract with the City? AID
■ In performing your business or outside employment, do you use any City
facilities or equipment? Al If so, describe:
■ Is any of your business or employment conducted in the City? YESIf so,
describe: T W) t-c- 3 E It , ,v1 A/ d�
L(2-5SLyUm TN /mt CI7-y'
■ Does your business advertisement or circulars, if any, contain any
reference to the City or your City employment? AJO
■ If your business uses advertisements, circulars, applications, or order
forms that you have designed or have had designed for you, please attach
a copy of the applicable form(s).
Page 2 of 3
■ If you provide training or education as part of your business:
Do you identify yourself to your clients or students as being employed by
the City of Lansing? 165 .- /Y) - rr -TE�
FPLlf 6k,7S 7[JAJj T1C5 Fc)2 �� i o ,��z� � L, F—
P�izi !�qUC t!:�5 -76 T�L Tc)P► c)r s/LJO Y
Do you include in any of the written materials or aids or reference in any
way in your presentations reference to policies, procedures, methods or
materials as being those also used by the City of Lansing? If so,
attach a copy of the material or aid and explain the reference in your
presentation.
■ Is there any additional information that you believe would assist the Ethics
Board in its review of your business or personal activities for potential
conflicts of interest? AJO If so, please describe:
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.
Page 3 of 3